{
  "resourceType": "Bundle",
  "type": "transaction",
  "entry": [ {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32",
    "resource": {
      "resourceType": "Patient",
      "id": "9a57c612-581f-1c85-d505-c6c44e983d32",
      "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: -7325168486804677499  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": "Julian715 Lemke654"
      }, {
        "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
        "valueCode": "F"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/birthPlace",
        "valueAddress": {
          "city": "Wellesley",
          "state": "Massachusetts",
          "country": "US"
        }
      }, {
        "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
        "valueDecimal": 1.4605452844446853
      }, {
        "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
        "valueDecimal": 35.539454715555316
      } ],
      "identifier": [ {
        "system": "https://github.com/synthetichealth/synthea",
        "value": "9a57c612-581f-1c85-d505-c6c44e983d32"
      }, {
        "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": "9a57c612-581f-1c85-d505-c6c44e983d32"
      }, {
        "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": "999-60-7706"
      }, {
        "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": "S99974368"
      }, {
        "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": "X20170287X"
      } ],
      "name": [ {
        "use": "official",
        "family": "Wisoky380",
        "given": [ "Marleen824" ],
        "prefix": [ "Mrs." ]
      }, {
        "use": "maiden",
        "family": "Pfeffer420",
        "given": [ "Marleen824" ],
        "prefix": [ "Mrs." ]
      } ],
      "telecom": [ {
        "system": "phone",
        "value": "555-187-3950",
        "use": "home"
      } ],
      "gender": "female",
      "birthDate": "1988-03-24",
      "address": [ {
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
          "extension": [ {
            "url": "latitude",
            "valueDecimal": 41.892739344980185
          }, {
            "url": "longitude",
            "valueDecimal": -70.85400536744024
          } ]
        } ],
        "line": [ "455 Harvey Crossroad Suite 55" ],
        "city": "Middleborough",
        "state": "Massachusetts",
        "postalCode": "00000",
        "country": "US"
      } ],
      "maritalStatus": {
        "coding": [ {
          "system": "http://hl7.org/fhir/v3/MaritalStatus",
          "code": "M",
          "display": "M"
        } ],
        "text": "M"
      },
      "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:9a57c612-581f-1c85-e9d9-6a8718bfa0e3",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-e9d9-6a8718bfa0e3",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "1988-12-14T12:49:30+00:00",
        "end": "1988-12-14T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "24079001",
          "display": "Atopic dermatitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3ee8-22ae91345c43",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-3ee8-22ae91345c43",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "24079001",
          "display": "Atopic dermatitis (disorder)"
        } ],
        "text": "Atopic dermatitis (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e9d9-6a8718bfa0e3"
      },
      "onsetDateTime": "1988-12-14T12:49:30+00:00",
      "assertedDate": "1988-12-14T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8c36-c717bef6aea1",
    "resource": {
      "resourceType": "CarePlan",
      "id": "9a57c612-581f-1c85-8c36-c717bef6aea1",
      "status": "active",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e9d9-6a8718bfa0e3"
      },
      "period": {
        "start": "1988-12-14T12:49:30+00:00"
      },
      "addresses": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3ee8-22ae91345c43"
      } ],
      "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": "in-progress"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3c6b-302d2d8598d3",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-3c6b-302d2d8598d3",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "1988-12-14T12:49:30+00:00",
        "end": "1988-12-14T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3ee8-22ae91345c43"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-e9d9-6a8718bfa0e3"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:076a4e7d-4c2f-f04d-01cb-19cdc121c3f7",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "076a4e7d-4c2f-f04d-01cb-19cdc121c3f7",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      } ],
      "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": "9a57c612-581f-1c85-3c6b-302d2d8598d3"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "1988-12-14T13:04:30+00:00",
        "end": "1989-12-14T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-3ee8-22ae91345c43"
        },
        "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:9a57c612-581f-1c85-8285-95d1c29fb01e",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-8285-95d1c29fb01e",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "1989-05-09T20:49:30+00:00",
        "end": "1989-05-09T21:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "735029006",
          "display": "Shellfish (substance)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3bcf-cfa055435574",
    "resource": {
      "resourceType": "CarePlan",
      "id": "9a57c612-581f-1c85-3bcf-cfa055435574",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8285-95d1c29fb01e"
      },
      "period": {
        "start": "1989-05-09T20:49:30+00:00"
      },
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "409002",
              "display": "Food allergy diet (finding)"
            } ],
            "text": "Food allergy diet (finding)"
          },
          "status": "in-progress"
        }
      }, {
        "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:9a57c612-581f-1c85-0ca8-0e732f4b2815",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0ca8-0e732f4b2815",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "1989-05-09T20:49:30+00:00",
        "end": "1989-05-09T21:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-8285-95d1c29fb01e"
        } ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:7b9c7319-7ce9-5aab-0e92-cd9d24a7117a",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "7b9c7319-7ce9-5aab-0e92-cd9d24a7117a",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-0ca8-0e732f4b2815"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "1989-05-09T21:04:30+00:00",
        "end": "1990-05-09T21:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-d99e-3ff52cda526a",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-d99e-3ff52cda526a",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "1989-05-21T18:49:30+00:00",
        "end": "1989-05-21T19:20:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "609328004",
          "display": "Allergic disposition (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-39fc-8a40bfe3daca",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-39fc-8a40bfe3daca",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c5fd-6a4635ccf09d",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-c5fd-6a4635ccf09d",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "84489001",
          "display": "Mold (organism)"
        } ],
        "text": "Mold (organism)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1334-17f2d7c1c385",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-1334-17f2d7c1c385",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "260147004",
          "display": "House dust mite (organism)"
        } ],
        "text": "House dust mite (organism)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-447c-1af29eb5bab5",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-447c-1af29eb5bab5",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "264287008",
          "display": "Animal dander (substance)"
        } ],
        "text": "Animal dander (substance)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-bd2b-1ec5ace17ece",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-bd2b-1ec5ace17ece",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "256277009",
          "display": "Grass pollen (substance)"
        } ],
        "text": "Grass pollen (substance)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-91a0-75fa2fef370f",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-91a0-75fa2fef370f",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "782576004",
          "display": "Tree pollen (substance)"
        } ],
        "text": "Tree pollen (substance)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f79a-c8888b0f9ec7",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-f79a-c8888b0f9ec7",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "735029006",
          "display": "Shellfish (substance)"
        } ],
        "text": "Shellfish (substance)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-75f4-daad542dee0f",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "9a57c612-581f-1c85-75f4-daad542dee0f",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "type": "allergy",
      "category": [ "food" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "762952008",
          "display": "Peanut (substance)"
        } ],
        "text": "Peanut (substance)"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "assertedDate": "1989-05-21T18:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "AllergyIntolerance"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6636-62e57a9516f1",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "9a57c612-581f-1c85-6636-62e57a9516f1",
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "141918",
          "display": "Terfenadine 60 MG Oral Tablet"
        } ],
        "text": "Terfenadine 60 MG Oral Tablet"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d99e-3ff52cda526a"
      },
      "authoredOn": "1989-05-21T19:20:30+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
          "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
        }
      },
      "dosageInstruction": [ {
        "sequence": 1,
        "asNeededBoolean": true
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0f8b-64f53c5602a5",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0f8b-64f53c5602a5",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "1989-05-21T18:49:30+00:00",
        "end": "1989-05-21T19:20:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "prescription": {
        "reference": "urn:uuid:9a57c612-581f-1c85-6636-62e57a9516f1"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d99e-3ff52cda526a"
        } ]
      } ],
      "total": {
        "value": 91.72,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e779-b880d79ef726",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "9a57c612-581f-1c85-e779-b880d79ef726",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d99e-3ff52cda526a"
      },
      "authoredOn": "1989-05-21T19:20:30+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
          "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
        }
      },
      "dosageInstruction": [ {
        "sequence": 1,
        "asNeededBoolean": true
      } ]
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4f35-49a02ab39749",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-4f35-49a02ab39749",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "1989-05-21T18:49:30+00:00",
        "end": "1989-05-21T19:20:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "prescription": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e779-b880d79ef726"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d99e-3ff52cda526a"
        } ]
      } ],
      "total": {
        "value": 75.33,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d39a-98714f346a69",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-d39a-98714f346a69",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "1989-05-21T18:49:30+00:00",
        "end": "1989-05-21T19:20:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d99e-3ff52cda526a"
        } ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:c78255e8-b192-0c9b-2205-fdaa3e47cf92",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "c78255e8-b192-0c9b-2205-fdaa3e47cf92",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-d39a-98714f346a69"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "1989-05-21T19:20:30+00:00",
        "end": "1990-05-21T19:20:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": 516.95,
        "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:9a57c612-581f-1c85-327b-098e3f286942",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-327b-098e3f286942",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2001-03-01T01:49:30+00:00",
        "end": "2001-03-01T02:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "75498004",
          "display": "Acute bacterial sinusitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-fe33-b6ca37de0ea0",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-fe33-b6ca37de0ea0",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "40055000",
          "display": "Chronic sinusitis (disorder)"
        } ],
        "text": "Chronic sinusitis (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-327b-098e3f286942"
      },
      "onsetDateTime": "2001-03-01T01:49:30+00:00",
      "assertedDate": "2001-03-01T01:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-38a0-b0973bf13eea",
    "resource": {
      "resourceType": "Device",
      "id": "9a57c612-581f-1c85-38a0-b0973bf13eea",
      "udi": {
        "deviceIdentifier": "46978583723258",
        "carrierHRF": "(01)46978583723258(11)010208(17)260223(10)849410(21)7307075107089"
      },
      "status": "active",
      "type": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "170615005",
          "display": "Home nebulizer (physical object)"
        } ],
        "text": "Home nebulizer (physical object)"
      },
      "lotNumber": "849410",
      "manufactureDate": "2001-02-08T01:49:30+00:00",
      "expirationDate": "2026-02-23T01:49:30+00:00",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      }
    },
    "request": {
      "method": "POST",
      "url": "Device"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-90a9-079f9431bdec",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-90a9-079f9431bdec",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2001-03-01T01:49:30+00:00",
        "end": "2001-03-01T02:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-fe33-b6ca37de0ea0"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-327b-098e3f286942"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 3,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 7.38,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 92.93,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:4bc6dc1f-4637-64a2-7e9a-f98896192b7a",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "4bc6dc1f-4637-64a2-7e9a-f98896192b7a",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-90a9-079f9431bdec"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2001-03-01T02:04:30+00:00",
        "end": "2002-03-01T02:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-fe33-b6ca37de0ea0"
        },
        "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,
        "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": 1.476,
            "system": "urn: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": 5.904,
            "system": "urn: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": 7.38,
            "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": 7.38,
            "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": 92.93,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 74.344,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6273-6ecf2c78ea39",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-6273-6ecf2c78ea39",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2006-05-25T12:49:30+00:00",
        "end": "2006-05-25T13:24:40+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e393-0fc1c1d3c7f7",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-e393-0fc1c1d3c7f7",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-6273-6ecf2c78ea39"
      },
      "onsetDateTime": "2006-05-25T13:24:40+00:00",
      "assertedDate": "2006-05-25T13:24:40+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ab5d-178e362f65af",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-ab5d-178e362f65af",
      "clinicalStatus": "resolved",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-6273-6ecf2c78ea39"
      },
      "onsetDateTime": "2006-05-25T13:24:40+00:00",
      "abatementDateTime": "2018-05-03T13:47:21+00:00",
      "assertedDate": "2006-05-25T13:24:40+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0715-c5597f2f9e9b",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0715-c5597f2f9e9b",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2006-05-25T12:49:30+00:00",
        "end": "2006-05-25T13:24:40+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e393-0fc1c1d3c7f7"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ab5d-178e362f65af"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-6273-6ecf2c78ea39"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 2 ]
      } ],
      "total": {
        "value": 136.80,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:49dd7a9b-f354-4468-8166-8d924dd7f3f9",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "49dd7a9b-f354-4468-8166-8d924dd7f3f9",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-0715-c5597f2f9e9b"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2006-05-25T13:24:40+00:00",
        "end": "2007-05-25T13:24:40+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-e393-0fc1c1d3c7f7"
        },
        "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:9a57c612-581f-1c85-ab5d-178e362f65af"
        },
        "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"
          } ]
        }
      }, {
        "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"
          } ]
        }
      } ],
      "totalCost": {
        "value": 704.20,
        "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:9a57c612-581f-1c85-da47-3d039a5d2957",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-da47-3d039a5d2957",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2007-05-31T12:49:30+00:00",
        "end": "2007-05-31T13:27:45+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c2ab-56e5f4a20697",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-c2ab-56e5f4a20697",
      "clinicalStatus": "active",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-da47-3d039a5d2957"
      },
      "onsetDateTime": "2007-05-31T13:27:45+00:00",
      "assertedDate": "2007-05-31T13:27:45+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f023-89afbc58a4d5",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-f023-89afbc58a4d5",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2007-05-31T12:49:30+00:00",
        "end": "2007-05-31T13:27:45+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-c2ab-56e5f4a20697"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-da47-3d039a5d2957"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 136.80,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:fc00ea8b-ea6c-bf3d-9cff-3d8244f06f46",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "fc00ea8b-ea6c-bf3d-9cff-3d8244f06f46",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicare"
        }
      } ],
      "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": "9a57c612-581f-1c85-f023-89afbc58a4d5"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2007-05-31T13:27:45+00:00",
        "end": "2008-05-31T13:27:45+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-c2ab-56e5f4a20697"
        },
        "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": 704.20,
        "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:9a57c612-581f-1c85-35bc-51854eb98964",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-35bc-51854eb98964",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2010-06-10T12:49:30+00:00",
        "end": "2010-06-10T13:26:29+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3628-b2271f27af52",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-3628-b2271f27af52",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "714628002",
          "display": "Prediabetes (finding)"
        } ],
        "text": "Prediabetes (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-35bc-51854eb98964"
      },
      "onsetDateTime": "2010-06-10T12:49:30+00:00",
      "assertedDate": "2010-06-10T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d390-0e15cb730da4",
    "resource": {
      "resourceType": "CarePlan",
      "id": "9a57c612-581f-1c85-d390-0e15cb730da4",
      "status": "active",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "735985000",
          "display": "Diabetes self management plan (record artifact)"
        } ],
        "text": "Diabetes self management plan (record artifact)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-35bc-51854eb98964"
      },
      "period": {
        "start": "2010-06-10T12:49:30+00:00"
      },
      "addresses": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3628-b2271f27af52"
      } ],
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "160670007",
              "display": "Diabetic diet (finding)"
            } ],
            "text": "Diabetic diet (finding)"
          },
          "status": "in-progress"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "229065009",
              "display": "Exercise therapy (regime/therapy)"
            } ],
            "text": "Exercise therapy (regime/therapy)"
          },
          "status": "in-progress"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-caa4-229213bda3d1",
    "resource": {
      "resourceType": "Device",
      "id": "9a57c612-581f-1c85-caa4-229213bda3d1",
      "udi": {
        "deviceIdentifier": "88366290369747",
        "carrierHRF": "(01)88366290369747(11)100520(17)350604(10)85139(21)4861"
      },
      "status": "active",
      "type": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "337414009",
          "display": "Blood glucose meter (physical object)"
        } ],
        "text": "Blood glucose meter (physical object)"
      },
      "lotNumber": "85139",
      "manufactureDate": "2010-05-20T12:49:30+00:00",
      "expirationDate": "2035-06-04T12:49:30+00:00",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      }
    },
    "request": {
      "method": "POST",
      "url": "Device"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ad88-79b9895675c1",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-ad88-79b9895675c1",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 50
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "337388004",
            "display": "Blood glucose testing strips (physical object)"
          } ],
          "text": "Blood glucose testing strips (physical object)"
        }
      },
      "occurrenceDateTime": "2010-06-10T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-05ba-e9607f6043a2",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-05ba-e9607f6043a2",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2010-06-10T12:49:30+00:00",
        "end": "2010-06-10T13:26:29+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "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:9a57c612-581f-1c85-3628-b2271f27af52"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-35bc-51854eb98964"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 3,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 63.64,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 6.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 207.24,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:b4729e8c-107d-adbe-5108-71826b015f2b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "b4729e8c-107d-adbe-5108-71826b015f2b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-05ba-e9607f6043a2"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2010-06-10T13:26:29+00:00",
        "end": "2011-06-10T13:26:29+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-3628-b2271f27af52"
        },
        "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"
          } ]
        }
      }, {
        "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": 12.728000000000002,
            "system": "urn: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": 50.912000000000006,
            "system": "urn: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": 63.64,
            "system": "urn: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": 63.64,
            "system": "urn: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": 1.36,
            "system": "urn: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": 5.44,
            "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": 6.80,
            "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": 6.80,
            "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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 1767.60,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 165.79200000000003,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b138-8b2f6fd0f823",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-b138-8b2f6fd0f823",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2013-06-13T12:49:30+00:00",
        "end": "2013-06-13T13:20:02+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2360-186635138de4",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-2360-186635138de4",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "422650009",
          "display": "Social isolation (finding)"
        } ],
        "text": "Social isolation (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b138-8b2f6fd0f823"
      },
      "onsetDateTime": "2013-06-13T13:20:02+00:00",
      "abatementDateTime": "2018-05-03T13:47:21+00:00",
      "assertedDate": "2013-06-13T13:20:02+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-56a5-866acb02b3fb",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-56a5-866acb02b3fb",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 50
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "337388004",
            "display": "Blood glucose testing strips (physical object)"
          } ],
          "text": "Blood glucose testing strips (physical object)"
        }
      },
      "occurrenceDateTime": "2013-06-13T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-693a-843dccdce1c1",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-693a-843dccdce1c1",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 100
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "1137596000",
            "display": "Blood lancet (physical object)"
          } ],
          "text": "Blood lancet (physical object)"
        }
      },
      "occurrenceDateTime": "2013-06-13T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b9d5-1c392bc3fb40",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-b9d5-1c392bc3fb40",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2013-06-13T12:49:30+00:00",
        "end": "2013-06-13T13:20:02+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "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:9a57c612-581f-1c85-2360-186635138de4"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-b138-8b2f6fd0f823"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 6.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 143.60,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:b8dadc62-c505-717a-a57d-3d2e157bcb45",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "b8dadc62-c505-717a-a57d-3d2e157bcb45",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-b9d5-1c392bc3fb40"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2013-06-13T13:20:02+00:00",
        "end": "2014-06-13T13:20:02+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-2360-186635138de4"
        },
        "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": 1.36,
            "system": "urn: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": 5.44,
            "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": 6.80,
            "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": 6.80,
            "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": 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": 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": 4,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 1648.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 114.88000000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-40f7-e7fc1c55f846",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-40f7-e7fc1c55f846",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2015-04-02T12:49:30+00:00",
        "end": "2015-04-02T13:47:35+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4fe9-356ccbef2040",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-4fe9-356ccbef2040",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "271737000",
          "display": "Anemia (disorder)"
        } ],
        "text": "Anemia (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-40f7-e7fc1c55f846"
      },
      "onsetDateTime": "2015-04-02T12:49:30+00:00",
      "assertedDate": "2015-04-02T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5b60-c53d350b4203",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-5b60-c53d350b4203",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 50
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "337388004",
            "display": "Blood glucose testing strips (physical object)"
          } ],
          "text": "Blood glucose testing strips (physical object)"
        }
      },
      "occurrenceDateTime": "2015-04-02T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e400-ed2fa2c07e52",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-e400-ed2fa2c07e52",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2015-04-02T12:49:30+00:00",
        "end": "2015-04-02T13:47:35+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4fe9-356ccbef2040"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-40f7-e7fc1c55f846"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 6.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 92.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:efb2014f-c444-82e1-fe80-89d376909c4b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "efb2014f-c444-82e1-fe80-89d376909c4b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-e400-ed2fa2c07e52"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2015-04-02T13:47:35+00:00",
        "end": "2016-04-02T13:47:35+00:00"
      },
      "created": "2015-04-02T13:47:35+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e400-ed2fa2c07e52"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-4fe9-356ccbef2040"
        },
        "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": "2015-04-02T12:49:30+00:00",
          "end": "2015-04-02T13:47:35+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-40f7-e7fc1c55f846"
        } ],
        "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"
            } ]
          },
          "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": "2015-04-02T12:49:30+00:00",
          "end": "2015-04-02T13:47:35+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 6.80,
          "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": 1.36,
            "system": "urn: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": 5.44,
            "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": 6.80,
            "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": 6.80,
            "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"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2015-04-02T12:49:30+00:00",
          "end": "2015-04-02T13:47:35+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 734.33,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 73.88,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d618-9f1c88cd1758",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-d618-9f1c88cd1758",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "698314001",
          "display": "Consultation for treatment (procedure)"
        } ],
        "text": "Consultation for treatment (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2016-01-13T07:11:43+00:00",
        "end": "2016-01-13T07:26:43+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4ec2-97d438ceaa03",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "9a57c612-581f-1c85-4ec2-97d438ceaa03",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "748879",
          "display": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Levora 0.15/30 28 Day]"
        } ],
        "text": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Levora 0.15/30 28 Day]"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d618-9f1c88cd1758"
      },
      "authoredOn": "2016-01-13T07:11:43+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
          "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a60c-801d040527f7",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-a60c-801d040527f7",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-01-13T07:11:43+00:00",
        "end": "2016-01-13T07:26:43+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "prescription": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4ec2-97d438ceaa03"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d618-9f1c88cd1758"
        } ]
      } ],
      "total": {
        "value": 584.64,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-cee6-a5e4e2f8d9bf",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-cee6-a5e4e2f8d9bf",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-01-13T07:11:43+00:00",
        "end": "2016-01-13T07:26:43+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d618-9f1c88cd1758"
        } ]
      } ],
      "total": {
        "value": 142.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:1b8ba4b8-3d91-1c55-6c02-247ba6338d20",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "1b8ba4b8-3d91-1c55-6c02-247ba6338d20",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-cee6-a5e4e2f8d9bf"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-01-13T07:26:43+00:00",
        "end": "2017-01-13T07:26:43+00:00"
      },
      "created": "2016-01-13T07:26:43+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-cee6-a5e4e2f8d9bf"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2016-01-13T07:11:43+00:00",
          "end": "2016-01-13T07:26:43+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:9a57c612-581f-1c85-d618-9f1c88cd1758"
        } ],
        "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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 142.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 114.06400000000002,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-35c0-d3f941d2dd1b",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-35c0-d3f941d2dd1b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2016-06-16T12:49:30+00:00",
        "end": "2016-06-16T13:42:03+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8a01-177e27b19661",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-8a01-177e27b19661",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "73595000",
          "display": "Stress (finding)"
        } ],
        "text": "Stress (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-35c0-d3f941d2dd1b"
      },
      "onsetDateTime": "2016-06-16T13:42:03+00:00",
      "abatementDateTime": "2018-05-03T13:47:21+00:00",
      "assertedDate": "2016-06-16T13:42:03+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a555-3596f8533e41",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-a555-3596f8533e41",
      "clinicalStatus": "resolved",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-35c0-d3f941d2dd1b"
      },
      "onsetDateTime": "2016-06-16T13:42:03+00:00",
      "abatementDateTime": "2018-05-03T13:47:21+00:00",
      "assertedDate": "2016-06-16T13:42:03+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a07d-202b1cdd10bb",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-a07d-202b1cdd10bb",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 50
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "337388004",
            "display": "Blood glucose testing strips (physical object)"
          } ],
          "text": "Blood glucose testing strips (physical object)"
        }
      },
      "occurrenceDateTime": "2016-06-16T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e8a0-275af9015ad7",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-e8a0-275af9015ad7",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 100
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "1137596000",
            "display": "Blood lancet (physical object)"
          } ],
          "text": "Blood lancet (physical object)"
        }
      },
      "occurrenceDateTime": "2016-06-16T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1a4f-def82595b91a",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-1a4f-def82595b91a",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-06-16T12:49:30+00:00",
        "end": "2016-06-16T13:42:03+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "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:9a57c612-581f-1c85-8a01-177e27b19661"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a555-3596f8533e41"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-35c0-d3f941d2dd1b"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 6.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 5,
        "diagnosisLinkId": [ 2 ]
      } ],
      "total": {
        "value": 143.60,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:66227385-dcb4-edf0-a923-96cb0c1a962b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "66227385-dcb4-edf0-a923-96cb0c1a962b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-1a4f-def82595b91a"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2016-06-16T13:42:03+00:00",
        "end": "2017-06-16T13:42:03+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-8a01-177e27b19661"
        },
        "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:9a57c612-581f-1c85-a555-3596f8533e41"
        },
        "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": 1.36,
            "system": "urn: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": 5.44,
            "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": 6.80,
            "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": 6.80,
            "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": 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": 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": 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,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "22",
            "display": "Outpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 1167.02,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 114.88000000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6afc-bf1e7cea3669",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-6afc-bf1e7cea3669",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2016-08-18T12:49:30+00:00",
        "end": "2016-08-18T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8d59-190fcccc6f8e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8d59-190fcccc6f8e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "76601001",
          "display": "Intramuscular injection (procedure)"
        } ],
        "text": "Intramuscular injection (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-6afc-bf1e7cea3669"
      },
      "performedPeriod": {
        "start": "2016-08-18T12:49:30+00:00",
        "end": "2016-08-18T13:02:52+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6529-dac53c020f8d",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-6529-dac53c020f8d",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-08-18T12:49:30+00:00",
        "end": "2016-08-18T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8d59-190fcccc6f8e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-6afc-bf1e7cea3669"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "76601001"
          } ]
        },
        "net": {
          "value": 1712.60,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1855.18,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:9d59b998-c57a-ea32-aebe-b3e4dee4f903",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "9d59b998-c57a-ea32-aebe-b3e4dee4f903",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-6529-dac53c020f8d"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-08-18T13:04:30+00:00",
        "end": "2017-08-18T13:04:30+00:00"
      },
      "created": "2016-08-18T13:04:30+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-6529-dac53c020f8d"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2016-08-18T12:49:30+00:00",
          "end": "2016-08-18T13:04:30+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:9a57c612-581f-1c85-6afc-bf1e7cea3669"
        } ],
        "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,
        "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": "76601001"
          } ]
        },
        "servicedPeriod": {
          "start": "2016-08-18T12:49:30+00:00",
          "end": "2016-08-18T13:04:30+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 1712.60,
          "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": 342.52,
            "system": "urn: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": 1370.08,
            "system": "urn: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": 1712.60,
            "system": "urn: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": 1712.60,
            "system": "urn: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": 1855.18,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1484.144,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f47d-a533227e4283",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-f47d-a533227e4283",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2016-11-17T12:49:30+00:00",
        "end": "2016-11-17T13:04:31+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4e3f-506037526d6d",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4e3f-506037526d6d",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "76601001",
          "display": "Intramuscular injection (procedure)"
        } ],
        "text": "Intramuscular injection (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-f47d-a533227e4283"
      },
      "performedPeriod": {
        "start": "2016-11-17T12:49:30+00:00",
        "end": "2016-11-17T13:04:31+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0bad-32c8e4f35463",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0bad-32c8e4f35463",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-11-17T12:49:30+00:00",
        "end": "2016-11-17T13:04:31+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4e3f-506037526d6d"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-f47d-a533227e4283"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "76601001"
          } ]
        },
        "net": {
          "value": 4288.36,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 4430.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:fdb956f2-c685-541b-2d1e-ff2e0c9f8ab9",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "fdb956f2-c685-541b-2d1e-ff2e0c9f8ab9",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-0bad-32c8e4f35463"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2016-11-17T13:04:31+00:00",
        "end": "2017-11-17T13:04:31+00:00"
      },
      "created": "2016-11-17T13:04:31+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0bad-32c8e4f35463"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2016-11-17T12:49:30+00:00",
          "end": "2016-11-17T13:04:31+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:9a57c612-581f-1c85-f47d-a533227e4283"
        } ],
        "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,
        "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": "76601001"
          } ]
        },
        "servicedPeriod": {
          "start": "2016-11-17T12:49:30+00:00",
          "end": "2016-11-17T13:04:31+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 4288.36,
          "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": 857.672,
            "system": "urn: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": 3430.688,
            "system": "urn: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": 4288.36,
            "system": "urn: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": 4288.36,
            "system": "urn: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": 4430.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 3544.752,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b086-6fa2afeb10ab",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-b086-6fa2afeb10ab",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2017-01-07T22:49:30+00:00",
        "end": "2017-01-07T23:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "444814009",
          "display": "Viral sinusitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-898e-fd8dd37ac64c",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-898e-fd8dd37ac64c",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "444814009",
          "display": "Viral sinusitis (disorder)"
        } ],
        "text": "Viral sinusitis (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b086-6fa2afeb10ab"
      },
      "onsetDateTime": "2017-01-07T22:49:30+00:00",
      "abatementDateTime": "2017-01-28T22:49:30+00:00",
      "assertedDate": "2017-01-07T22:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b48e-0d59288d59c9",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-b48e-0d59288d59c9",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-01-07T22:49:30+00:00",
        "end": "2017-01-07T23:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-898e-fd8dd37ac64c"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-b086-6fa2afeb10ab"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:95d11e2f-a787-12ff-ffdf-eff867979ed8",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "95d11e2f-a787-12ff-ffdf-eff867979ed8",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-b48e-0d59288d59c9"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2017-01-07T23:04:30+00:00",
        "end": "2018-01-07T23:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-898e-fd8dd37ac64c"
        },
        "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:9a57c612-581f-1c85-ad37-5cb77a5c0df4",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-ad37-5cb77a5c0df4",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2017-02-16T12:49:30+00:00",
        "end": "2017-02-16T13:06:26+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7abc-50fee5e00fb3",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-7abc-50fee5e00fb3",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "76601001",
          "display": "Intramuscular injection (procedure)"
        } ],
        "text": "Intramuscular injection (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ad37-5cb77a5c0df4"
      },
      "performedPeriod": {
        "start": "2017-02-16T12:49:30+00:00",
        "end": "2017-02-16T13:06:26+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b747-b8c822df5cbc",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-b747-b8c822df5cbc",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-02-16T12:49:30+00:00",
        "end": "2017-02-16T13:06:26+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-7abc-50fee5e00fb3"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-ad37-5cb77a5c0df4"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "76601001"
          } ]
        },
        "net": {
          "value": 2328.07,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 2470.65,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:9462cf95-c53d-d947-496a-3893a067ff54",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "9462cf95-c53d-d947-496a-3893a067ff54",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-b747-b8c822df5cbc"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-02-16T13:06:26+00:00",
        "end": "2018-02-16T13:06:26+00:00"
      },
      "created": "2017-02-16T13:06:26+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b747-b8c822df5cbc"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2017-02-16T12:49:30+00:00",
          "end": "2017-02-16T13:06:26+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:9a57c612-581f-1c85-ad37-5cb77a5c0df4"
        } ],
        "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,
        "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": "76601001"
          } ]
        },
        "servicedPeriod": {
          "start": "2017-02-16T12:49:30+00:00",
          "end": "2017-02-16T13:06:26+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 2328.07,
          "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": 465.61400000000003,
            "system": "urn: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": 1862.4560000000001,
            "system": "urn: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": 2328.07,
            "system": "urn: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": 2328.07,
            "system": "urn: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": 2470.65,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1976.5200000000002,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-dbc3-3104a5ad52e6",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-dbc3-3104a5ad52e6",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2017-05-18T12:49:30+00:00",
        "end": "2017-05-18T13:06:42+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-34a5-3070b776cb60",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-34a5-3070b776cb60",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "76601001",
          "display": "Intramuscular injection (procedure)"
        } ],
        "text": "Intramuscular injection (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-dbc3-3104a5ad52e6"
      },
      "performedPeriod": {
        "start": "2017-05-18T12:49:30+00:00",
        "end": "2017-05-18T13:06:42+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-99c7-807eb5cc7a95",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-99c7-807eb5cc7a95",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-05-18T12:49:30+00:00",
        "end": "2017-05-18T13:06:42+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-34a5-3070b776cb60"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-dbc3-3104a5ad52e6"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "76601001"
          } ]
        },
        "net": {
          "value": 1108.27,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1250.85,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:4fcca458-bd11-0cb8-d381-40907d640312",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "4fcca458-bd11-0cb8-d381-40907d640312",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-99c7-807eb5cc7a95"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-05-18T13:06:42+00:00",
        "end": "2018-05-18T13:06:42+00:00"
      },
      "created": "2017-05-18T13:06:42+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-99c7-807eb5cc7a95"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2017-05-18T12:49:30+00:00",
          "end": "2017-05-18T13:06:42+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:9a57c612-581f-1c85-dbc3-3104a5ad52e6"
        } ],
        "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,
        "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": "76601001"
          } ]
        },
        "servicedPeriod": {
          "start": "2017-05-18T12:49:30+00:00",
          "end": "2017-05-18T13:06:42+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 1108.27,
          "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": 221.654,
            "system": "urn: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": 886.616,
            "system": "urn: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": 1108.27,
            "system": "urn: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": 1108.27,
            "system": "urn: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": 1250.85,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1000.6800000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-422a-9f430c1b4d5c",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-422a-9f430c1b4d5c",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2017-08-17T12:49:30+00:00",
        "end": "2017-08-17T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9592-a7a2cd109a37",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-9592-a7a2cd109a37",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "76601001",
          "display": "Intramuscular injection (procedure)"
        } ],
        "text": "Intramuscular injection (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-422a-9f430c1b4d5c"
      },
      "performedPeriod": {
        "start": "2017-08-17T12:49:30+00:00",
        "end": "2017-08-17T13:02:27+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-cb20-2b13ebed86db",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-cb20-2b13ebed86db",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-08-17T12:49:30+00:00",
        "end": "2017-08-17T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-9592-a7a2cd109a37"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-422a-9f430c1b4d5c"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "76601001"
          } ]
        },
        "net": {
          "value": 2499.81,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 2642.39,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:0bca002d-4cb4-8330-1a9c-e634fb009c9a",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "0bca002d-4cb4-8330-1a9c-e634fb009c9a",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-cb20-2b13ebed86db"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-08-17T13:04:30+00:00",
        "end": "2018-08-17T13:04:30+00:00"
      },
      "created": "2017-08-17T13:04:30+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-cb20-2b13ebed86db"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2017-08-17T12:49:30+00:00",
          "end": "2017-08-17T13:04:30+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:9a57c612-581f-1c85-422a-9f430c1b4d5c"
        } ],
        "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,
        "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": "76601001"
          } ]
        },
        "servicedPeriod": {
          "start": "2017-08-17T12:49:30+00:00",
          "end": "2017-08-17T13:04:30+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 2499.81,
          "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": 499.962,
            "system": "urn: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": 1999.848,
            "system": "urn: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": 2499.81,
            "system": "urn: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": 2499.81,
            "system": "urn: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": 2642.39,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2113.912,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d1fe-c04745f5b8b3",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-d1fe-c04745f5b8b3",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2017-11-16T12:49:30+00:00",
        "end": "2017-11-16T13:06:56+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4150-01ee94a4f0cb",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4150-01ee94a4f0cb",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82810-3",
          "display": "Pregnancy status"
        } ],
        "text": "Pregnancy status"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d1fe-c04745f5b8b3"
      },
      "effectiveDateTime": "2017-11-30T12:49:30+00:00",
      "issued": "2017-11-30T12:49:30.549+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "77386006",
          "display": "Pregnant"
        } ],
        "text": "Pregnant"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7173-5bb9b14d9f3b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-7173-5bb9b14d9f3b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "76601001",
          "display": "Intramuscular injection (procedure)"
        } ],
        "text": "Intramuscular injection (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d1fe-c04745f5b8b3"
      },
      "performedPeriod": {
        "start": "2017-11-16T12:49:30+00:00",
        "end": "2017-11-16T13:06:56+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-97bb-8e0c19f927a7",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-97bb-8e0c19f927a7",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-11-16T12:49:30+00:00",
        "end": "2017-11-16T13:06:56+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-7173-5bb9b14d9f3b"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d1fe-c04745f5b8b3"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "76601001"
          } ]
        },
        "net": {
          "value": 1108.27,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1250.85,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:7a6fa353-4013-cd76-db3a-f3c9daed5050",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "7a6fa353-4013-cd76-db3a-f3c9daed5050",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-97bb-8e0c19f927a7"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2017-11-16T13:06:56+00:00",
        "end": "2018-11-16T13:06:56+00:00"
      },
      "created": "2017-11-16T13:06:56+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-97bb-8e0c19f927a7"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2017-11-16T12:49:30+00:00",
          "end": "2017-11-16T13:06:56+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:9a57c612-581f-1c85-d1fe-c04745f5b8b3"
        } ],
        "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,
        "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": "76601001"
          } ]
        },
        "servicedPeriod": {
          "start": "2017-11-16T12:49:30+00:00",
          "end": "2017-11-16T13:06:56+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 1108.27,
          "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": 221.654,
            "system": "urn: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": 886.616,
            "system": "urn: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": 1108.27,
            "system": "urn: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": 1108.27,
            "system": "urn: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": 1250.85,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1000.6800000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-0097-6b9ce715dd27",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424441002",
          "display": "Prenatal initial visit (regime/therapy)"
        } ],
        "text": "Prenatal initial visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-3e14-bc33c87c1188",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ],
        "text": "Normal pregnancy (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "onsetDateTime": "2018-01-25T12:49:30+00:00",
      "abatementDateTime": "2018-08-23T12:49:30+00:00",
      "assertedDate": "2018-01-25T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c0cb-cef2cb61162b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-c0cb-cef2cb61162b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "252160004",
          "display": "Standard pregnancy test (procedure)"
        } ],
        "text": "Standard pregnancy test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1492-1e327fdd155b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1492-1e327fdd155b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169230002",
          "display": "Ultrasound scan for fetal viability (procedure)"
        } ],
        "text": "Ultrasound scan for fetal viability (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0809-1ca543c1af0e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-0809-1ca543c1af0e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-728c-a91d5d088d4f",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-728c-a91d5d088d4f",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d51f-51c41eeaf845",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d51f-51c41eeaf845",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "44608003",
          "display": "Blood group typing (procedure)"
        } ],
        "text": "Blood group typing (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4855-3285c522dbe2",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4855-3285c522dbe2",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104091002",
          "display": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
        } ],
        "text": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6954-ab475f376039",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-6954-ab475f376039",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "47758006",
          "display": "Hepatitis B surface antigen measurement (procedure)"
        } ],
        "text": "Hepatitis B surface antigen measurement (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c129-1603b9403880",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-c129-1603b9403880",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "31676001",
          "display": "Human immunodeficiency virus antigen test (procedure)"
        } ],
        "text": "Human immunodeficiency virus antigen test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7d98-f9bafff2dc7e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-7d98-f9bafff2dc7e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "310861008",
          "display": "Chlamydia antigen test (procedure)"
        } ],
        "text": "Chlamydia antigen test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-66a9-c8d01a89a7a3",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-66a9-c8d01a89a7a3",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "165829005",
          "display": "Gonorrhea infection titer test (procedure)"
        } ],
        "text": "Gonorrhea infection titer test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-54a5-0b036e627128",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-54a5-0b036e627128",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "269828009",
          "display": "Syphilis infectious titer test (procedure)"
        } ],
        "text": "Syphilis infectious titer test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e246-263be0f822dc",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-e246-263be0f822dc",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "117010004",
          "display": "Urine culture (procedure)"
        } ],
        "text": "Urine culture (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b5a5-9eb0f181b08f",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-b5a5-9eb0f181b08f",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "90226004",
          "display": "Cytopathology procedure, preparation of smear, genital source (procedure)"
        } ],
        "text": "Cytopathology procedure, preparation of smear, genital source (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2a63-ee2dc88ba83b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-2a63-ee2dc88ba83b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "395123002",
          "display": "Urine screening test for diabetes (procedure)"
        } ],
        "text": "Urine screening test for diabetes (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0cb0-cb95f1b1f355",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-0cb0-cb95f1b1f355",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104375008",
          "display": "Hepatitis C antibody, confirmatory test (procedure)"
        } ],
        "text": "Hepatitis C antibody, confirmatory test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8ffe-36cb61d95bf4",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8ffe-36cb61d95bf4",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314098000",
          "display": "Rubella screening test (procedure)"
        } ],
        "text": "Rubella screening test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-64b3-aa9b3dd68ca8",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-64b3-aa9b3dd68ca8",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104326007",
          "display": "Measurement of Varicella-zoster virus antibody (procedure)"
        } ],
        "text": "Measurement of Varicella-zoster virus antibody (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a94c-c571ee27a03e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-a94c-c571ee27a03e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "28163009",
          "display": "Skin test for tuberculosis, Tine test (procedure)"
        } ],
        "text": "Skin test for tuberculosis, Tine test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1b0f-5ad1b1497ec4",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1b0f-5ad1b1497ec4",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "60218003",
          "display": "Urinalysis, protein, qualitative (procedure)"
        } ],
        "text": "Urinalysis, protein, qualitative (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b6d3-82ea8159477e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-b6d3-82ea8159477e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "performedPeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a34a-2b7486679c47",
    "resource": {
      "resourceType": "CarePlan",
      "id": "9a57c612-581f-1c85-a34a-2b7486679c47",
      "status": "completed",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "134435003",
          "display": "Routine antenatal care (regime/therapy)"
        } ],
        "text": "Routine antenatal care (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
      },
      "period": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-08-23T12:49:30+00:00"
      },
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "135892000",
              "display": "Antenatal education (procedure)"
            } ],
            "text": "Antenatal education (procedure)"
          },
          "status": "completed"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "713076009",
              "display": "Antenatal risk assessment (procedure)"
            } ],
            "text": "Antenatal risk assessment (procedure)"
          },
          "status": "completed"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "312404004",
              "display": "Antenatal blood tests (procedure)"
            } ],
            "text": "Antenatal blood tests (procedure)"
          },
          "status": "completed"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6cef-07d79e2ad294",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-6cef-07d79e2ad294",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-01-25T12:49:30+00:00",
        "end": "2018-01-25T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-c0cb-cef2cb61162b"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1492-1e327fdd155b"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-0809-1ca543c1af0e"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-728c-a91d5d088d4f"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d51f-51c41eeaf845"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4855-3285c522dbe2"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6954-ab475f376039"
        }
      }, {
        "sequence": 8,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-c129-1603b9403880"
        }
      }, {
        "sequence": 9,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-7d98-f9bafff2dc7e"
        }
      }, {
        "sequence": 10,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-66a9-c8d01a89a7a3"
        }
      }, {
        "sequence": 11,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-54a5-0b036e627128"
        }
      }, {
        "sequence": 12,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e246-263be0f822dc"
        }
      }, {
        "sequence": 13,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b5a5-9eb0f181b08f"
        }
      }, {
        "sequence": 14,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-2a63-ee2dc88ba83b"
        }
      }, {
        "sequence": 15,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-0cb0-cb95f1b1f355"
        }
      }, {
        "sequence": 16,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8ffe-36cb61d95bf4"
        }
      }, {
        "sequence": 17,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-64b3-aa9b3dd68ca8"
        }
      }, {
        "sequence": 18,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a94c-c571ee27a03e"
        }
      }, {
        "sequence": 19,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1b0f-5ad1b1497ec4"
        }
      }, {
        "sequence": 20,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b6d3-82ea8159477e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-0097-6b9ce715dd27"
        } ]
      }, {
        "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": "252160004"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "169230002"
          } ]
        },
        "net": {
          "value": 4049.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 5216.14,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "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": "44608003"
          } ]
        },
        "net": {
          "value": 1123.95,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "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": "104091002"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "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": "47758006"
          } ]
        },
        "net": {
          "value": 1340.31,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 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": "31676001"
          } ]
        },
        "net": {
          "value": 1642.84,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 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": "310861008"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "procedureLinkId": [ 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": "165829005"
          } ]
        },
        "net": {
          "value": 2679.60,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 13,
        "procedureLinkId": [ 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": "269828009"
          } ]
        },
        "net": {
          "value": 3451.20,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 14,
        "procedureLinkId": [ 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": "117010004"
          } ]
        },
        "net": {
          "value": 1002.01,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 15,
        "procedureLinkId": [ 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": "90226004"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 16,
        "procedureLinkId": [ 14 ],
        "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": "395123002"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 17,
        "procedureLinkId": [ 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": "104375008"
          } ]
        },
        "net": {
          "value": 1981.66,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 18,
        "procedureLinkId": [ 16 ],
        "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": "314098000"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 19,
        "procedureLinkId": [ 17 ],
        "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": "104326007"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 20,
        "procedureLinkId": [ 18 ],
        "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": "28163009"
          } ]
        },
        "net": {
          "value": 2271.48,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 21,
        "procedureLinkId": [ 19 ],
        "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": "60218003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 22,
        "procedureLinkId": [ 20 ],
        "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": "5880005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 35033.05,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:546c5010-1f1d-2d62-7ecd-1b6095bad7df",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "546c5010-1f1d-2d62-7ecd-1b6095bad7df",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      } ],
      "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": "9a57c612-581f-1c85-6cef-07d79e2ad294"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-01-25T13:04:30+00:00",
        "end": "2019-01-25T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-3e14-bc33c87c1188"
        },
        "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": 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,
        "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": "252160004"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "169230002"
          } ]
        },
        "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": 809.94,
            "system": "urn: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": 3239.76,
            "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": 4049.70,
            "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": 4049.70,
            "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": "274804006"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1043.228,
            "system": "urn: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": 4172.912,
            "system": "urn: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": 5216.14,
            "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_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 5216.14,
            "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_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": "44608003"
          } ]
        },
        "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": 224.79000000000002,
            "system": "urn: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": 899.1600000000001,
            "system": "urn: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": 1123.95,
            "system": "urn: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": 1123.95,
            "system": "urn: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": "104091002"
          } ]
        },
        "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": 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": 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": "47758006"
          } ]
        },
        "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": 268.062,
            "system": "urn: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": 1072.248,
            "system": "urn: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": 1340.31,
            "system": "urn: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": 1340.31,
            "system": "urn: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": "31676001"
          } ]
        },
        "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": 328.568,
            "system": "urn: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": 1314.272,
            "system": "urn: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": 1642.84,
            "system": "urn: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": 1642.84,
            "system": "urn: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": "310861008"
          } ]
        },
        "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": 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": 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": "165829005"
          } ]
        },
        "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": 535.92,
            "system": "urn: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": 2143.68,
            "system": "urn: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": 2679.60,
            "system": "urn: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": 2679.60,
            "system": "urn: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": "269828009"
          } ]
        },
        "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": 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_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 2760.96,
            "system": "urn: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": 3451.20,
            "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": 3451.20,
            "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"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 14,
        "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": "117010004"
          } ]
        },
        "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": 200.40200000000002,
            "system": "urn: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": 801.6080000000001,
            "system": "urn: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": 1002.01,
            "system": "urn: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": 1002.01,
            "system": "urn: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": "90226004"
          } ]
        },
        "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": 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": 16,
        "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": "395123002"
          } ]
        },
        "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": 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": 17,
        "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": "104375008"
          } ]
        },
        "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": 396.33200000000005,
            "system": "urn: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": 1585.3280000000002,
            "system": "urn: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": 1981.66,
            "system": "urn: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": 1981.66,
            "system": "urn: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": 18,
        "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": "314098000"
          } ]
        },
        "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": 19,
        "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": "104326007"
          } ]
        },
        "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": 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": 20,
        "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": "28163009"
          } ]
        },
        "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": 454.29600000000005,
            "system": "urn: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": 1817.1840000000002,
            "system": "urn: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": 2271.48,
            "system": "urn: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": 2271.48,
            "system": "urn: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": 21,
        "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": "60218003"
          } ]
        },
        "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": 22,
        "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": "5880005"
          } ]
        },
        "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": 35033.05,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 28026.440000000002,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f666-294c1650a6a2",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-f666-294c1650a6a2",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-02-22T12:49:30+00:00",
        "end": "2018-02-22T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-515b-fc535c6826d9",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-515b-fc535c6826d9",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-f666-294c1650a6a2"
      },
      "performedPeriod": {
        "start": "2018-02-22T12:49:30+00:00",
        "end": "2018-02-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c4aa-6d61856fd171",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-c4aa-6d61856fd171",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-f666-294c1650a6a2"
      },
      "performedPeriod": {
        "start": "2018-02-22T12:49:30+00:00",
        "end": "2018-02-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-dc14-3eeb2574c661",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-dc14-3eeb2574c661",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "443529005",
          "display": "Detection of chromosomal aneuploidy in prenatal amniotic fluid specimen using fluorescence in situ hybridization screening technique (procedure)"
        } ],
        "text": "Detection of chromosomal aneuploidy in prenatal amniotic fluid specimen using fluorescence in situ hybridization screening technique (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-f666-294c1650a6a2"
      },
      "performedPeriod": {
        "start": "2018-02-22T12:49:30+00:00",
        "end": "2018-02-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8bd2-88b51a2bbbd4",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-8bd2-88b51a2bbbd4",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-02-22T12:49:30+00:00",
        "end": "2018-02-22T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-515b-fc535c6826d9"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-c4aa-6d61856fd171"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-dc14-3eeb2574c661"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-f666-294c1650a6a2"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 2261.69,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "443529005"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 5528.76,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:c5b71d1d-47a6-0ca4-d00a-1377cb5b02fb",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "c5b71d1d-47a6-0ca4-d00a-1377cb5b02fb",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      } ],
      "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": "9a57c612-581f-1c85-8bd2-88b51a2bbbd4"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-02-22T13:04:30+00:00",
        "end": "2019-02-22T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "443529005"
          } ]
        },
        "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": 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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 5528.76,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 4423.008,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3eb7-7a824dd6db89",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-3eb7-7a824dd6db89",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-03-22T12:49:30+00:00",
        "end": "2018-03-22T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8abf-6448e0bcafa0",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8abf-6448e0bcafa0",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "271442007",
          "display": "Fetal anatomy study (procedure)"
        } ],
        "text": "Fetal anatomy study (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3eb7-7a824dd6db89"
      },
      "performedPeriod": {
        "start": "2018-03-22T12:49:30+00:00",
        "end": "2018-03-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5201-ae2e89576039",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5201-ae2e89576039",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "275833003",
          "display": "Alpha-fetoprotein test - antenatal (procedure)"
        } ],
        "text": "Alpha-fetoprotein test - antenatal (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3eb7-7a824dd6db89"
      },
      "performedPeriod": {
        "start": "2018-03-22T12:49:30+00:00",
        "end": "2018-03-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d3da-f3b508440d30",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d3da-f3b508440d30",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3eb7-7a824dd6db89"
      },
      "performedPeriod": {
        "start": "2018-03-22T12:49:30+00:00",
        "end": "2018-03-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-57af-0f72f18de942",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-57af-0f72f18de942",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3eb7-7a824dd6db89"
      },
      "performedPeriod": {
        "start": "2018-03-22T12:49:30+00:00",
        "end": "2018-03-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2ea2-502bc2e301c8",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-2ea2-502bc2e301c8",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-03-22T12:49:30+00:00",
        "end": "2018-03-22T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8abf-6448e0bcafa0"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5201-ae2e89576039"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d3da-f3b508440d30"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-57af-0f72f18de942"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-3eb7-7a824dd6db89"
        } ]
      }, {
        "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": "271442007"
          } ]
        },
        "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": "275833003"
          } ]
        },
        "net": {
          "value": 2418.37,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 4012.67,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 9266.71,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:fbd12fe4-df4c-5c83-7efe-71bf5ef9722d",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "fbd12fe4-df4c-5c83-7efe-71bf5ef9722d",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicaid"
        }
      } ],
      "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": "9a57c612-581f-1c85-2ea2-502bc2e301c8"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-03-22T13:04:30+00:00",
        "end": "2019-03-22T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "271442007"
          } ]
        },
        "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": "275833003"
          } ]
        },
        "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": 483.674,
            "system": "urn: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": 1934.696,
            "system": "urn: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": 2418.37,
            "system": "urn: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": 2418.37,
            "system": "urn: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": "274804006"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 802.5340000000001,
            "system": "urn: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": 3210.1360000000004,
            "system": "urn: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": 4012.67,
            "system": "urn: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": 4012.67,
            "system": "urn: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": 9266.71,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 7413.368,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3888-faab2ad5549f",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-3888-faab2ad5549f",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-04-19T12:49:30+00:00",
        "end": "2018-04-19T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ceb4-6af8145970de",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ceb4-6af8145970de",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3888-faab2ad5549f"
      },
      "performedPeriod": {
        "start": "2018-04-19T12:49:30+00:00",
        "end": "2018-04-19T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1f5f-28342a2a2815",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1f5f-28342a2a2815",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3888-faab2ad5549f"
      },
      "performedPeriod": {
        "start": "2018-04-19T12:49:30+00:00",
        "end": "2018-04-19T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-778c-04e6238fcadc",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-778c-04e6238fcadc",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-04-19T12:49:30+00:00",
        "end": "2018-04-19T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ceb4-6af8145970de"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1f5f-28342a2a2815"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-3888-faab2ad5549f"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 2261.69,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 5701.63,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 8105.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:97186c61-adc2-deb1-3f5b-56c445f5b2cf",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "97186c61-adc2-deb1-3f5b-56c445f5b2cf",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-778c-04e6238fcadc"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-04-19T13:04:30+00:00",
        "end": "2019-04-19T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1140.326,
            "system": "urn: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": 4561.304,
            "system": "urn: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": 5701.63,
            "system": "urn: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": 5701.63,
            "system": "urn: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": 8105.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 6484.72,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-9ac2-8d9d5509ef2c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-05-03T12:49:30+00:00",
        "end": "2018-05-03T13:47:21+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6a61-154f41ca8d78",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-6a61-154f41ca8d78",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "onsetDateTime": "2018-05-03T12:49:30+00:00",
      "abatementDateTime": "2019-06-20T12:49:30+00:00",
      "assertedDate": "2018-05-03T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5b96-efacad83f70f",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-5b96-efacad83f70f",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "160904001",
          "display": "Part-time employment (finding)"
        } ],
        "text": "Part-time employment (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "onsetDateTime": "2018-05-03T13:47:21+00:00",
      "abatementDateTime": "2019-06-20T13:48:32+00:00",
      "assertedDate": "2018-05-03T13:47:21+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-038c-c1e008e4bbd6",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-038c-c1e008e4bbd6",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        } ],
        "text": "Hemoglobin A1c/Hemoglobin.total in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 6.0800,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-be35-bf878b5b56d9",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-be35-bf878b5b56d9",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 160.30,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-86dd-4142ab2c1a03",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-86dd-4142ab2c1a03",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-535e-95e1f6410a6d",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-535e-95e1f6410a6d",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 74.600,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2fc7-1f665daf52d0",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-2fc7-1f665daf52d0",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 29.030,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-589c-896bc2e1f4b5",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-589c-896bc2e1f4b5",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 83,
          "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": 100,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1b48-313b3b373bb5",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-1b48-313b3b373bb5",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 95,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-02c6-87b5c9dd7f38",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-02c6-87b5c9dd7f38",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 14,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-aadf-1388841bcc7e",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-aadf-1388841bcc7e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2339-0",
          "display": "Glucose [Mass/volume] in Blood"
        } ],
        "text": "Glucose [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 95.490,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-04b2-023a29b2a86d",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-04b2-023a29b2a86d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6299-2",
          "display": "Urea nitrogen [Mass/volume] in Blood"
        } ],
        "text": "Urea nitrogen [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 8.7300,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-73d2-e9fa9a598655",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-73d2-e9fa9a598655",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "38483-4",
          "display": "Creatinine [Mass/volume] in Blood"
        } ],
        "text": "Creatinine [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 1.3000,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0691-808971394efc",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-0691-808971394efc",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "49765-1",
          "display": "Calcium [Mass/volume] in Blood"
        } ],
        "text": "Calcium [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 9.7700,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f63d-733092d00ef7",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-f63d-733092d00ef7",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2947-0",
          "display": "Sodium [Moles/volume] in Blood"
        } ],
        "text": "Sodium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 139.70,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4b95-f5ad98df4292",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4b95-f5ad98df4292",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6298-4",
          "display": "Potassium [Moles/volume] in Blood"
        } ],
        "text": "Potassium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 4.5400,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a82c-46fd7f3bc597",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-a82c-46fd7f3bc597",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2069-3",
          "display": "Chloride [Moles/volume] in Blood"
        } ],
        "text": "Chloride [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 109.35,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-91e8-566508f117ab",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-91e8-566508f117ab",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "20565-8",
          "display": "Carbon dioxide, total [Moles/volume] in Blood"
        } ],
        "text": "Carbon dioxide, total [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 21.610,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-285a-391492737a7d",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-285a-391492737a7d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2093-3",
          "display": "Cholesterol [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Cholesterol [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 169.27,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c606-cfcb9046d4d1",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c606-cfcb9046d4d1",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2571-8",
          "display": "Triglyceride [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Triglyceride [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 100.41,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d46c-00fbd6844c14",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-d46c-00fbd6844c14",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "18262-6",
          "display": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
        } ],
        "text": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 97.180,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7961-5d1d44f9b1d2",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-7961-5d1d44f9b1d2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2085-9",
          "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 52,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-84d8-97866ffcf562",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-84d8-97866ffcf562",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+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:9a57c612-581f-1c85-a841-2c7e926908ef",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-a841-2c7e926908ef",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T13:47:21+00:00",
      "issued": "2018-05-03T13:47:21.549+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": "LA6568-5",
            "display": "Not at all"
          } ],
          "text": "Not at all"
        }
      }, {
        "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": "LA30131-9",
            "display": "3 to 5 times a week"
          } ],
          "text": "3 to 5 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": "LA30125-1",
            "display": "Food"
          } ],
          "text": "Food"
        }
      }, {
        "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": 7688,
          "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": "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": "67875-5",
            "display": "Employment status - current"
          } ],
          "text": "Employment status - current"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30138-4",
            "display": "Part-time or temporary work"
          } ],
          "text": "Part-time or temporary 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": "455 Harvey Crossroad Suite 55"
      }, {
        "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:9a57c612-581f-1c85-8487-c4ad1a9800ab",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-8487-c4ad1a9800ab",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T14:08:37+00:00",
      "issued": "2018-05-03T14:08:37.549+00:00",
      "valueQuantity": {
        "value": 11,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a9e5-7fb495595ea8",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-a9e5-7fb495595ea8",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "performedPeriod": {
        "start": "2018-05-03T12:49:30+00:00",
        "end": "2018-05-03T13:47:21+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a190-244295a4fca1",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-a190-244295a4fca1",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "performedPeriod": {
        "start": "2018-05-03T13:47:21+00:00",
        "end": "2018-05-03T14:08:37+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b3a8-a1c0b3b968b9",
    "resource": {
      "resourceType": "Immunization",
      "id": "9a57c612-581f-1c85-b3a8-a1c0b3b968b9",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "encounter": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "date": "2018-05-03T12:49:30+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-cbae-b035ab3ffa25",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-cbae-b035ab3ffa25",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "51990-0",
          "display": "Basic metabolic panel - Blood"
        } ],
        "text": "Basic metabolic panel - Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-aadf-1388841bcc7e",
        "display": "Glucose [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-04b2-023a29b2a86d",
        "display": "Urea nitrogen [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-73d2-e9fa9a598655",
        "display": "Creatinine [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-0691-808971394efc",
        "display": "Calcium [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-f63d-733092d00ef7",
        "display": "Sodium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4b95-f5ad98df4292",
        "display": "Potassium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-a82c-46fd7f3bc597",
        "display": "Chloride [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-91e8-566508f117ab",
        "display": "Carbon dioxide, total [Moles/volume] in Blood"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-fbae-08aaebcdedbd",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-fbae-08aaebcdedbd",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "57698-3",
          "display": "Lipid panel with direct LDL - Serum or Plasma"
        } ],
        "text": "Lipid panel with direct LDL - Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T12:49:30+00:00",
      "issued": "2018-05-03T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-285a-391492737a7d",
        "display": "Cholesterol [Mass/volume] in Serum or Plasma"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-c606-cfcb9046d4d1",
        "display": "Triglyceride [Mass/volume] in Serum or Plasma"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-d46c-00fbd6844c14",
        "display": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-7961-5d1d44f9b1d2",
        "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4a8e-d3d23aa93799",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-4a8e-d3d23aa93799",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
      },
      "effectiveDateTime": "2018-05-03T14:08:37+00:00",
      "issued": "2018-05-03T14:08:37.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-8487-c4ad1a9800ab",
        "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-957f-7fa8773166ed",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-957f-7fa8773166ed",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 50
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "337388004",
            "display": "Blood glucose testing strips (physical object)"
          } ],
          "text": "Blood glucose testing strips (physical object)"
        }
      },
      "occurrenceDateTime": "2018-05-03T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2a33-6a1216b6a950",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-2a33-6a1216b6a950",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-05-03T12:49:30+00:00",
        "end": "2018-05-03T13:47:21+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b3a8-a1c0b3b968b9"
        }
      }, {
        "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"
          } ]
        }
      }, {
        "sequence": 5,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6a61-154f41ca8d78"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5b96-efacad83f70f"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a9e5-7fb495595ea8"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a190-244295a4fca1"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 6.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710824005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 9,
        "procedureLinkId": [ 2 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "710841007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "informationLinkId": [ 5 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1314.89,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:3aaabfbb-26ed-69ab-f1df-7d51c7daace2",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "3aaabfbb-26ed-69ab-f1df-7d51c7daace2",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-2a33-6a1216b6a950"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-05-03T13:47:21+00:00",
        "end": "2019-05-03T13:47:21+00:00"
      },
      "created": "2018-05-03T13:47:21+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-2a33-6a1216b6a950"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-6a61-154f41ca8d78"
        },
        "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:9a57c612-581f-1c85-5b96-efacad83f70f"
        },
        "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": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-9ac2-8d9d5509ef2c"
        } ],
        "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"
            } ]
          },
          "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": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+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"
            } ]
          }
        } ]
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      }, {
        "sequence": 4,
        "informationLinkId": [ 2 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 6.80,
          "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": 1.36,
            "system": "urn: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": 5.44,
            "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": 6.80,
            "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": 6.80,
            "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"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 5,
        "informationLinkId": [ 3 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 74.58,
          "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": 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"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      }, {
        "sequence": 6,
        "informationLinkId": [ 4 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 74.58,
          "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": 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"
            } ]
          },
          "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": "710824005"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "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": 8,
        "diagnosisLinkId": [ 2 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      }, {
        "sequence": 9,
        "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": "710841007"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "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": 10,
        "informationLinkId": [ 5 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-05-03T12:49:30+00:00",
          "end": "2018-05-03T13:47:21+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 74.58,
          "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": 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"
            } ]
          },
          "reason": {
            "coding": [ {
              "system": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
              "code": "A",
              "display": "Allowed"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 808.91,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1051.912,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6c1a-b9e917ec6307",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-6c1a-b9e917ec6307",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-05-10T12:49:30+00:00",
        "end": "2018-05-10T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "444814009",
          "display": "Viral sinusitis (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ca99-7ae758516c5c",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-ca99-7ae758516c5c",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "444814009",
          "display": "Viral sinusitis (disorder)"
        } ],
        "text": "Viral sinusitis (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-6c1a-b9e917ec6307"
      },
      "onsetDateTime": "2018-05-10T12:49:30+00:00",
      "abatementDateTime": "2018-05-21T12:49:30+00:00",
      "assertedDate": "2018-05-10T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5467-d2126e8d0a50",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-5467-d2126e8d0a50",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-05-10T12:49:30+00:00",
        "end": "2018-05-10T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ca99-7ae758516c5c"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-6c1a-b9e917ec6307"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 85.55,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:de43924a-8067-c927-7676-666828e0c650",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "de43924a-8067-c927-7676-666828e0c650",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-5467-d2126e8d0a50"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-05-10T13:04:30+00:00",
        "end": "2019-05-10T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-ca99-7ae758516c5c"
        },
        "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:9a57c612-581f-1c85-5ec4-100b8a9888b3",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-5ec4-100b8a9888b3",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-05-17T12:49:30+00:00",
        "end": "2018-05-17T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ad26-6d82098c7850",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ad26-6d82098c7850",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-5ec4-100b8a9888b3"
      },
      "performedPeriod": {
        "start": "2018-05-17T12:49:30+00:00",
        "end": "2018-05-17T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d3f4-32df57d50284",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d3f4-32df57d50284",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-5ec4-100b8a9888b3"
      },
      "performedPeriod": {
        "start": "2018-05-17T12:49:30+00:00",
        "end": "2018-05-17T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1126-3c9dca6bbbe0",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-1126-3c9dca6bbbe0",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-05-17T12:49:30+00:00",
        "end": "2018-05-17T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ad26-6d82098c7850"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d3f4-32df57d50284"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-5ec4-100b8a9888b3"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 3055.02,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 9046.75,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 12244.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ad8e4a49-4523-951c-8834-56fe4c8db7dd",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ad8e4a49-4523-951c-8834-56fe4c8db7dd",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-1126-3c9dca6bbbe0"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-05-17T13:04:30+00:00",
        "end": "2019-05-17T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 611.004,
            "system": "urn: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": 2444.016,
            "system": "urn: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": 3055.02,
            "system": "urn: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": 3055.02,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1809.3500000000001,
            "system": "urn: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": 7237.400000000001,
            "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": 9046.75,
            "system": "urn: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": 9046.75,
            "system": "urn: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": 12244.35,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 9795.48,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-4774-3879f5306f00",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-952a-e88951a69c9b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-952a-e88951a69c9b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104091002",
          "display": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
        } ],
        "text": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00"
      },
      "performedPeriod": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-dd52-fc8a794e7b8e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-dd52-fc8a794e7b8e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "399014008",
          "display": "Administration of vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae antigens (procedure)"
        } ],
        "text": "Administration of vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae antigens (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00"
      },
      "performedPeriod": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a075-04ac82def24b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-a075-04ac82def24b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "268556000",
          "display": "Urine screening for glucose (procedure)"
        } ],
        "text": "Urine screening for glucose (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00"
      },
      "performedPeriod": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-286c-2d09707c486d",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-286c-2d09707c486d",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00"
      },
      "performedPeriod": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2305-cf6a57a68a1e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-2305-cf6a57a68a1e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00"
      },
      "performedPeriod": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3ed6-2990fa0def42",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-3ed6-2990fa0def42",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-06-14T12:49:30+00:00",
        "end": "2018-06-14T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-952a-e88951a69c9b"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-dd52-fc8a794e7b8e"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a075-04ac82def24b"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-286c-2d09707c486d"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-2305-cf6a57a68a1e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-4774-3879f5306f00"
        } ]
      }, {
        "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": "104091002"
          } ]
        },
        "net": {
          "value": 862.80,
          "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": "399014008"
          } ]
        },
        "net": {
          "value": 1108.27,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "268556000"
          } ]
        },
        "net": {
          "value": 976.46,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 8341.88,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 13693.68,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:bc0ad486-36fa-9a5a-0c81-77d2a8c4fb26",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "bc0ad486-36fa-9a5a-0c81-77d2a8c4fb26",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-3ed6-2990fa0def42"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-06-14T13:04:30+00:00",
        "end": "2019-06-14T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "104091002"
          } ]
        },
        "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": 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": 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": "399014008"
          } ]
        },
        "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": 221.654,
            "system": "urn: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": 886.616,
            "system": "urn: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": 1108.27,
            "system": "urn: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": 1108.27,
            "system": "urn: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": "268556000"
          } ]
        },
        "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": 195.29200000000003,
            "system": "urn: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": 781.1680000000001,
            "system": "urn: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": 976.46,
            "system": "urn: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": 976.46,
            "system": "urn: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": "274804006"
          } ]
        },
        "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": 1668.376,
            "system": "urn: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": 6673.504,
            "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": 8341.88,
            "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": 8341.88,
            "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": 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": "225158009"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 13693.68,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 10954.944000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ff36-de7279e7fe00",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-ff36-de7279e7fe00",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-07-12T12:49:30+00:00",
        "end": "2018-07-12T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-13bf-da0dedf0f92c",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-13bf-da0dedf0f92c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ff36-de7279e7fe00"
      },
      "performedPeriod": {
        "start": "2018-07-12T12:49:30+00:00",
        "end": "2018-07-12T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4c1e-fe4ea67545e7",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4c1e-fe4ea67545e7",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ff36-de7279e7fe00"
      },
      "performedPeriod": {
        "start": "2018-07-12T12:49:30+00:00",
        "end": "2018-07-12T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0a71-584c14020fd2",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0a71-584c14020fd2",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-07-12T12:49:30+00:00",
        "end": "2018-07-12T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-13bf-da0dedf0f92c"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4c1e-fe4ea67545e7"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-ff36-de7279e7fe00"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 3364.57,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 3376.75,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 6883.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:d1c016c7-2b2a-45eb-4864-839d158b113c",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "d1c016c7-2b2a-45eb-4864-839d158b113c",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-0a71-584c14020fd2"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-07-12T13:04:30+00:00",
        "end": "2019-07-12T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 672.9140000000001,
            "system": "urn: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": 2691.6560000000004,
            "system": "urn: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": 3364.57,
            "system": "urn: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": 3364.57,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 675.35,
            "system": "urn: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": 2701.4,
            "system": "urn: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": 3376.75,
            "system": "urn: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": 3376.75,
            "system": "urn: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": 6883.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 5507.120000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b0ba-1bb474c11f23",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-b0ba-1bb474c11f23",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-08-09T12:49:30+00:00",
        "end": "2018-08-09T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-82d6-decd295eedb8",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-82d6-decd295eedb8",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "118001005",
          "display": "Streptococcus pneumoniae group B antigen assay (procedure)"
        } ],
        "text": "Streptococcus pneumoniae group B antigen assay (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b0ba-1bb474c11f23"
      },
      "performedPeriod": {
        "start": "2018-08-09T12:49:30+00:00",
        "end": "2018-08-09T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5a3f-b9ae280e36a2",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5a3f-b9ae280e36a2",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b0ba-1bb474c11f23"
      },
      "performedPeriod": {
        "start": "2018-08-09T12:49:30+00:00",
        "end": "2018-08-09T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e400-05590d4120e2",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-e400-05590d4120e2",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b0ba-1bb474c11f23"
      },
      "performedPeriod": {
        "start": "2018-08-09T12:49:30+00:00",
        "end": "2018-08-09T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0c0d-99a0e8e9d77f",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0c0d-99a0e8e9d77f",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-08-09T12:49:30+00:00",
        "end": "2018-08-09T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-82d6-decd295eedb8"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5a3f-b9ae280e36a2"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e400-05590d4120e2"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-b0ba-1bb474c11f23"
        } ]
      }, {
        "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": "118001005"
          } ]
        },
        "net": {
          "value": 1241.38,
          "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": "274804006"
          } ]
        },
        "net": {
          "value": 3017.30,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 7297.30,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 11698.56,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:6762efa4-5c5f-8edd-54ae-0a18711d257e",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "6762efa4-5c5f-8edd-54ae-0a18711d257e",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-0c0d-99a0e8e9d77f"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-08-09T13:04:30+00:00",
        "end": "2019-08-09T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "118001005"
          } ]
        },
        "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": 248.27600000000004,
            "system": "urn: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": 993.1040000000002,
            "system": "urn: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": 1241.38,
            "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": 1241.38,
            "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"
            } ]
          }
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "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": 603.46,
            "system": "urn: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": 2413.84,
            "system": "urn: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": 3017.30,
            "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": 3017.30,
            "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": 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": "225158009"
          } ]
        },
        "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": 1459.46,
            "system": "urn: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": 5837.84,
            "system": "urn: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": 7297.30,
            "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": 7297.30,
            "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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 11698.56,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 9358.848,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-bc98-374ec59b01d3",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-bc98-374ec59b01d3",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "EMER"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "183460006",
          "display": "Obstetric emergency hospital admission (procedure)"
        } ],
        "text": "Obstetric emergency hospital admission (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999882399",
          "display": "Dr. Jettie913 Rodriguez71"
        }
      } ],
      "period": {
        "start": "2018-08-23T12:49:30+00:00",
        "end": "2018-08-23T13:49:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|36d328a2-68bb-3967-a9bf-00897a7c945f",
        "display": "HANNAH B G SHAW HOME"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-35eb-00c617ab6471",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-35eb-00c617ab6471",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "386216000",
          "display": "Human parturition, function (observable entity)"
        } ],
        "text": "Human parturition, function (observable entity)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-bc98-374ec59b01d3"
      },
      "performedPeriod": {
        "start": "2018-08-23T12:49:30+00:00",
        "end": "2018-08-23T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f82c-1a0419509981",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-f82c-1a0419509981",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-08-23T12:49:30+00:00",
        "end": "2018-08-23T13:49:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|36d328a2-68bb-3967-a9bf-00897a7c945f",
        "display": "HANNAH B G SHAW HOME"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-35eb-00c617ab6471"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 146.18,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-bc98-374ec59b01d3"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "386216000"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 577.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:6c7802fd-ac84-8300-7b4c-c6ab2fd09c6a",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "6c7802fd-ac84-8300-7b4c-c6ab2fd09c6a",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999882399"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999882399"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-f82c-1a0419509981"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-08-23T13:49:30+00:00",
        "end": "2019-08-23T13:49:30+00:00"
      },
      "created": "2018-08-23T13:49:30+00:00",
      "provider": {
        "identifier": {
          "value": "c34d702c-1cce-3ce3-98db-d107c9b6bd4b"
        }
      },
      "organization": {
        "identifier": {
          "value": "36d328a2-68bb-3967-a9bf-00897a7c945f"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-f82c-1a0419509981"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999882399"
          }
        },
        "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": "2018-08-23T12:49:30+00:00",
          "end": "2018-08-23T13:49:30+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:9a57c612-581f-1c85-bc98-374ec59b01d3"
        } ],
        "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,
        "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": "386216000"
          } ]
        },
        "servicedPeriod": {
          "start": "2018-08-23T12:49:30+00:00",
          "end": "2018-08-23T13:49:30+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": 577.58,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 462.064,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d3c3-0042f9f3620b",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-d3c3-0042f9f3620b",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169762003",
          "display": "Postnatal visit (regime/therapy)"
        } ],
        "text": "Postnatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2018-10-04T12:49:30+00:00",
        "end": "2018-10-04T13:04:30+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b0b6-9f269de71288",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-b0b6-9f269de71288",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82810-3",
          "display": "Pregnancy status"
        } ],
        "text": "Pregnancy status"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d3c3-0042f9f3620b"
      },
      "effectiveDateTime": "2018-11-08T12:49:30+00:00",
      "issued": "2018-11-08T12:49:30.549+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "77386006",
          "display": "Pregnant"
        } ],
        "text": "Pregnant"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-71ef-dd358d94e3d4",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-71ef-dd358d94e3d4",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d3c3-0042f9f3620b"
      },
      "performedPeriod": {
        "start": "2018-10-04T12:49:30+00:00",
        "end": "2018-10-04T13:04:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3077-b9c26aa56152",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3077-b9c26aa56152",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d3c3-0042f9f3620b"
      },
      "performedPeriod": {
        "start": "2018-10-04T12:49:30+00:00",
        "end": "2018-10-04T13:04:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-66e2-9983987c54ee",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-66e2-9983987c54ee",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2018-10-04T12:49:30+00:00",
        "end": "2018-10-04T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-71ef-dd358d94e3d4"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3077-b9c26aa56152"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d3c3-0042f9f3620b"
        } ]
      }, {
        "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": "5880005"
          } ]
        },
        "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": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1005.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:fa72c670-77d8-dbda-5b3e-16e71fa6de25",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "fa72c670-77d8-dbda-5b3e-16e71fa6de25",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-66e2-9983987c54ee"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2018-10-04T13:04:30+00:00",
        "end": "2019-10-04T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "5880005"
          } ]
        },
        "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": "171207006"
          } ]
        },
        "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": 1005.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 804.3040000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-50f8-eb0a8ca1f8ca",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424441002",
          "display": "Prenatal initial visit (regime/therapy)"
        } ],
        "text": "Prenatal initial visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-01-03T12:49:30+00:00",
        "end": "2019-01-03T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-6f09-70e65b21362e",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ],
        "text": "Normal pregnancy (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca"
      },
      "onsetDateTime": "2019-01-03T12:49:30+00:00",
      "abatementDateTime": "2019-01-16T12:49:30+00:00",
      "assertedDate": "2019-01-03T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-125d-09775288028b",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-125d-09775288028b",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "19169002",
          "display": "Miscarriage in first trimester (disorder)"
        } ],
        "text": "Miscarriage in first trimester (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca"
      },
      "onsetDateTime": "2019-01-03T12:49:30+00:00",
      "abatementDateTime": "2019-01-16T12:49:30+00:00",
      "assertedDate": "2019-01-03T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a1c7-3721a69655ee",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-a1c7-3721a69655ee",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "156073000",
          "display": "Complete miscarriage (disorder)"
        } ],
        "text": "Complete miscarriage (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca"
      },
      "onsetDateTime": "2019-01-03T12:49:30+00:00",
      "abatementDateTime": "2019-01-16T12:49:30+00:00",
      "assertedDate": "2019-01-03T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-07d4-6e93079b2924",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-07d4-6e93079b2924",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "252160004",
          "display": "Standard pregnancy test (procedure)"
        } ],
        "text": "Standard pregnancy test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca"
      },
      "performedPeriod": {
        "start": "2019-01-03T12:49:30+00:00",
        "end": "2019-01-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ebcb-1860650bc146",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ebcb-1860650bc146",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169230002",
          "display": "Ultrasound scan for fetal viability (procedure)"
        } ],
        "text": "Ultrasound scan for fetal viability (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca"
      },
      "performedPeriod": {
        "start": "2019-01-03T12:49:30+00:00",
        "end": "2019-01-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6e04-eed86ff21224",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-6e04-eed86ff21224",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-01-03T12:49:30+00:00",
        "end": "2019-01-03T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-125d-09775288028b"
        }
      }, {
        "sequence": 3,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a1c7-3721a69655ee"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-07d4-6e93079b2924"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ebcb-1860650bc146"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-50f8-eb0a8ca1f8ca"
        } ]
      }, {
        "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": "252160004"
          } ]
        },
        "net": {
          "value": 7559.68,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "169230002"
          } ]
        },
        "net": {
          "value": 4049.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 6,
        "diagnosisLinkId": [ 3 ]
      } ],
      "total": {
        "value": 11751.96,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:3c7bf8c7-c517-088a-07cc-6f733c5ebaeb",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "3c7bf8c7-c517-088a-07cc-6f733c5ebaeb",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-6e04-eed86ff21224"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-01-03T13:04:30+00:00",
        "end": "2020-01-03T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-6f09-70e65b21362e"
        },
        "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:9a57c612-581f-1c85-125d-09775288028b"
        },
        "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:9a57c612-581f-1c85-a1c7-3721a69655ee"
        },
        "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": 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,
        "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": "252160004"
          } ]
        },
        "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": 1511.9360000000001,
            "system": "urn: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": 6047.744000000001,
            "system": "urn: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": 7559.68,
            "system": "urn: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": 7559.68,
            "system": "urn: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": "169230002"
          } ]
        },
        "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": 809.94,
            "system": "urn: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": 3239.76,
            "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": 4049.70,
            "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": 4049.70,
            "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,
        "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": 6,
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      } ],
      "totalCost": {
        "value": 11751.96,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 9401.568000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-74f4-879cdd2e9858",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-74f4-879cdd2e9858",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-01-16T12:49:30+00:00",
        "end": "2019-01-16T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "156073000",
          "display": "Complete miscarriage (disorder)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9594-7fbe75efb806",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-9594-7fbe75efb806",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "161744009",
          "display": "Past pregnancy history of miscarriage (situation)"
        } ],
        "text": "Past pregnancy history of miscarriage (situation)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-74f4-879cdd2e9858"
      },
      "onsetDateTime": "2019-01-16T12:49:30+00:00",
      "assertedDate": "2019-01-16T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5553-7cf1cf542790",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-5553-7cf1cf542790",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82810-3",
          "display": "Pregnancy status"
        } ],
        "text": "Pregnancy status"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-74f4-879cdd2e9858"
      },
      "effectiveDateTime": "2019-03-28T12:49:30+00:00",
      "issued": "2019-03-28T12:49:30.549+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "77386006",
          "display": "Pregnant"
        } ],
        "text": "Pregnant"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3609-d5391cfacf53",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3609-d5391cfacf53",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-74f4-879cdd2e9858"
      },
      "performedPeriod": {
        "start": "2019-01-16T12:49:30+00:00",
        "end": "2019-01-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6db8-cecba6e99d3f",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-6db8-cecba6e99d3f",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-74f4-879cdd2e9858"
      },
      "performedPeriod": {
        "start": "2019-01-16T12:49:30+00:00",
        "end": "2019-01-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-a1c7-3721a69655ee",
        "display": "Complete miscarriage (disorder)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8a57-d41ad2ab40b7",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-8a57-d41ad2ab40b7",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-01-16T12:49:30+00:00",
        "end": "2019-01-16T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-9594-7fbe75efb806"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3609-d5391cfacf53"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6db8-cecba6e99d3f"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-74f4-879cdd2e9858"
        } ]
      }, {
        "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": "5880005"
          } ]
        },
        "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": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "diagnosisLinkId": [ 1 ]
      } ],
      "total": {
        "value": 1005.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:7ec24229-c435-c98a-cadb-ac3899b56f2b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "7ec24229-c435-c98a-cadb-ac3899b56f2b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-8a57-d41ad2ab40b7"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-01-16T13:04:30+00:00",
        "end": "2020-01-16T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-9594-7fbe75efb806"
        },
        "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": 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": "5880005"
          } ]
        },
        "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": "171207006"
          } ]
        },
        "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"
          } ]
        }
      } ],
      "totalCost": {
        "value": 1005.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 804.3040000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a8da-7908eb954a7c",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-a8da-7908eb954a7c",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424441002",
          "display": "Prenatal initial visit (regime/therapy)"
        } ],
        "text": "Prenatal initial visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-05-23T12:49:30+00:00",
        "end": "2019-05-23T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-4a9a-5eea685d81e1",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ],
        "text": "Normal pregnancy (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8da-7908eb954a7c"
      },
      "onsetDateTime": "2019-05-23T12:49:30+00:00",
      "abatementDateTime": "2019-06-27T12:49:30+00:00",
      "assertedDate": "2019-05-23T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9a13-acd017a191cd",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-9a13-acd017a191cd",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "252160004",
          "display": "Standard pregnancy test (procedure)"
        } ],
        "text": "Standard pregnancy test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8da-7908eb954a7c"
      },
      "performedPeriod": {
        "start": "2019-05-23T12:49:30+00:00",
        "end": "2019-05-23T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8dca-94dd5a1a4912",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8dca-94dd5a1a4912",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169230002",
          "display": "Ultrasound scan for fetal viability (procedure)"
        } ],
        "text": "Ultrasound scan for fetal viability (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8da-7908eb954a7c"
      },
      "performedPeriod": {
        "start": "2019-05-23T12:49:30+00:00",
        "end": "2019-05-23T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2e1e-9fd28b01bc3a",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-2e1e-9fd28b01bc3a",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-05-23T12:49:30+00:00",
        "end": "2019-05-23T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-9a13-acd017a191cd"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8dca-94dd5a1a4912"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-a8da-7908eb954a7c"
        } ]
      }, {
        "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": "252160004"
          } ]
        },
        "net": {
          "value": 6651.20,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "169230002"
          } ]
        },
        "net": {
          "value": 4049.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 10843.48,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ae3a492a-06da-4f00-c2d2-7bfe2486954f",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ae3a492a-06da-4f00-c2d2-7bfe2486954f",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-2e1e-9fd28b01bc3a"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-05-23T13:04:30+00:00",
        "end": "2020-05-23T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-4a9a-5eea685d81e1"
        },
        "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": 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,
        "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": "252160004"
          } ]
        },
        "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": 1330.24,
            "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_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 5320.96,
            "system": "urn: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": 6651.20,
            "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": 6651.20,
            "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"
            } ]
          }
        } ]
      }, {
        "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": "169230002"
          } ]
        },
        "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": 809.94,
            "system": "urn: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": 3239.76,
            "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": 4049.70,
            "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": 4049.70,
            "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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 10843.48,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 8674.784,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ff6d-f853bf18aeac",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-ff6d-f853bf18aeac",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "270427003",
          "display": "Patient-initiated encounter (procedure)"
        } ],
        "text": "Patient-initiated encounter (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-06-01T12:49:30+00:00",
        "end": "2019-06-01T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-898b-e1974071bcf7",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-898b-e1974071bcf7",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "10383002",
          "display": "Counseling for termination of pregnancy (procedure)"
        } ],
        "text": "Counseling for termination of pregnancy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ff6d-f853bf18aeac"
      },
      "performedPeriod": {
        "start": "2019-06-01T12:49:30+00:00",
        "end": "2019-06-01T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2721-b2562b385ee3",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-2721-b2562b385ee3",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "714812005",
          "display": "Induced termination of pregnancy (procedure)"
        } ],
        "text": "Induced termination of pregnancy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ff6d-f853bf18aeac"
      },
      "performedPeriod": {
        "start": "2019-06-01T12:49:30+00:00",
        "end": "2019-06-01T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f737-3884ddc93605",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-f737-3884ddc93605",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-06-01T12:49:30+00:00",
        "end": "2019-06-01T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-898b-e1974071bcf7"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-2721-b2562b385ee3"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-ff6d-f853bf18aeac"
        } ]
      }, {
        "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": "10383002"
          } ]
        },
        "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": "714812005"
          } ]
        },
        "net": {
          "value": 3928.03,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 4444.98,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:953f8389-4c7b-d375-5069-06b68e56994d",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "953f8389-4c7b-d375-5069-06b68e56994d",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-f737-3884ddc93605"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-06-01T13:04:30+00:00",
        "end": "2020-06-01T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "10383002"
          } ]
        },
        "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": "714812005"
          } ]
        },
        "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": 785.6060000000001,
            "system": "urn: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": 3142.4240000000004,
            "system": "urn: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": 3928.03,
            "system": "urn: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": 3928.03,
            "system": "urn: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": 4444.98,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 3555.9840000000004,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-4014-c842836ae170",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2019-06-20T12:49:30+00:00",
        "end": "2019-06-20T13:48:32+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-739a-2a1dc8003b37",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-739a-2a1dc8003b37",
      "clinicalStatus": "resolved",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "onsetDateTime": "2019-06-20T13:48:32+00:00",
      "abatementDateTime": "2022-06-23T13:28:26+00:00",
      "assertedDate": "2019-06-20T13:48:32+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b7af-c5c6625fd8fe",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-b7af-c5c6625fd8fe",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "422650009",
          "display": "Social isolation (finding)"
        } ],
        "text": "Social isolation (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "onsetDateTime": "2019-06-20T13:48:32+00:00",
      "abatementDateTime": "2025-06-26T13:28:40+00:00",
      "assertedDate": "2019-06-20T13:48:32+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9816-b52f4739834c",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-9816-b52f4739834c",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "73595000",
          "display": "Stress (finding)"
        } ],
        "text": "Stress (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "onsetDateTime": "2019-06-20T13:48:32+00:00",
      "abatementDateTime": "2025-06-26T13:28:40+00:00",
      "assertedDate": "2019-06-20T13:48:32+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-85da-b95892336744",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-85da-b95892336744",
      "clinicalStatus": "resolved",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "onsetDateTime": "2019-06-20T13:48:32+00:00",
      "abatementDateTime": "2022-06-23T13:28:26+00:00",
      "assertedDate": "2019-06-20T13:48:32+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-62ff-e0689775070d",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-62ff-e0689775070d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        } ],
        "text": "Hemoglobin A1c/Hemoglobin.total in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 5.8800,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7099-c31c915324b4",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-7099-c31c915324b4",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 160.30,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9c9c-0f6780cdb5b2",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-9c9c-0f6780cdb5b2",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b0e8-03f7bdb32589",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-b0e8-03f7bdb32589",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 76,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-aef8-f2f54d38a8b1",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-aef8-f2f54d38a8b1",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 29.580,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-02ce-1280f24e9235",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-02ce-1280f24e9235",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+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": 100,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8bc4-17cdfd684298",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-8bc4-17cdfd684298",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 77,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-33f8-bb5d384a25e1",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-33f8-bb5d384a25e1",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 14,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7963-1eeed75f6351",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-7963-1eeed75f6351",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2339-0",
          "display": "Glucose [Mass/volume] in Blood"
        } ],
        "text": "Glucose [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 83.030,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4df3-ed29086c9673",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4df3-ed29086c9673",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6299-2",
          "display": "Urea nitrogen [Mass/volume] in Blood"
        } ],
        "text": "Urea nitrogen [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 10.100,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6c61-54dfd7c4e529",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-6c61-54dfd7c4e529",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "38483-4",
          "display": "Creatinine [Mass/volume] in Blood"
        } ],
        "text": "Creatinine [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 1.2600,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-db3d-f65c425320fc",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-db3d-f65c425320fc",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "49765-1",
          "display": "Calcium [Mass/volume] in Blood"
        } ],
        "text": "Calcium [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 10.150,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b0f1-1c0571018d07",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-b0f1-1c0571018d07",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2947-0",
          "display": "Sodium [Moles/volume] in Blood"
        } ],
        "text": "Sodium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 140.51,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e7e8-7e28ebc1209c",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-e7e8-7e28ebc1209c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6298-4",
          "display": "Potassium [Moles/volume] in Blood"
        } ],
        "text": "Potassium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 4.4700,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4bb3-8afe143a7f1c",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4bb3-8afe143a7f1c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2069-3",
          "display": "Chloride [Moles/volume] in Blood"
        } ],
        "text": "Chloride [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 108.13,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f1ef-a707698dd797",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-f1ef-a707698dd797",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "20565-8",
          "display": "Carbon dioxide, total [Moles/volume] in Blood"
        } ],
        "text": "Carbon dioxide, total [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 28.690,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3dee-b7a3394b9734",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-3dee-b7a3394b9734",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+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:9a57c612-581f-1c85-3119-84bb021c3301",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-3119-84bb021c3301",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T13:48:32+00:00",
      "issued": "2019-06-20T13:48:32.549+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": "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": "LA27722-0",
            "display": "Less than once a week"
          } ],
          "text": "Less than once 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": "LA30124-4",
            "display": "Utilities"
          } ],
          "text": "Utilities"
        }
      }, {
        "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": 7688,
          "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": "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": "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": "455 Harvey Crossroad Suite 55"
      }, {
        "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": "LA33-6",
            "display": "Yes"
          } ],
          "text": "Yes"
        }
      }, {
        "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:9a57c612-581f-1c85-6ca6-3f144879bcaa",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-6ca6-3f144879bcaa",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T14:15:59+00:00",
      "issued": "2019-06-20T14:15:59.549+00:00",
      "valueQuantity": {
        "value": 14,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-efed-c935ab2aa919",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-efed-c935ab2aa919",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T14:55:09+00:00",
      "issued": "2019-06-20T14:55:09.549+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-138c-ae8ade1b3d09",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-138c-ae8ade1b3d09",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T15:30:00+00:00",
      "issued": "2019-06-20T15:30:00.549+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-fd47-f237cd6fca88",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-fd47-f237cd6fca88",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "430193006",
          "display": "Medication reconciliation (procedure)"
        } ],
        "text": "Medication reconciliation (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T12:49:30+00:00",
        "end": "2019-06-20T13:04:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4391-7a77d801c8f5",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4391-7a77d801c8f5",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T12:49:30+00:00",
        "end": "2019-06-20T13:48:32+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d651-7ee57b2afa69",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d651-7ee57b2afa69",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T13:48:32+00:00",
        "end": "2019-06-20T14:15:59+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5b57-353edad890de",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5b57-353edad890de",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T14:15:59+00:00",
        "end": "2019-06-20T14:27:53+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-aa11-b1b8cb1cffa9",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-aa11-b1b8cb1cffa9",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T14:27:53+00:00",
        "end": "2019-06-20T14:55:09+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-107e-ccb5a2d0ce1e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-107e-ccb5a2d0ce1e",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T14:55:09+00:00",
        "end": "2019-06-20T15:06:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5301-79addaf51a46",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5301-79addaf51a46",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T15:06:30+00:00",
        "end": "2019-06-20T15:30:00+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b6b4-16b295e2446c",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-b6b4-16b295e2446c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "performedPeriod": {
        "start": "2019-06-20T15:30:00+00:00",
        "end": "2019-06-20T15:35:07+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-45d2-d7e9c1948d81",
    "resource": {
      "resourceType": "Immunization",
      "id": "9a57c612-581f-1c85-45d2-d7e9c1948d81",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "encounter": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "date": "2019-06-20T12:49:30+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6c60-06a4fa89b940",
    "resource": {
      "resourceType": "Immunization",
      "id": "9a57c612-581f-1c85-6c60-06a4fa89b940",
      "status": "completed",
      "notGiven": false,
      "vaccineCode": {
        "coding": [ {
          "system": "http://hl7.org/fhir/sid/cvx",
          "code": "113",
          "display": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
        } ],
        "text": "Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed"
      },
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "encounter": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "date": "2019-06-20T12:49:30+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a57e-e783ba9e0327",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-a57e-e783ba9e0327",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "51990-0",
          "display": "Basic metabolic panel - Blood"
        } ],
        "text": "Basic metabolic panel - Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T12:49:30+00:00",
      "issued": "2019-06-20T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-7963-1eeed75f6351",
        "display": "Glucose [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4df3-ed29086c9673",
        "display": "Urea nitrogen [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6c61-54dfd7c4e529",
        "display": "Creatinine [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-db3d-f65c425320fc",
        "display": "Calcium [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b0f1-1c0571018d07",
        "display": "Sodium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-e7e8-7e28ebc1209c",
        "display": "Potassium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4bb3-8afe143a7f1c",
        "display": "Chloride [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-f1ef-a707698dd797",
        "display": "Carbon dioxide, total [Moles/volume] in Blood"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2622-5f8b6861df5c",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-2622-5f8b6861df5c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T14:15:59+00:00",
      "issued": "2019-06-20T14:15:59.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-6ca6-3f144879bcaa",
        "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8e2d-001bae4fbdbd",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-8e2d-001bae4fbdbd",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T14:55:09+00:00",
      "issued": "2019-06-20T14:55:09.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-efed-c935ab2aa919",
        "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b23a-5dbc2532e053",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-b23a-5dbc2532e053",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
      },
      "effectiveDateTime": "2019-06-20T15:30:00+00:00",
      "issued": "2019-06-20T15:30:00.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-138c-ae8ade1b3d09",
        "display": "Total score [AUDIT-C]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d242-541fc3c02612",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-d242-541fc3c02612",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 100
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "1137596000",
            "display": "Blood lancet (physical object)"
          } ],
          "text": "Blood lancet (physical object)"
        }
      },
      "occurrenceDateTime": "2019-06-20T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-78c3-58e4eac273d1",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-78c3-58e4eac273d1",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-06-20T12:49:30+00:00",
        "end": "2019-06-20T13:48:32+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-45d2-d7e9c1948d81"
        }
      }, {
        "sequence": 2,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6c60-06a4fa89b940"
        }
      }, {
        "sequence": 3,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 5,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 6,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 7,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-739a-2a1dc8003b37"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b7af-c5c6625fd8fe"
        }
      }, {
        "sequence": 3,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-9816-b52f4739834c"
        }
      }, {
        "sequence": 4,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-85da-b95892336744"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-fd47-f237cd6fca88"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4391-7a77d801c8f5"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d651-7ee57b2afa69"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5b57-353edad890de"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-aa11-b1b8cb1cffa9"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-107e-ccb5a2d0ce1e"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5301-79addaf51a46"
        }
      }, {
        "sequence": 8,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b6b4-16b295e2446c"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-4014-c842836ae170"
        } ]
      }, {
        "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": 419.02,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 0.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 4 ],
        "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": "710824005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 9,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 10,
        "diagnosisLinkId": [ 3 ]
      }, {
        "sequence": 11,
        "diagnosisLinkId": [ 4 ]
      }, {
        "sequence": 12,
        "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": "710841007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 13,
        "informationLinkId": [ 5 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 14,
        "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": 15,
        "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": 16,
        "informationLinkId": [ 6 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 17,
        "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": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 18,
        "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": "763302001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 19,
        "informationLinkId": [ 7 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 20,
        "procedureLinkId": [ 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"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 4145.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:f526f6d6-66c0-c500-cb6e-2ae4b2da2f0f",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "f526f6d6-66c0-c500-cb6e-2ae4b2da2f0f",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-78c3-58e4eac273d1"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-06-20T13:48:32+00:00",
        "end": "2020-06-20T13:48:32+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-739a-2a1dc8003b37"
        },
        "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:9a57c612-581f-1c85-b7af-c5c6625fd8fe"
        },
        "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:9a57c612-581f-1c85-9816-b52f4739834c"
        },
        "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:9a57c612-581f-1c85-85da-b95892336744"
        },
        "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,
        "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": 83.804,
            "system": "urn: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": 335.216,
            "system": "urn: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": 419.02,
            "system": "urn: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": 419.02,
            "system": "urn: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": 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": "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": "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": 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,
        "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,
        "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": 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": "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": 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"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 14,
        "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": 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": "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": 16,
        "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": 17,
        "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": 18,
        "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": 19,
        "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": 20,
        "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": 1333.80,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 3316.752,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-dbe7-7f28e092fc8b",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-dbe7-7f28e092fc8b",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-06-27T12:49:30+00:00",
        "end": "2019-06-27T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4389-6510568cbcd8",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4389-6510568cbcd8",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "386394001",
          "display": "Pregnancy termination care (regime/therapy)"
        } ],
        "text": "Pregnancy termination care (regime/therapy)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-dbe7-7f28e092fc8b"
      },
      "performedPeriod": {
        "start": "2019-06-27T12:49:30+00:00",
        "end": "2019-06-27T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0d9d-28eb36422f64",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-0d9d-28eb36422f64",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-dbe7-7f28e092fc8b"
      },
      "performedPeriod": {
        "start": "2019-06-27T12:49:30+00:00",
        "end": "2019-06-27T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a366-c29161ba8457",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-a366-c29161ba8457",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-dbe7-7f28e092fc8b"
      },
      "performedPeriod": {
        "start": "2019-06-27T12:49:30+00:00",
        "end": "2019-06-27T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-fea6-b17e46ad7066",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-fea6-b17e46ad7066",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-06-27T12:49:30+00:00",
        "end": "2019-06-27T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4389-6510568cbcd8"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-0d9d-28eb36422f64"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a366-c29161ba8457"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-dbe7-7f28e092fc8b"
        } ]
      }, {
        "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": "386394001"
          } ]
        },
        "net": {
          "value": 438.30,
          "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": "5880005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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"
        }
      } ],
      "total": {
        "value": 1443.68,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:0308ecb0-8f8d-a802-dfc6-1c1637c90142",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "0308ecb0-8f8d-a802-dfc6-1c1637c90142",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-fea6-b17e46ad7066"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-06-27T13:04:30+00:00",
        "end": "2020-06-27T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "386394001"
          } ]
        },
        "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": 87.66000000000001,
            "system": "urn: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": 350.64000000000004,
            "system": "urn: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": 438.30,
            "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": 438.30,
            "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": 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": "5880005"
          } ]
        },
        "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,
        "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": "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": 1443.68,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1154.944,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-939b-7b13b4a1c566",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-07-04T12:49:30+00:00",
        "end": "2019-07-04T17:09:58+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|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c9ce-3fbd2c21e301",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-c9ce-3fbd2c21e301",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "109570002",
          "display": "Primary dental caries (disorder)"
        } ],
        "text": "Primary dental caries (disorder)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "onsetDateTime": "2019-07-04T16:03:45+00:00",
      "abatementDateTime": "2019-07-04T16:37:42+00:00",
      "assertedDate": "2019-07-04T16:03:45+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8d62-0cc8bc69c90b",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-8d62-0cc8bc69c90b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82810-3",
          "display": "Pregnancy status"
        } ],
        "text": "Pregnancy status"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "effectiveDateTime": "2019-08-08T12:49:30+00:00",
      "issued": "2019-08-08T12:49:30.549+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "77386006",
          "display": "Pregnant"
        } ],
        "text": "Pregnant"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5410-c416abf1f09c",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5410-c416abf1f09c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T12:49:30+00:00",
        "end": "2019-07-04T13:19:15+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d8a9-a7b812e44907",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d8a9-a7b812e44907",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T13:19:15+00:00",
        "end": "2019-07-04T14:04:08+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e225-bd5fab68d0bb",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-e225-bd5fab68d0bb",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T14:04:08+00:00",
        "end": "2019-07-04T14:39:31+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8624-166f50449416",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8624-166f50449416",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T14:39:31+00:00",
        "end": "2019-07-04T15:13:13+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c881-4eb2a6065762",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-c881-4eb2a6065762",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "241046008",
          "display": "Dental plain X-ray bitewing (procedure)"
        } ],
        "text": "Dental plain X-ray bitewing (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T15:13:13+00:00",
        "end": "2019-07-04T15:43:13+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3c9a-f1d2b14ab0b7",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3c9a-f1d2b14ab0b7",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T15:13:13+00:00",
        "end": "2019-07-04T16:03:45+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1bc5-606c3dff13aa",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1bc5-606c3dff13aa",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "1259293006",
          "display": "Application of composite dental filling material to dentin of tooth following fracture of tooth (procedure)"
        } ],
        "text": "Application of composite dental filling material to dentin of tooth following fracture of tooth (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T16:03:45+00:00",
        "end": "2019-07-04T16:37:42+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-c9ce-3fbd2c21e301",
        "display": "Primary dental caries (disorder)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-14e8-2a49374a20f6",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-14e8-2a49374a20f6",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T16:37:42+00:00",
        "end": "2019-07-04T17:03:57+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b08c-c703dabebfdc",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-b08c-c703dabebfdc",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "performedPeriod": {
        "start": "2019-07-04T17:03:57+00:00",
        "end": "2019-07-04T17:09:58+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ffe3-6891032e2e35",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "9a57c612-581f-1c85-ffe3-6891032e2e35",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "authoredOn": "2019-07-04T16:37:42+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
          "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-cca6-59403524540a",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-cca6-59403524540a",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-07-04T12:49:30+00:00",
        "end": "2019-07-04T17:09:58+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "prescription": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ffe3-6891032e2e35"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
        } ]
      } ],
      "total": {
        "value": 129.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:6526845b-16c1-9285-3b7f-f2e67adafc94",
    "resource": {
      "resourceType": "MedicationAdministration",
      "id": "6526845b-16c1-9285-3b7f-f2e67adafc94",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "effectiveDateTime": "2019-07-04T16:37:42+00:00"
    },
    "request": {
      "method": "POST",
      "url": "MedicationAdministration"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d242-91aa85822bb6",
    "resource": {
      "resourceType": "ImagingStudy",
      "id": "9a57c612-581f-1c85-d242-91aa85822bb6",
      "uid": "urn:oid:1.2.840.99999999.76986703.1562253193549",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
      },
      "started": "2019-07-04T15:13:13+00:00",
      "numberOfSeries": 1,
      "numberOfInstances": 1,
      "procedureCode": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "241046008",
          "display": "Dental plain X-ray bitewing (procedure)"
        } ],
        "text": "Dental plain X-ray bitewing (procedure)"
      } ],
      "series": [ {
        "uid": "urn:oid:1.2.840.99999999.1.72351973.1562253193549",
        "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": "700016008",
          "display": "Structure of region of internal part of mouth (body structure)"
        },
        "started": "2019-07-04T15:13:13+00:00",
        "instance": [ {
          "uid": "urn:oid:1.2.840.99999999.1.1.71139897.1562253193549",
          "number": 1,
          "sopClass": "urn:oid:1.2.840.10008.5.1.4.1.1.1.3",
          "title": "Digital Intra-Oral X-Ray Image"
        } ]
      } ]
    },
    "request": {
      "method": "POST",
      "url": "ImagingStudy"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9bda-ba80a4dc4690",
    "resource": {
      "resourceType": "Device",
      "id": "9a57c612-581f-1c85-9bda-ba80a4dc4690",
      "udi": {
        "deviceIdentifier": "78356981754046",
        "carrierHRF": "(01)78356981754046(11)190613(17)440627(10)684598133(21)523327851572031756"
      },
      "status": "active",
      "type": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "706298007",
          "display": "Dental x-ray system (physical object)"
        } ],
        "text": "Dental x-ray system (physical object)"
      },
      "lotNumber": "684598133",
      "manufactureDate": "2019-06-13T15:13:13+00:00",
      "expirationDate": "2044-06-27T15:13:13+00:00",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      }
    },
    "request": {
      "method": "POST",
      "url": "Device"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2ad8-3d4c81a5afe2",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-2ad8-3d4c81a5afe2",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-07-04T14:04:08+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f55b-9b67512c7195",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-f55b-9b67512c7195",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-07-04T14:04:08+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-023d-cd81a80a9171",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-023d-cd81a80a9171",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-07-04T14:04:08+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ce91-b6dd41f6ab34",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-ce91-b6dd41f6ab34",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-07-04T12:49:30+00:00",
        "end": "2019-07-04T17:09:58+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "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"
          } ]
        }
      }, {
        "sequence": 4,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-c9ce-3fbd2c21e301"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5410-c416abf1f09c"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d8a9-a7b812e44907"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e225-bd5fab68d0bb"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8624-166f50449416"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-c881-4eb2a6065762"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3c9a-f1d2b14ab0b7"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1bc5-606c3dff13aa"
        }
      }, {
        "sequence": 8,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-14e8-2a49374a20f6"
        }
      }, {
        "sequence": 9,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b08c-c703dabebfdc"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-939b-7b13b4a1c566"
        } ]
      }, {
        "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,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 0.00,
          "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": "241046008"
          } ]
        },
        "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": "274788003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 13,
        "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": "1259293006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 14,
        "procedureLinkId": [ 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": "68071007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 15,
        "procedureLinkId": [ 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": "243085009"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3968.15,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:6209bbc7-f995-cf7c-070e-795e9a833510",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "6209bbc7-f995-cf7c-070e-795e9a833510",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-ce91-b6dd41f6ab34"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-07-04T17:09:58+00:00",
        "end": "2020-07-04T17:09:58+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-c9ce-3fbd2c21e301"
        },
        "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,
        "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,
        "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": 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": "241046008"
          } ]
        },
        "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": "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": 12,
        "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": 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": "1259293006"
          } ]
        },
        "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": 14,
        "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": 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": "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": 3968.15,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 3174.5199999999995,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-a8e7-451f8ee3c48e",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424441002",
          "display": "Prenatal initial visit (regime/therapy)"
        } ],
        "text": "Prenatal initial visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ],
        "text": "Normal pregnancy (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "onsetDateTime": "2019-10-03T12:49:30+00:00",
      "abatementDateTime": "2020-04-16T12:49:30+00:00",
      "assertedDate": "2019-10-03T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8660-7f678492da80",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8660-7f678492da80",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "252160004",
          "display": "Standard pregnancy test (procedure)"
        } ],
        "text": "Standard pregnancy test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-03ca-f4b842e2cc48",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-03ca-f4b842e2cc48",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169230002",
          "display": "Ultrasound scan for fetal viability (procedure)"
        } ],
        "text": "Ultrasound scan for fetal viability (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-89ef-5acdda3347a6",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-89ef-5acdda3347a6",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8091-7de6ef15f070",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8091-7de6ef15f070",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3316-673a9c635981",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3316-673a9c635981",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "44608003",
          "display": "Blood group typing (procedure)"
        } ],
        "text": "Blood group typing (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3432-754e05170eaa",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3432-754e05170eaa",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104091002",
          "display": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
        } ],
        "text": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7938-b4578b22fb6c",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-7938-b4578b22fb6c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "47758006",
          "display": "Hepatitis B surface antigen measurement (procedure)"
        } ],
        "text": "Hepatitis B surface antigen measurement (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3126-0bbac5e8b3be",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3126-0bbac5e8b3be",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "31676001",
          "display": "Human immunodeficiency virus antigen test (procedure)"
        } ],
        "text": "Human immunodeficiency virus antigen test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-65a9-6177e10bfaf1",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-65a9-6177e10bfaf1",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "310861008",
          "display": "Chlamydia antigen test (procedure)"
        } ],
        "text": "Chlamydia antigen test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1c68-d7b9c4ad1020",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1c68-d7b9c4ad1020",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "165829005",
          "display": "Gonorrhea infection titer test (procedure)"
        } ],
        "text": "Gonorrhea infection titer test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5d3b-3ba94e4a59d2",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5d3b-3ba94e4a59d2",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "269828009",
          "display": "Syphilis infectious titer test (procedure)"
        } ],
        "text": "Syphilis infectious titer test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ee57-02270e6006ad",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ee57-02270e6006ad",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "117010004",
          "display": "Urine culture (procedure)"
        } ],
        "text": "Urine culture (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e0a3-162860e42f73",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-e0a3-162860e42f73",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "90226004",
          "display": "Cytopathology procedure, preparation of smear, genital source (procedure)"
        } ],
        "text": "Cytopathology procedure, preparation of smear, genital source (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6df7-15be93a086a6",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-6df7-15be93a086a6",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "395123002",
          "display": "Urine screening test for diabetes (procedure)"
        } ],
        "text": "Urine screening test for diabetes (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f1c2-b6175753bc79",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f1c2-b6175753bc79",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104375008",
          "display": "Hepatitis C antibody, confirmatory test (procedure)"
        } ],
        "text": "Hepatitis C antibody, confirmatory test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9d69-b3f33c2701fc",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-9d69-b3f33c2701fc",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "314098000",
          "display": "Rubella screening test (procedure)"
        } ],
        "text": "Rubella screening test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ca0a-456ce63c94ad",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ca0a-456ce63c94ad",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104326007",
          "display": "Measurement of Varicella-zoster virus antibody (procedure)"
        } ],
        "text": "Measurement of Varicella-zoster virus antibody (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-01df-42ff173683cd",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-01df-42ff173683cd",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "28163009",
          "display": "Skin test for tuberculosis, Tine test (procedure)"
        } ],
        "text": "Skin test for tuberculosis, Tine test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4e89-812cc32f0326",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4e89-812cc32f0326",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "60218003",
          "display": "Urinalysis, protein, qualitative (procedure)"
        } ],
        "text": "Urinalysis, protein, qualitative (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-cdf1-e93ac52a2b2e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-cdf1-e93ac52a2b2e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "performedPeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6b48-62eed7435938",
    "resource": {
      "resourceType": "CarePlan",
      "id": "9a57c612-581f-1c85-6b48-62eed7435938",
      "status": "completed",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "134435003",
          "display": "Routine antenatal care (regime/therapy)"
        } ],
        "text": "Routine antenatal care (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
      },
      "period": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2020-04-16T12:49:30+00:00"
      },
      "activity": [ {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "135892000",
              "display": "Antenatal education (procedure)"
            } ],
            "text": "Antenatal education (procedure)"
          },
          "status": "completed"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "713076009",
              "display": "Antenatal risk assessment (procedure)"
            } ],
            "text": "Antenatal risk assessment (procedure)"
          },
          "status": "completed"
        }
      }, {
        "detail": {
          "code": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "312404004",
              "display": "Antenatal blood tests (procedure)"
            } ],
            "text": "Antenatal blood tests (procedure)"
          },
          "status": "completed"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-da97-4a8e69f077dd",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-da97-4a8e69f077dd",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-10-03T12:49:30+00:00",
        "end": "2019-10-03T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8660-7f678492da80"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-03ca-f4b842e2cc48"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-89ef-5acdda3347a6"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8091-7de6ef15f070"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3316-673a9c635981"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3432-754e05170eaa"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-7938-b4578b22fb6c"
        }
      }, {
        "sequence": 8,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3126-0bbac5e8b3be"
        }
      }, {
        "sequence": 9,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-65a9-6177e10bfaf1"
        }
      }, {
        "sequence": 10,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1c68-d7b9c4ad1020"
        }
      }, {
        "sequence": 11,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5d3b-3ba94e4a59d2"
        }
      }, {
        "sequence": 12,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ee57-02270e6006ad"
        }
      }, {
        "sequence": 13,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e0a3-162860e42f73"
        }
      }, {
        "sequence": 14,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6df7-15be93a086a6"
        }
      }, {
        "sequence": 15,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f1c2-b6175753bc79"
        }
      }, {
        "sequence": 16,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-9d69-b3f33c2701fc"
        }
      }, {
        "sequence": 17,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ca0a-456ce63c94ad"
        }
      }, {
        "sequence": 18,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-01df-42ff173683cd"
        }
      }, {
        "sequence": 19,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4e89-812cc32f0326"
        }
      }, {
        "sequence": 20,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-cdf1-e93ac52a2b2e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-a8e7-451f8ee3c48e"
        } ]
      }, {
        "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": "252160004"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "169230002"
          } ]
        },
        "net": {
          "value": 4049.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 9046.75,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 9046.75,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "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": "44608003"
          } ]
        },
        "net": {
          "value": 1321.85,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 8,
        "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": "104091002"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "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": "47758006"
          } ]
        },
        "net": {
          "value": 2483.36,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 10,
        "procedureLinkId": [ 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": "31676001"
          } ]
        },
        "net": {
          "value": 2167.50,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "procedureLinkId": [ 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": "310861008"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 12,
        "procedureLinkId": [ 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": "165829005"
          } ]
        },
        "net": {
          "value": 2255.11,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 13,
        "procedureLinkId": [ 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": "269828009"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 14,
        "procedureLinkId": [ 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": "117010004"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 15,
        "procedureLinkId": [ 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": "90226004"
          } ]
        },
        "net": {
          "value": 1825.68,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 16,
        "procedureLinkId": [ 14 ],
        "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": "395123002"
          } ]
        },
        "net": {
          "value": 2011.04,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 17,
        "procedureLinkId": [ 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": "104375008"
          } ]
        },
        "net": {
          "value": 2393.95,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 18,
        "procedureLinkId": [ 16 ],
        "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": "314098000"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 19,
        "procedureLinkId": [ 17 ],
        "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": "104326007"
          } ]
        },
        "net": {
          "value": 3451.20,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 20,
        "procedureLinkId": [ 18 ],
        "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": "28163009"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 21,
        "procedureLinkId": [ 19 ],
        "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": "60218003"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 22,
        "procedureLinkId": [ 20 ],
        "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": "5880005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 48065.36,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:705c946b-9c72-4967-77c7-fb9d1b18561c",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "705c946b-9c72-4967-77c7-fb9d1b18561c",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-da97-4a8e69f077dd"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-10-03T13:04:30+00:00",
        "end": "2020-10-03T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-b251-7ea1b2d8b2bf"
        },
        "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": 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,
        "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": "252160004"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": "169230002"
          } ]
        },
        "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": 809.94,
            "system": "urn: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": 3239.76,
            "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": 4049.70,
            "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": 4049.70,
            "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": "274804006"
          } ]
        },
        "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": 1809.3500000000001,
            "system": "urn: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": 7237.400000000001,
            "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": 9046.75,
            "system": "urn: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": 9046.75,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1809.3500000000001,
            "system": "urn: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": 7237.400000000001,
            "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": 9046.75,
            "system": "urn: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": 9046.75,
            "system": "urn: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": "44608003"
          } ]
        },
        "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": 264.37,
            "system": "urn: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": 1057.48,
            "system": "urn: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": 1321.85,
            "system": "urn: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": 1321.85,
            "system": "urn: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": "104091002"
          } ]
        },
        "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": 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": 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": "47758006"
          } ]
        },
        "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": 496.672,
            "system": "urn: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": 1986.688,
            "system": "urn: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": 2483.36,
            "system": "urn: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": 2483.36,
            "system": "urn: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": "31676001"
          } ]
        },
        "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": 433.5,
            "system": "urn: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": 1734.0,
            "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": 2167.50,
            "system": "urn: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": 2167.50,
            "system": "urn: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": "310861008"
          } ]
        },
        "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": 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": 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": "165829005"
          } ]
        },
        "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": 451.02200000000005,
            "system": "urn: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": 1804.0880000000002,
            "system": "urn: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": 2255.11,
            "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_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 2255.11,
            "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_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": "269828009"
          } ]
        },
        "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": 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": 14,
        "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": "117010004"
          } ]
        },
        "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": 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": 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": "90226004"
          } ]
        },
        "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": 365.136,
            "system": "urn: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": 1460.544,
            "system": "urn: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": 1825.68,
            "system": "urn: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": 1825.68,
            "system": "urn: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": 16,
        "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": "395123002"
          } ]
        },
        "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": 402.208,
            "system": "urn: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": 1608.832,
            "system": "urn: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": 2011.04,
            "system": "urn: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": 2011.04,
            "system": "urn: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": 17,
        "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": "104375008"
          } ]
        },
        "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": 478.78999999999996,
            "system": "urn: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": 1915.1599999999999,
            "system": "urn: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": 2393.95,
            "system": "urn: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": 2393.95,
            "system": "urn: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": 18,
        "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": "314098000"
          } ]
        },
        "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": 19,
        "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": "104326007"
          } ]
        },
        "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": 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_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 2760.96,
            "system": "urn: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": 3451.20,
            "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": 3451.20,
            "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"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 20,
        "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": "28163009"
          } ]
        },
        "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": 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": 21,
        "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": "60218003"
          } ]
        },
        "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": 22,
        "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": "5880005"
          } ]
        },
        "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": 48065.36,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 38452.288000000015,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8d16-bafe6b65cfdb",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-8d16-bafe6b65cfdb",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-10-31T12:49:30+00:00",
        "end": "2019-10-31T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ad1c-84195de23e65",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ad1c-84195de23e65",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8d16-bafe6b65cfdb"
      },
      "performedPeriod": {
        "start": "2019-10-31T12:49:30+00:00",
        "end": "2019-10-31T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3c03-89cdb0ca5b8e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3c03-89cdb0ca5b8e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8d16-bafe6b65cfdb"
      },
      "performedPeriod": {
        "start": "2019-10-31T12:49:30+00:00",
        "end": "2019-10-31T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-978b-e40861f78209",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-978b-e40861f78209",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "443529005",
          "display": "Detection of chromosomal aneuploidy in prenatal amniotic fluid specimen using fluorescence in situ hybridization screening technique (procedure)"
        } ],
        "text": "Detection of chromosomal aneuploidy in prenatal amniotic fluid specimen using fluorescence in situ hybridization screening technique (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8d16-bafe6b65cfdb"
      },
      "performedPeriod": {
        "start": "2019-10-31T12:49:30+00:00",
        "end": "2019-10-31T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3f6b-e884171fbd71",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-3f6b-e884171fbd71",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-10-31T12:49:30+00:00",
        "end": "2019-10-31T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ad1c-84195de23e65"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3c03-89cdb0ca5b8e"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-978b-e40861f78209"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-8d16-bafe6b65cfdb"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 4232.96,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 9046.75,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "443529005"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 14285.09,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:12156cb1-7715-ebf4-d01a-9c171f5147bd",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "12156cb1-7715-ebf4-d01a-9c171f5147bd",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-3f6b-e884171fbd71"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-10-31T13:04:30+00:00",
        "end": "2020-10-31T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 846.5920000000001,
            "system": "urn: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": 3386.3680000000004,
            "system": "urn: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": 4232.96,
            "system": "urn: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": 4232.96,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1809.3500000000001,
            "system": "urn: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": 7237.400000000001,
            "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": 9046.75,
            "system": "urn: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": 9046.75,
            "system": "urn: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": "443529005"
          } ]
        },
        "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": 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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 14285.09,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 11428.072,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4ef3-a9609555d36c",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-4ef3-a9609555d36c",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-11-28T12:49:30+00:00",
        "end": "2019-11-28T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f846-1f1d70665a8a",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f846-1f1d70665a8a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "271442007",
          "display": "Fetal anatomy study (procedure)"
        } ],
        "text": "Fetal anatomy study (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4ef3-a9609555d36c"
      },
      "performedPeriod": {
        "start": "2019-11-28T12:49:30+00:00",
        "end": "2019-11-28T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1e90-95498c41f86a",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1e90-95498c41f86a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "275833003",
          "display": "Alpha-fetoprotein test - antenatal (procedure)"
        } ],
        "text": "Alpha-fetoprotein test - antenatal (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4ef3-a9609555d36c"
      },
      "performedPeriod": {
        "start": "2019-11-28T12:49:30+00:00",
        "end": "2019-11-28T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-246f-31eed54752eb",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-246f-31eed54752eb",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4ef3-a9609555d36c"
      },
      "performedPeriod": {
        "start": "2019-11-28T12:49:30+00:00",
        "end": "2019-11-28T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d95c-446c1afe7528",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d95c-446c1afe7528",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4ef3-a9609555d36c"
      },
      "performedPeriod": {
        "start": "2019-11-28T12:49:30+00:00",
        "end": "2019-11-28T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-929f-8f280d061d82",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-929f-8f280d061d82",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-11-28T12:49:30+00:00",
        "end": "2019-11-28T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f846-1f1d70665a8a"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1e90-95498c41f86a"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-246f-31eed54752eb"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d95c-446c1afe7528"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-4ef3-a9609555d36c"
        } ]
      }, {
        "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": "271442007"
          } ]
        },
        "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": "275833003"
          } ]
        },
        "net": {
          "value": 1137.65,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 2409.76,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 6383.08,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:e59e751d-96c1-7c9c-bcb4-f122e2dae6ab",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "e59e751d-96c1-7c9c-bcb4-f122e2dae6ab",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-929f-8f280d061d82"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-11-28T13:04:30+00:00",
        "end": "2020-11-28T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "271442007"
          } ]
        },
        "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": "275833003"
          } ]
        },
        "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": 227.53000000000003,
            "system": "urn: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": 910.1200000000001,
            "system": "urn: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": 1137.65,
            "system": "urn: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": 1137.65,
            "system": "urn: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": "274804006"
          } ]
        },
        "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": 481.95200000000006,
            "system": "urn: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": 1927.8080000000002,
            "system": "urn: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": 2409.76,
            "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_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 2409.76,
            "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_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": "225158009"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 6383.08,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 5106.464,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-955b-961b12235ded",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-955b-961b12235ded",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2019-12-26T12:49:30+00:00",
        "end": "2019-12-26T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ec99-5123941fbd93",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ec99-5123941fbd93",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-955b-961b12235ded"
      },
      "performedPeriod": {
        "start": "2019-12-26T12:49:30+00:00",
        "end": "2019-12-26T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4a81-4e9e8518d849",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-4a81-4e9e8518d849",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-955b-961b12235ded"
      },
      "performedPeriod": {
        "start": "2019-12-26T12:49:30+00:00",
        "end": "2019-12-26T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0e9d-91ee0c4a5c74",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-0e9d-91ee0c4a5c74",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2019-12-26T12:49:30+00:00",
        "end": "2019-12-26T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ec99-5123941fbd93"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-4a81-4e9e8518d849"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-955b-961b12235ded"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 9046.75,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 11451.02,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:d1b40ee9-37dd-fc9b-2c37-c4b7da004f92",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "d1b40ee9-37dd-fc9b-2c37-c4b7da004f92",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-0e9d-91ee0c4a5c74"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2019-12-26T13:04:30+00:00",
        "end": "2020-12-26T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 1809.3500000000001,
            "system": "urn: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": 7237.400000000001,
            "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": 9046.75,
            "system": "urn: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": 9046.75,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 11451.02,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 9160.816,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2162-5ecde0baa934",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-2162-5ecde0baa934",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2020-01-23T12:49:30+00:00",
        "end": "2020-01-23T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0943-ec7ae6936050",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-0943-ec7ae6936050",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-2162-5ecde0baa934"
      },
      "performedPeriod": {
        "start": "2020-01-23T12:49:30+00:00",
        "end": "2020-01-23T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-83d0-8942830053ec",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-83d0-8942830053ec",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-2162-5ecde0baa934"
      },
      "performedPeriod": {
        "start": "2020-01-23T12:49:30+00:00",
        "end": "2020-01-23T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8eb4-b0f795fc8ae2",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-8eb4-b0f795fc8ae2",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-01-23T12:49:30+00:00",
        "end": "2020-01-23T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-0943-ec7ae6936050"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-83d0-8942830053ec"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-2162-5ecde0baa934"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 9046.75,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 8736.75,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 17926.08,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:1635a7f7-894e-94e3-4b65-0d9fc4ac0f37",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "1635a7f7-894e-94e3-4b65-0d9fc4ac0f37",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-8eb4-b0f795fc8ae2"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2020-01-23T13:04:30+00:00",
        "end": "2021-01-23T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 1809.3500000000001,
            "system": "urn: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": 7237.400000000001,
            "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": 9046.75,
            "system": "urn: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": 9046.75,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1747.3500000000001,
            "system": "urn: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": 6989.400000000001,
            "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": 8736.75,
            "system": "urn: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": 8736.75,
            "system": "urn: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": 17926.08,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 14340.864000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-94e4-f929f12571e9",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f831-4770f14551e6",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f831-4770f14551e6",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "104091002",
          "display": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
        } ],
        "text": "Hemogram, automated, with red blood cells, white blood cells, hemoglobin, hematocrit, indices, platelet count, and manual white blood cell differential (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9"
      },
      "performedPeriod": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5c50-1ae3abb1d6ea",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-5c50-1ae3abb1d6ea",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "399014008",
          "display": "Administration of vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae antigens (procedure)"
        } ],
        "text": "Administration of vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae antigens (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9"
      },
      "performedPeriod": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-57a7-a50a61126de1",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-57a7-a50a61126de1",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "268556000",
          "display": "Urine screening for glucose (procedure)"
        } ],
        "text": "Urine screening for glucose (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9"
      },
      "performedPeriod": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f976-4d38b9b308a0",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f976-4d38b9b308a0",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9"
      },
      "performedPeriod": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8cd1-33fe6df2dca0",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-8cd1-33fe6df2dca0",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9"
      },
      "performedPeriod": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7f7b-348e0436afb3",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-7f7b-348e0436afb3",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-02-20T12:49:30+00:00",
        "end": "2020-02-20T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f831-4770f14551e6"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-5c50-1ae3abb1d6ea"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-57a7-a50a61126de1"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f976-4d38b9b308a0"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8cd1-33fe6df2dca0"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-94e4-f929f12571e9"
        } ]
      }, {
        "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": "104091002"
          } ]
        },
        "net": {
          "value": 1371.61,
          "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": "399014008"
          } ]
        },
        "net": {
          "value": 1108.27,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "268556000"
          } ]
        },
        "net": {
          "value": 862.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 3842.97,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "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": "225158009"
          } ]
        },
        "net": {
          "value": 2261.69,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 9589.92,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:94405e68-885b-8fe2-81b8-88819d192683",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "94405e68-885b-8fe2-81b8-88819d192683",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-7f7b-348e0436afb3"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2020-02-20T13:04:30+00:00",
        "end": "2021-02-20T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "104091002"
          } ]
        },
        "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": 274.322,
            "system": "urn: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": 1097.288,
            "system": "urn: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": 1371.61,
            "system": "urn: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": 1371.61,
            "system": "urn: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": "399014008"
          } ]
        },
        "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": 221.654,
            "system": "urn: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": 886.616,
            "system": "urn: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": 1108.27,
            "system": "urn: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": 1108.27,
            "system": "urn: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": "268556000"
          } ]
        },
        "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": 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": "274804006"
          } ]
        },
        "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": 768.594,
            "system": "urn: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": 3074.376,
            "system": "urn: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": 3842.97,
            "system": "urn: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": 3842.97,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 452.338,
            "system": "urn: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": 1809.352,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 2261.69,
            "system": "urn: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": 9589.92,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 7671.936,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8fe3-517b78db9a4b",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-8fe3-517b78db9a4b",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2020-03-19T12:49:30+00:00",
        "end": "2020-03-19T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-03d6-5ac2e5a8201f",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-03d6-5ac2e5a8201f",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "274804006",
          "display": "Evaluation of uterine fundal height (procedure)"
        } ],
        "text": "Evaluation of uterine fundal height (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8fe3-517b78db9a4b"
      },
      "performedPeriod": {
        "start": "2020-03-19T12:49:30+00:00",
        "end": "2020-03-19T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-47cb-38a9f77e226c",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-47cb-38a9f77e226c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "225158009",
          "display": "Auscultation of the fetal heart (procedure)"
        } ],
        "text": "Auscultation of the fetal heart (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8fe3-517b78db9a4b"
      },
      "performedPeriod": {
        "start": "2020-03-19T12:49:30+00:00",
        "end": "2020-03-19T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9713-f34003fdb26a",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-9713-f34003fdb26a",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-03-19T12:49:30+00:00",
        "end": "2020-03-19T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-03d6-5ac2e5a8201f"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-47cb-38a9f77e226c"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-8fe3-517b78db9a4b"
        } ]
      }, {
        "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": "274804006"
          } ]
        },
        "net": {
          "value": 3370.45,
          "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": "225158009"
          } ]
        },
        "net": {
          "value": 6417.01,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 9930.04,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:c0d1ac94-483c-62be-2ae0-843af651ae98",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "c0d1ac94-483c-62be-2ae0-843af651ae98",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-9713-f34003fdb26a"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2020-03-19T13:04:30+00:00",
        "end": "2021-03-19T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "274804006"
          } ]
        },
        "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": 674.09,
            "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_prvdr_pmt_amt",
              "display": "Line Provider Payment Amount"
            } ]
          },
          "amount": {
            "value": 2696.36,
            "system": "urn: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": 3370.45,
            "system": "urn: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": 3370.45,
            "system": "urn: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": "225158009"
          } ]
        },
        "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": 1283.402,
            "system": "urn: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": 5133.608,
            "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": 6417.01,
            "system": "urn: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": 6417.01,
            "system": "urn: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": 9930.04,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 7944.032,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5ed1-c99ee0292087",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-5ed1-c99ee0292087",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "EMER"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "183460006",
          "display": "Obstetric emergency hospital admission (procedure)"
        } ],
        "text": "Obstetric emergency hospital admission (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999882399",
          "display": "Dr. Jettie913 Rodriguez71"
        }
      } ],
      "period": {
        "start": "2020-04-16T12:49:30+00:00",
        "end": "2020-04-16T13:49:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|36d328a2-68bb-3967-a9bf-00897a7c945f",
        "display": "HANNAH B G SHAW HOME"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3103-03d1c87e1b92",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3103-03d1c87e1b92",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "236974004",
          "display": "Instrumental delivery (procedure)"
        } ],
        "text": "Instrumental delivery (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-5ed1-c99ee0292087"
      },
      "performedPeriod": {
        "start": "2020-04-16T12:49:30+00:00",
        "end": "2020-04-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a94d-69140e1e27bf",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-a94d-69140e1e27bf",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "367494004",
          "display": "Premature birth of newborn (finding)"
        } ],
        "text": "Premature birth of newborn (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-5ed1-c99ee0292087"
      },
      "performedPeriod": {
        "start": "2020-04-16T12:49:30+00:00",
        "end": "2020-04-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9856-d69cd5f9a14e",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-9856-d69cd5f9a14e",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-04-16T12:49:30+00:00",
        "end": "2020-04-16T13:49:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|36d328a2-68bb-3967-a9bf-00897a7c945f",
        "display": "HANNAH B G SHAW HOME"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3103-03d1c87e1b92"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-a94d-69140e1e27bf"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 146.18,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-5ed1-c99ee0292087"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "236974004"
          } ]
        },
        "net": {
          "value": 2835.67,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "procedureLinkId": [ 2 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "367494004"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3413.25,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:fd04799f-8760-2be2-a8ae-0e5d1e01195f",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "fd04799f-8760-2be2-a8ae-0e5d1e01195f",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999882399"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999882399"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-9856-d69cd5f9a14e"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-04-16T13:49:30+00:00",
        "end": "2021-04-16T13:49:30+00:00"
      },
      "created": "2020-04-16T13:49:30+00:00",
      "provider": {
        "identifier": {
          "value": "c34d702c-1cce-3ce3-98db-d107c9b6bd4b"
        }
      },
      "organization": {
        "identifier": {
          "value": "36d328a2-68bb-3967-a9bf-00897a7c945f"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-9856-d69cd5f9a14e"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999882399"
          }
        },
        "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": "2020-04-16T12:49:30+00:00",
          "end": "2020-04-16T13:49:30+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:9a57c612-581f-1c85-5ed1-c99ee0292087"
        } ],
        "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,
        "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": "236974004"
          } ]
        },
        "servicedPeriod": {
          "start": "2020-04-16T12:49:30+00:00",
          "end": "2020-04-16T13:49:30+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "23",
            "display": "Emergency Room"
          } ]
        },
        "net": {
          "value": 2835.67,
          "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": 567.134,
            "system": "urn: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": 2268.536,
            "system": "urn: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": 2835.67,
            "system": "urn: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": 2835.67,
            "system": "urn: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": 3,
        "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": "367494004"
          } ]
        },
        "servicedPeriod": {
          "start": "2020-04-16T12:49:30+00:00",
          "end": "2020-04-16T13:49:30+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": 3413.25,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2730.6,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3591-b0aba6ab3e50",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-3591-b0aba6ab3e50",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169762003",
          "display": "Postnatal visit (regime/therapy)"
        } ],
        "text": "Postnatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2020-05-28T12:49:30+00:00",
        "end": "2020-05-28T13:04:30+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-10a2-ea1533823ff0",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-10a2-ea1533823ff0",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3591-b0aba6ab3e50"
      },
      "performedPeriod": {
        "start": "2020-05-28T12:49:30+00:00",
        "end": "2020-05-28T13:04:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1eb2-7459d3afc757",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1eb2-7459d3afc757",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-3591-b0aba6ab3e50"
      },
      "performedPeriod": {
        "start": "2020-05-28T12:49:30+00:00",
        "end": "2020-05-28T13:04:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3506-451c0590596d",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-3506-451c0590596d",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-05-28T12:49:30+00:00",
        "end": "2020-05-28T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-10a2-ea1533823ff0"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1eb2-7459d3afc757"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-3591-b0aba6ab3e50"
        } ]
      }, {
        "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": "5880005"
          } ]
        },
        "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": "171207006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 1005.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:0996b864-7fce-5cdf-89a3-8e593d64fdcc",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "0996b864-7fce-5cdf-89a3-8e593d64fdcc",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-3506-451c0590596d"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2020-05-28T13:04:30+00:00",
        "end": "2021-05-28T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "5880005"
          } ]
        },
        "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": "171207006"
          } ]
        },
        "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": 1005.38,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 804.3040000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d317-622cbc7da829",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-d317-622cbc7da829",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "698314001",
          "display": "Consultation for treatment (procedure)"
        } ],
        "text": "Consultation for treatment (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2020-06-04T12:49:30+00:00",
        "end": "2020-06-04T13:22:18+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d7b0-7c870386cb9c",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-d7b0-7c870386cb9c",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169553002",
          "display": "Implantation of subcutaneous contraceptive (procedure)"
        } ],
        "text": "Implantation of subcutaneous contraceptive (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d317-622cbc7da829"
      },
      "performedPeriod": {
        "start": "2020-06-04T12:49:30+00:00",
        "end": "2020-06-04T13:22:18+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2560-5ec2e112f5eb",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "9a57c612-581f-1c85-2560-5ec2e112f5eb",
      "status": "completed",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "389221",
          "display": "Etonogestrel 68 MG Drug Implant"
        } ],
        "text": "Etonogestrel 68 MG Drug Implant"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d317-622cbc7da829"
      },
      "authoredOn": "2020-06-04T12:49:30+00:00",
      "requester": {
        "agent": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        },
        "onBehalfOf": {
          "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
          "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "MedicationRequest"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4f2b-93117ebdaade",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-4f2b-93117ebdaade",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-06-04T12:49:30+00:00",
        "end": "2020-06-04T13:22:18+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "prescription": {
        "reference": "urn:uuid:9a57c612-581f-1c85-2560-5ec2e112f5eb"
      },
      "item": [ {
        "sequence": 1,
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d317-622cbc7da829"
        } ]
      } ],
      "total": {
        "value": 52.17,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ffe4fe87-2317-ec0f-bd7b-9f74a3b4f414",
    "resource": {
      "resourceType": "MedicationAdministration",
      "id": "ffe4fe87-2317-ec0f-bd7b-9f74a3b4f414",
      "status": "completed",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "389221",
          "display": "Etonogestrel 68 MG Drug Implant"
        } ],
        "text": "Etonogestrel 68 MG Drug Implant"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d317-622cbc7da829"
      },
      "effectiveDateTime": "2020-06-04T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "MedicationAdministration"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5cb2-f95ee5f73e5e",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-5cb2-f95ee5f73e5e",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-06-04T12:49:30+00:00",
        "end": "2020-06-04T13:22:18+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d7b0-7c870386cb9c"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-d317-622cbc7da829"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "169553002"
          } ]
        },
        "net": {
          "value": 14014.56,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 14157.14,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:b38cda63-da45-5c62-378f-3b2f2abc1cb1",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "b38cda63-da45-5c62-378f-3b2f2abc1cb1",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-5cb2-f95ee5f73e5e"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2020-06-04T13:22:18+00:00",
        "end": "2021-06-04T13:22:18+00:00"
      },
      "created": "2020-06-04T13:22:18+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-5cb2-f95ee5f73e5e"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2020-06-04T12:49:30+00:00",
          "end": "2020-06-04T13:22:18+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:9a57c612-581f-1c85-d317-622cbc7da829"
        } ],
        "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,
        "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": "169553002"
          } ]
        },
        "servicedPeriod": {
          "start": "2020-06-04T12:49:30+00:00",
          "end": "2020-06-04T13:22:18+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 14014.56,
          "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": 2802.9120000000003,
            "system": "urn: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": 11211.648000000001,
            "system": "urn: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": 14014.56,
            "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_alowd_chrg_amt",
              "display": "Line Allowed Charge Amount"
            } ]
          },
          "amount": {
            "value": 14014.56,
            "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_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": 14157.14,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 11325.712000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-8e27-23e9df682e8b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2022-06-23T12:49:30+00:00",
        "end": "2022-06-23T13:28:26+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-16ac-353c6fdd8f6f",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-16ac-353c6fdd8f6f",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "onsetDateTime": "2022-06-23T12:49:30+00:00",
      "assertedDate": "2022-06-23T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8aa7-272e2ed26162",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-8aa7-272e2ed26162",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "160904001",
          "display": "Part-time employment (finding)"
        } ],
        "text": "Part-time employment (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "onsetDateTime": "2022-06-23T13:28:26+00:00",
      "abatementDateTime": "2025-06-26T13:28:40+00:00",
      "assertedDate": "2022-06-23T13:28:26+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e089-022c8d2512c4",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-e089-022c8d2512c4",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        } ],
        "text": "Hemoglobin A1c/Hemoglobin.total in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 5.9200,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f74f-af6fda609537",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-f74f-af6fda609537",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 160.30,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-eae6-3416f950af12",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-eae6-3416f950af12",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e7a0-73cea9e0388b",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-e7a0-73cea9e0388b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 72.100,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c2ee-f55e58020c93",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c2ee-f55e58020c93",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 28.060,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-19ef-624d776bf37c",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-19ef-624d776bf37c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 79,
          "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": 100,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4cb5-f407640a8c17",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4cb5-f407640a8c17",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 69,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-820a-cf9080a4e084",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-820a-cf9080a4e084",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 13,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-65fb-7c791b87ac7f",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-65fb-7c791b87ac7f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2339-0",
          "display": "Glucose [Mass/volume] in Blood"
        } ],
        "text": "Glucose [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 92.420,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6763-f696c9322976",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-6763-f696c9322976",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6299-2",
          "display": "Urea nitrogen [Mass/volume] in Blood"
        } ],
        "text": "Urea nitrogen [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 16.260,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1bd9-2af83831f068",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-1bd9-2af83831f068",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "38483-4",
          "display": "Creatinine [Mass/volume] in Blood"
        } ],
        "text": "Creatinine [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 1.4300,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f233-8869247f9b02",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-f233-8869247f9b02",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "49765-1",
          "display": "Calcium [Mass/volume] in Blood"
        } ],
        "text": "Calcium [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 9.0400,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8c34-9c3c7dcf6b4b",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-8c34-9c3c7dcf6b4b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2947-0",
          "display": "Sodium [Moles/volume] in Blood"
        } ],
        "text": "Sodium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 143.25,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4ea0-5b4a694eb077",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4ea0-5b4a694eb077",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6298-4",
          "display": "Potassium [Moles/volume] in Blood"
        } ],
        "text": "Potassium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 3.7700,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0061-cb5a45be5b89",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-0061-cb5a45be5b89",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2069-3",
          "display": "Chloride [Moles/volume] in Blood"
        } ],
        "text": "Chloride [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 107.75,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-76fe-ce912e045ab3",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-76fe-ce912e045ab3",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "20565-8",
          "display": "Carbon dioxide, total [Moles/volume] in Blood"
        } ],
        "text": "Carbon dioxide, total [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 24.950,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2cef-3ec0915a64a3",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-2cef-3ec0915a64a3",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2093-3",
          "display": "Cholesterol [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Cholesterol [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 173.05,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8407-fac8e95e6ce9",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-8407-fac8e95e6ce9",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2571-8",
          "display": "Triglyceride [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Triglyceride [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 123.38,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-10e7-26d705241c0b",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-10e7-26d705241c0b",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "18262-6",
          "display": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
        } ],
        "text": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 85.470,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0dc8-586b124086bf",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-0dc8-586b124086bf",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2085-9",
          "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 62.900,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9200-47d9ba3e8ac0",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-9200-47d9ba3e8ac0",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 3.7196,
        "unit": "10*3/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*3/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1706-04a8e8b7261c",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-1706-04a8e8b7261c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 3.9313,
        "unit": "10*6/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*6/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d6b4-008d63a7264f",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-d6b4-008d63a7264f",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 14.677,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-75c4-6aa0af58b77d",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-75c4-6aa0af58b77d",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 46.821,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-39c5-6eb7a3fa7676",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-39c5-6eb7a3fa7676",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 80.320,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3107-436ca1116738",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-3107-436ca1116738",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 31.418,
        "unit": "pg",
        "system": "http://unitsofmeasure.org",
        "code": "pg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e814-8576fd354fb8",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-e814-8576fd354fb8",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 35.861,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-df04-74410cf17ae1",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-df04-74410cf17ae1",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 43.253,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0ddb-e3b960c027dc",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-0ddb-e3b960c027dc",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 347.28,
        "unit": "10*3/uL",
        "system": "http://unitsofmeasure.org",
        "code": "10*3/uL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c52a-f767ecb72992",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c52a-f767ecb72992",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 16.358,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9462-fac180e07a6e",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-9462-fac180e07a6e",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 11.059,
        "unit": "fL",
        "system": "http://unitsofmeasure.org",
        "code": "fL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ab40-eabe27a1c867",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-ab40-eabe27a1c867",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+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:9a57c612-581f-1c85-01ff-5365a989e0f4",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-01ff-5365a989e0f4",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T13:28:26+00:00",
      "issued": "2022-06-23T13:28:26.549+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": "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": "LA30124-4",
            "display": "Utilities"
          } ],
          "text": "Utilities"
        }
      }, {
        "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": 7688,
          "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": "LA15652-3",
            "display": "Medicare"
          } ],
          "text": "Medicare"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "67875-5",
            "display": "Employment status - current"
          } ],
          "text": "Employment status - current"
        },
        "valueCodeableConcept": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "LA30138-4",
            "display": "Part-time or temporary work"
          } ],
          "text": "Part-time or temporary 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": "455 Harvey Crossroad Suite 55"
      }, {
        "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:9a57c612-581f-1c85-7f27-fa775edd79a8",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-7f27-fa775edd79a8",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T13:56:19+00:00",
      "issued": "2022-06-23T13:56:19.549+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-635d-0d86a2bda64f",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-635d-0d86a2bda64f",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T14:38:23+00:00",
      "issued": "2022-06-23T14:38:23.549+00:00",
      "valueQuantity": {
        "value": 0,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1326-3e42981252c6",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-1326-3e42981252c6",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T15:16:59+00:00",
      "issued": "2022-06-23T15:16:59.549+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-356c-0f4569c1ce3c",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-356c-0f4569c1ce3c",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "survey",
          "display": "survey"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82667-7",
          "display": "Total score [DAST-10]"
        } ],
        "text": "Total score [DAST-10]"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T15:56:37+00:00",
      "issued": "2022-06-23T15:56:37.549+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4c6f-b3d545b9684e",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-4c6f-b3d545b9684e",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "social-history",
          "display": "social-history"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82810-3",
          "display": "Pregnancy status"
        } ],
        "text": "Pregnancy status"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-10-27T12:49:30+00:00",
      "issued": "2022-10-27T12:49:30.549+00:00",
      "valueCodeableConcept": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "77386006",
          "display": "Pregnant"
        } ],
        "text": "Pregnant"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6775-6b2b857067ab",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-6775-6b2b857067ab",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T12:49:30+00:00",
        "end": "2022-06-23T13:28:26+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f46a-4ac432b88d49",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f46a-4ac432b88d49",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T13:28:26+00:00",
        "end": "2022-06-23T13:56:19+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b99c-659565285c4b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-b99c-659565285c4b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T13:56:19+00:00",
        "end": "2022-06-23T14:38:23+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e1e4-b14d5c3af35d",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-e1e4-b14d5c3af35d",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T14:38:23+00:00",
        "end": "2022-06-23T14:52:19+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e5c6-99d7c7edfedb",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-e5c6-99d7c7edfedb",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T14:52:19+00:00",
        "end": "2022-06-23T15:16:59+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-41cb-68a78b4c3cfd",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-41cb-68a78b4c3cfd",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T15:16:59+00:00",
        "end": "2022-06-23T15:27:30+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-b28e-ca30fa67fe4a",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-b28e-ca30fa67fe4a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "713106006",
          "display": "Screening for drug abuse (procedure)"
        } ],
        "text": "Screening for drug abuse (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "performedPeriod": {
        "start": "2022-06-23T15:27:30+00:00",
        "end": "2022-06-23T15:56:37+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-10b9-aa2d765e0241",
    "resource": {
      "resourceType": "Immunization",
      "id": "9a57c612-581f-1c85-10b9-aa2d765e0241",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "encounter": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "date": "2022-06-23T12:49:30+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-72b4-c1a09797b08d",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-72b4-c1a09797b08d",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "51990-0",
          "display": "Basic metabolic panel - Blood"
        } ],
        "text": "Basic metabolic panel - Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-65fb-7c791b87ac7f",
        "display": "Glucose [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6763-f696c9322976",
        "display": "Urea nitrogen [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-1bd9-2af83831f068",
        "display": "Creatinine [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-f233-8869247f9b02",
        "display": "Calcium [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-8c34-9c3c7dcf6b4b",
        "display": "Sodium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4ea0-5b4a694eb077",
        "display": "Potassium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-0061-cb5a45be5b89",
        "display": "Chloride [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-76fe-ce912e045ab3",
        "display": "Carbon dioxide, total [Moles/volume] in Blood"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-dc1a-82e2ddae4282",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-dc1a-82e2ddae4282",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "57698-3",
          "display": "Lipid panel with direct LDL - Serum or Plasma"
        } ],
        "text": "Lipid panel with direct LDL - Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-2cef-3ec0915a64a3",
        "display": "Cholesterol [Mass/volume] in Serum or Plasma"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-8407-fac8e95e6ce9",
        "display": "Triglyceride [Mass/volume] in Serum or Plasma"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-10e7-26d705241c0b",
        "display": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-0dc8-586b124086bf",
        "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2acc-b6a8da45a506",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-2acc-b6a8da45a506",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T12:49:30+00:00",
      "issued": "2022-06-23T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-9200-47d9ba3e8ac0",
        "display": "Leukocytes [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-1706-04a8e8b7261c",
        "display": "Erythrocytes [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-d6b4-008d63a7264f",
        "display": "Hemoglobin [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-75c4-6aa0af58b77d",
        "display": "Hematocrit [Volume Fraction] of Blood by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-39c5-6eb7a3fa7676",
        "display": "MCV [Entitic mean volume] in Red Blood Cells by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-3107-436ca1116738",
        "display": "MCH [Entitic mass] by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-e814-8576fd354fb8",
        "display": "MCHC [Entitic Mass/volume] in Red Blood Cells by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-df04-74410cf17ae1",
        "display": "Erythrocyte [DistWidth] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-0ddb-e3b960c027dc",
        "display": "Platelets [#/volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-c52a-f767ecb72992",
        "display": "Platelet distribution width [Entitic volume] in Blood by Automated count"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-9462-fac180e07a6e",
        "display": "Platelet [Entitic mean volume] in Blood by Automated count"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2a10-7697d239929d",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-2a10-7697d239929d",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T13:56:19+00:00",
      "issued": "2022-06-23T13:56:19.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-7f27-fa775edd79a8",
        "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5492-579191001d97",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-5492-579191001d97",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T14:38:23+00:00",
      "issued": "2022-06-23T14:38:23.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-635d-0d86a2bda64f",
        "display": "Total score [HARK]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6a35-f65d4d2ad141",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-6a35-f65d4d2ad141",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T15:16:59+00:00",
      "issued": "2022-06-23T15:16:59.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-1326-3e42981252c6",
        "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8863-b9623e36e7c3",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-8863-b9623e36e7c3",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "82666-9",
          "display": "Drug Abuse Screening Test-10 [DAST-10]"
        } ],
        "text": "Drug Abuse Screening Test-10 [DAST-10]"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
      },
      "effectiveDateTime": "2022-06-23T15:56:37+00:00",
      "issued": "2022-06-23T15:56:37.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-356c-0f4569c1ce3c",
        "display": "Total score [DAST-10]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2b5c-352c2547d9d6",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-2b5c-352c2547d9d6",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2022-06-23T12:49:30+00:00",
        "end": "2022-06-23T13:28:26+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-10b9-aa2d765e0241"
        }
      }, {
        "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"
          } ]
        }
      }, {
        "sequence": 5,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 6,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 7,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 8,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-16ac-353c6fdd8f6f"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-8aa7-272e2ed26162"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-6775-6b2b857067ab"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f46a-4ac432b88d49"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b99c-659565285c4b"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e1e4-b14d5c3af35d"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-e5c6-99d7c7edfedb"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-41cb-68a78b4c3cfd"
        }
      }, {
        "sequence": 7,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-b28e-ca30fa67fe4a"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-8e27-23e9df682e8b"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 6,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "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": 8,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 9,
        "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": 10,
        "informationLinkId": [ 5 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "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": 12,
        "informationLinkId": [ 6 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 13,
        "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": 14,
        "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": 15,
        "informationLinkId": [ 7 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 16,
        "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": "428211000124100"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 17,
        "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": "713106006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 18,
        "informationLinkId": [ 8 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3814.66,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ec06f61f-29bd-8a3a-1948-d198eda6f3be",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ec06f61f-29bd-8a3a-1948-d198eda6f3be",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicare"
        }
      } ],
      "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": "9a57c612-581f-1c85-2b5c-352c2547d9d6"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2022-06-23T13:28:26+00:00",
        "end": "2023-06-23T13:28:26+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-16ac-353c6fdd8f6f"
        },
        "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:9a57c612-581f-1c85-8aa7-272e2ed26162"
        },
        "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,
        "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": 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": 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": 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": "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": 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,
        "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": 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": "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": 12,
        "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": 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,
        "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": 15,
        "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": 16,
        "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": 17,
        "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": "713106006"
          } ]
        },
        "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": 18,
        "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": 927.94,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 3051.728,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-319d-a73dcaee6f59",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-319d-a73dcaee6f59",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "308335008",
          "display": "Patient encounter procedure (procedure)"
        } ],
        "text": "Patient encounter procedure (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2022-11-03T12:49:30+00:00",
        "end": "2022-11-03T13:26:49+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "389095005",
          "display": "Contraception care (regime/therapy)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1e9a-60b37c3c7165",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1e9a-60b37c3c7165",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "301807007",
          "display": "Removal of subcutaneous contraceptive (procedure)"
        } ],
        "text": "Removal of subcutaneous contraceptive (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-319d-a73dcaee6f59"
      },
      "performedPeriod": {
        "start": "2022-11-03T12:49:30+00:00",
        "end": "2022-11-03T13:26:49+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-fc49-5a39732d15a1",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-fc49-5a39732d15a1",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2022-11-03T12:49:30+00:00",
        "end": "2022-11-03T13:26:49+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1e9a-60b37c3c7165"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-319d-a73dcaee6f59"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "301807007"
          } ]
        },
        "net": {
          "value": 3910.33,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 4052.91,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:46252b00-1ec3-29f6-21b4-5657e8465738",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "46252b00-1ec3-29f6-21b4-5657e8465738",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicare"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-fc49-5a39732d15a1"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2022-11-03T13:26:49+00:00",
        "end": "2023-11-03T13:26:49+00:00"
      },
      "created": "2022-11-03T13:26:49+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-fc49-5a39732d15a1"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "2022-11-03T12:49:30+00:00",
          "end": "2022-11-03T13:26:49+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:9a57c612-581f-1c85-319d-a73dcaee6f59"
        } ],
        "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,
        "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": "301807007"
          } ]
        },
        "servicedPeriod": {
          "start": "2022-11-03T12:49:30+00:00",
          "end": "2022-11-03T13:26:49+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "net": {
          "value": 3910.33,
          "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": 782.066,
            "system": "urn: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": 3128.264,
            "system": "urn: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": 3910.33,
            "system": "urn: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": 3910.33,
            "system": "urn: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": 4052.91,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 3242.328,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-507b-fb713f25c10e",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-507b-fb713f25c10e",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424441002",
          "display": "Prenatal initial visit (regime/therapy)"
        } ],
        "text": "Prenatal initial visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2022-12-22T12:49:30+00:00",
        "end": "2022-12-22T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-331e-792d366ff390",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ],
        "text": "Normal pregnancy (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-507b-fb713f25c10e"
      },
      "onsetDateTime": "2022-12-22T12:49:30+00:00",
      "abatementDateTime": "2023-01-16T12:49:30+00:00",
      "assertedDate": "2022-12-22T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3277-25f356066450",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-3277-25f356066450",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "252160004",
          "display": "Standard pregnancy test (procedure)"
        } ],
        "text": "Standard pregnancy test (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-507b-fb713f25c10e"
      },
      "performedPeriod": {
        "start": "2022-12-22T12:49:30+00:00",
        "end": "2022-12-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0a15-a9ed2c1b4fc3",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-0a15-a9ed2c1b4fc3",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "169230002",
          "display": "Ultrasound scan for fetal viability (procedure)"
        } ],
        "text": "Ultrasound scan for fetal viability (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-507b-fb713f25c10e"
      },
      "performedPeriod": {
        "start": "2022-12-22T12:49:30+00:00",
        "end": "2022-12-22T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3bb6-fd0851fcc426",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-3bb6-fd0851fcc426",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2022-12-22T12:49:30+00:00",
        "end": "2022-12-22T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-3277-25f356066450"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-0a15-a9ed2c1b4fc3"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-507b-fb713f25c10e"
        } ]
      }, {
        "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": "252160004"
          } ]
        },
        "net": {
          "value": 4363.79,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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": "169230002"
          } ]
        },
        "net": {
          "value": 4049.70,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 8556.07,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:f4405e39-b55b-958a-e20b-e5440a192c2b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "f4405e39-b55b-958a-e20b-e5440a192c2b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicare"
        }
      } ],
      "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": "9a57c612-581f-1c85-3bb6-fd0851fcc426"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2022-12-22T13:04:30+00:00",
        "end": "2023-12-22T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-331e-792d366ff390"
        },
        "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": 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,
        "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": "252160004"
          } ]
        },
        "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": 872.758,
            "system": "urn: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": 3491.032,
            "system": "urn: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": 4363.79,
            "system": "urn: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": 4363.79,
            "system": "urn: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": "169230002"
          } ]
        },
        "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": 809.94,
            "system": "urn: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": 3239.76,
            "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": 4049.70,
            "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": 4049.70,
            "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"
            } ]
          }
        } ]
      } ],
      "totalCost": {
        "value": 8556.07,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 6844.856,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ce9a-0acb3e6084f5",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-ce9a-0acb3e6084f5",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "270427003",
          "display": "Patient-initiated encounter (procedure)"
        } ],
        "text": "Patient-initiated encounter (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2023-01-03T12:49:30+00:00",
        "end": "2023-01-03T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-770c-14e97129ee98",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-770c-14e97129ee98",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "10383002",
          "display": "Counseling for termination of pregnancy (procedure)"
        } ],
        "text": "Counseling for termination of pregnancy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ce9a-0acb3e6084f5"
      },
      "performedPeriod": {
        "start": "2023-01-03T12:49:30+00:00",
        "end": "2023-01-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f100-24978d17cc0e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f100-24978d17cc0e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "714812005",
          "display": "Induced termination of pregnancy (procedure)"
        } ],
        "text": "Induced termination of pregnancy (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-ce9a-0acb3e6084f5"
      },
      "performedPeriod": {
        "start": "2023-01-03T12:49:30+00:00",
        "end": "2023-01-03T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-26ef-e86b738acc82",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-26ef-e86b738acc82",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2023-01-03T12:49:30+00:00",
        "end": "2023-01-03T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-770c-14e97129ee98"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f100-24978d17cc0e"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 85.55,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-ce9a-0acb3e6084f5"
        } ]
      }, {
        "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": "10383002"
          } ]
        },
        "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": "714812005"
          } ]
        },
        "net": {
          "value": 10100.42,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 10617.37,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:ffdb6826-a307-8576-bd72-09146f85c10b",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "ffdb6826-a307-8576-bd72-09146f85c10b",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicare"
        }
      } ],
      "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": "9a57c612-581f-1c85-26ef-e86b738acc82"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2023-01-03T13:04:30+00:00",
        "end": "2024-01-03T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "10383002"
          } ]
        },
        "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": "714812005"
          } ]
        },
        "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": 2020.084,
            "system": "urn: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": 8080.336,
            "system": "urn: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": 10100.42,
            "system": "urn: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": 10100.42,
            "system": "urn: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": 10617.37,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 8493.896,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-e845-ee25254d65d2",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-e845-ee25254d65d2",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "424619006",
          "display": "Prenatal visit (regime/therapy)"
        } ],
        "text": "Prenatal visit (regime/therapy)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2023-01-16T12:49:30+00:00",
        "end": "2023-01-16T13:04:30+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "72892002",
          "display": "Normal pregnancy (finding)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-88d8-40ebe7e1470a",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-88d8-40ebe7e1470a",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "386394001",
          "display": "Pregnancy termination care (regime/therapy)"
        } ],
        "text": "Pregnancy termination care (regime/therapy)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e845-ee25254d65d2"
      },
      "performedPeriod": {
        "start": "2023-01-16T12:49:30+00:00",
        "end": "2023-01-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ebc6-2517dfcb6232",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-ebc6-2517dfcb6232",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "5880005",
          "display": "Physical examination procedure (procedure)"
        } ],
        "text": "Physical examination procedure (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e845-ee25254d65d2"
      },
      "performedPeriod": {
        "start": "2023-01-16T12:49:30+00:00",
        "end": "2023-01-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1208-384d4572d015",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1208-384d4572d015",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-e845-ee25254d65d2"
      },
      "performedPeriod": {
        "start": "2023-01-16T12:49:30+00:00",
        "end": "2023-01-16T13:04:30+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e14-bc33c87c1188",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-6f09-70e65b21362e",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-4a9a-5eea685d81e1",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-b251-7ea1b2d8b2bf",
        "display": "Normal pregnancy (finding)"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-331e-792d366ff390",
        "display": "Normal pregnancy (finding)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7787-d3c33a3785a8",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-7787-d3c33a3785a8",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2023-01-16T12:49:30+00:00",
        "end": "2023-01-16T13:04:30+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-88d8-40ebe7e1470a"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-ebc6-2517dfcb6232"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1208-384d4572d015"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-e845-ee25254d65d2"
        } ]
      }, {
        "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": "386394001"
          } ]
        },
        "net": {
          "value": 438.30,
          "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": "5880005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "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"
        }
      } ],
      "total": {
        "value": 1443.68,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:4bf33640-f572-3749-8cbb-ce73c98ff0fa",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "4bf33640-f572-3749-8cbb-ce73c98ff0fa",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Medicare"
        }
      } ],
      "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": "9a57c612-581f-1c85-7787-d3c33a3785a8"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2023-01-16T13:04:30+00:00",
        "end": "2024-01-16T13:04:30+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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": "386394001"
          } ]
        },
        "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": 87.66000000000001,
            "system": "urn: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": 350.64000000000004,
            "system": "urn: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": 438.30,
            "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": 438.30,
            "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": 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": "5880005"
          } ]
        },
        "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,
        "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": "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": 1443.68,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 1154.944,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4f07-406b2ce2a2d5",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-4f07-406b2ce2a2d5",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "698314001",
          "display": "Consultation for treatment (procedure)"
        } ],
        "text": "Consultation for treatment (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2023-05-20T13:22:18+00:00",
        "end": "2023-05-20T14:07:36+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "183996000",
          "display": "Sterilization requested (situation)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-11cb-23988a21715c",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-11cb-23988a21715c",
      "clinicalStatus": "resolved",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "183996000",
          "display": "Sterilization requested (situation)"
        } ],
        "text": "Sterilization requested (situation)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4f07-406b2ce2a2d5"
      },
      "onsetDateTime": "2023-05-20T13:22:18+00:00",
      "abatementDateTime": "2023-06-05T16:59:36+00:00",
      "assertedDate": "2023-05-20T13:22:18+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-69c3-01ae6deeed1b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-69c3-01ae6deeed1b",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "268533009",
          "display": "Sterilization education (procedure)"
        } ],
        "text": "Sterilization education (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-4f07-406b2ce2a2d5"
      },
      "performedPeriod": {
        "start": "2023-05-20T13:22:18+00:00",
        "end": "2023-05-20T14:07:36+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a1e1-e73de2eea2af",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-a1e1-e73de2eea2af",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2023-05-20T13:22:18+00:00",
        "end": "2023-05-20T14:07:36+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-11cb-23988a21715c"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-69c3-01ae6deeed1b"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 142.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-4f07-406b2ce2a2d5"
        } ]
      }, {
        "sequence": 2,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 3,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "268533009"
          } ]
        },
        "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:313f9efd-2c7e-7b69-731b-4e06cdc3fe96",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "313f9efd-2c7e-7b69-731b-4e06cdc3fe96",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      }, {
        "resourceType": "ReferralRequest",
        "id": "referral",
        "status": "completed",
        "intent": "order",
        "subject": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
        },
        "requester": {
          "agent": {
            "identifier": {
              "system": "http://hl7.org/fhir/sid/us-npi",
              "value": "9999986794"
            }
          }
        },
        "recipient": [ {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        } ]
      } ],
      "identifier": [ {
        "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
        "value": "9a57c612-581f-1c85-a1e1-e73de2eea2af"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2023-05-20T14:07:36+00:00",
        "end": "2024-05-20T14:07:36+00:00"
      },
      "created": "2023-05-20T14:07:36+00:00",
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "referral": {
        "reference": "#referral"
      },
      "claim": {
        "reference": "urn:uuid:9a57c612-581f-1c85-a1e1-e73de2eea2af"
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-11cb-23988a21715c"
        },
        "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": "2023-05-20T13:22:18+00:00",
          "end": "2023-05-20T14:07:36+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:9a57c612-581f-1c85-4f07-406b2ce2a2d5"
        } ],
        "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,
        "diagnosisLinkId": [ 1 ],
        "category": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
            "code": "1",
            "display": "Medical care"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-05-20T13:22:18+00:00",
          "end": "2023-05-20T14:07:36+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      }, {
        "sequence": 3,
        "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": "268533009"
          } ]
        },
        "servicedPeriod": {
          "start": "2023-05-20T13:22:18+00:00",
          "end": "2023-05-20T14:07:36+00:00"
        },
        "locationCodeableConcept": {
          "coding": [ {
            "system": "https://bluebutton.cms.gov/resources/variables/line_place_of_srvc_cd",
            "code": "21",
            "display": "Inpatient Hospital"
          } ]
        },
        "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": 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:9a57c612-581f-1c85-b488-fc699ddd04bf",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-b488-fc699ddd04bf",
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "IMP"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "305408004",
          "display": "Admission to surgical department (procedure)"
        } ],
        "text": "Admission to surgical department (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999986794",
          "display": "Dr. Mertie42 Lakin515"
        }
      } ],
      "period": {
        "start": "2023-06-05T14:07:36+00:00",
        "end": "2023-06-06T14:07:36+00:00"
      },
      "reason": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "183996000",
          "display": "Sterilization requested (situation)"
        } ]
      } ],
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-99ad-4039662dfbe5",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-99ad-4039662dfbe5",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "267020005",
          "display": "History of tubal ligation (situation)"
        } ],
        "text": "History of tubal ligation (situation)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b488-fc699ddd04bf"
      },
      "onsetDateTime": "2023-06-05T16:59:36+00:00",
      "assertedDate": "2023-06-05T16:59:36+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f148-f1f1835f2a7e",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-f148-f1f1835f2a7e",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "287664005",
          "display": "Ligation of bilateral fallopian tubes (procedure)"
        } ],
        "text": "Ligation of bilateral fallopian tubes (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b488-fc699ddd04bf"
      },
      "performedPeriod": {
        "start": "2023-06-05T14:07:36+00:00",
        "end": "2023-06-05T16:59:36+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-11cb-23988a21715c",
        "display": "Sterilization requested (situation)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-24ab-04552e606aef",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-24ab-04552e606aef",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "133899007",
          "display": "Postoperative care (regime/therapy)"
        } ],
        "text": "Postoperative care (regime/therapy)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b488-fc699ddd04bf"
      },
      "performedPeriod": {
        "start": "2023-06-05T16:59:36+00:00",
        "end": "2023-06-05T18:55:36+00:00"
      },
      "reasonReference": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-99ad-4039662dfbe5",
        "display": "History of tubal ligation (situation)"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7fda-8260b3bc613b",
    "resource": {
      "resourceType": "CarePlan",
      "id": "9a57c612-581f-1c85-7fda-8260b3bc613b",
      "status": "completed",
      "intent": "order",
      "category": [ {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "737471002",
          "display": "Minor surgery care management (procedure)"
        } ],
        "text": "Minor surgery care management (procedure)"
      } ],
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-b488-fc699ddd04bf"
      },
      "period": {
        "start": "2023-06-05T16:59:36+00:00",
        "end": "2023-06-19T18:55:36+00:00"
      },
      "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": "243077000",
              "display": "Recommendation to limit sexual activity (procedure)"
            } ],
            "text": "Recommendation to limit sexual activity (procedure)"
          },
          "status": "completed"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "CarePlan"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-463f-d559f7397116",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-463f-d559f7397116",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2023-06-05T14:07:36+00:00",
        "end": "2023-06-06T14:07:36+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|dd280187-8662-3732-af81-595d10572911",
        "display": "4499 ACUSHNET AVENUE OPERATING COMPANY, LLC"
      },
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-99ad-4039662dfbe5"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-f148-f1f1835f2a7e"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-24ab-04552e606aef"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 146.18,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-b488-fc699ddd04bf"
        } ]
      }, {
        "sequence": 2,
        "procedureLinkId": [ 1 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "287664005"
          } ]
        },
        "net": {
          "value": 12960.23,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "diagnosisLinkId": [ 1 ]
      }, {
        "sequence": 4,
        "procedureLinkId": [ 2 ],
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "133899007"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 13537.81,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:7dc445d2-071b-ed74-6df7-19efc235cf25",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "7dc445d2-071b-ed74-6df7-19efc235cf25",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "extension": [ {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-ime-op-clm-val-amt-extension",
        "valueMoney": {
          "value": 400.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-dsh-op-clm-val-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pass-thru-per-diem-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-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-inpatient-clm-tot-pps-cptl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-nch-bene-ip-ddctbl-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-nch-bene-pta-coinsrnc-lblty-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-nch-ip-ncvrd-chrg-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-nch-ip-tot-ddctn-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pps-cptl-dsprprtnt-shr-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pps-cptl-excptn-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pps-cptl-fsp-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pps-cptl-ime-amt-extension",
        "valueMoney": {
          "value": 400.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pps-cptl-outlier-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-pps-old-cptl-hld-hrmls-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-nch-drg-outlier-aprvd-pmt-amt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-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-inpatient-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-inpatient-prpayamt-extension",
        "valueMoney": {
          "value": 0.0,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-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": "9a57c612-581f-1c85-463f-d559f7397116"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-claim-query-cd-extension",
          "valueCoding": {
            "system": "https://bluebutton.cms.gov/assets/ig/ValueSet-claim-query-cd",
            "code": "3",
            "display": "Final Bill"
          }
        } ],
        "start": "2023-06-06T14:07:36+00:00",
        "end": "2024-06-06T14:07:36+00:00"
      },
      "provider": {
        "identifier": {
          "value": "322f0f96-66cb-31cd-b505-0b78f3dc7ffa"
        }
      },
      "organization": {
        "identifier": {
          "value": "dd280187-8662-3732-af81-595d10572911"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999986794"
          }
        },
        "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:9a57c612-581f-1c85-99ad-4039662dfbe5"
        },
        "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-inpatient-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": 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"
            } ]
          }
        } ]
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 2,
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "287664005"
          } ]
        },
        "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": 2592.0460000000003,
            "system": "urn: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": 10368.184000000001,
            "system": "urn: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": 12960.23,
            "system": "urn: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": 12960.23,
            "system": "urn: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-inpatient-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": "21",
            "display": "Inpatient Hospital"
          } ]
        }
      }, {
        "extension": [ {
          "url": "https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-rev-cntr-ndc-qty-extension",
          "valueQuantity": {
            "value": 0
          }
        } ],
        "sequence": 4,
        "service": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "version": "v1",
            "code": "133899007"
          } ]
        },
        "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": 13537.81,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 10830.248000000001,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b",
    "resource": {
      "resourceType": "Encounter",
      "id": "9a57c612-581f-1c85-06ab-e632d047207b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "participant": [ {
        "individual": {
          "reference": "Practitioner?identifier=http://hl7.org/fhir/sid/us-npi|9999947192",
          "display": "Dr. Yasmin241 Emard19"
        }
      } ],
      "period": {
        "start": "2025-06-26T12:49:30+00:00",
        "end": "2025-06-26T13:28:40+00:00"
      },
      "serviceProvider": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      }
    },
    "request": {
      "method": "POST",
      "url": "Encounter"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7b0e-672c3f8c0af5",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-7b0e-672c3f8c0af5",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "onsetDateTime": "2025-06-26T13:28:40+00:00",
      "assertedDate": "2025-06-26T13:28:40+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d661-13411d806a91",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-d661-13411d806a91",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "onsetDateTime": "2025-06-26T14:02:26+00:00",
      "assertedDate": "2025-06-26T14:02:26+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1c69-f0060447487a",
    "resource": {
      "resourceType": "Condition",
      "id": "9a57c612-581f-1c85-1c69-f0060447487a",
      "clinicalStatus": "active",
      "verificationStatus": "confirmed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "10939881000119105",
          "display": "Unhealthy alcohol drinking behavior (finding)"
        } ],
        "text": "Unhealthy alcohol drinking behavior (finding)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "onsetDateTime": "2025-06-26T15:22:33+00:00",
      "assertedDate": "2025-06-26T15:22:33+00:00"
    },
    "request": {
      "method": "POST",
      "url": "Condition"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5579-934f32996989",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-5579-934f32996989",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "4548-4",
          "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
        } ],
        "text": "Hemoglobin A1c/Hemoglobin.total in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 5.9400,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-96e6-50b4e23fe586",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-96e6-50b4e23fe586",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 160.30,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2da9-c494470527c8",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-2da9-c494470527c8",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ee6c-0038dd391244",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-ee6c-0038dd391244",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 76.400,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-127e-d7a2355d4c79",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-127e-d7a2355d4c79",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 29.720,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c40b-5bb3d08116d8",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c40b-5bb3d08116d8",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic Blood Pressure"
          } ],
          "text": "Diastolic Blood Pressure"
        },
        "valueQuantity": {
          "value": 83,
          "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": 93,
          "unit": "mm[Hg]",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-7684-1ce696f2cfd0",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-7684-1ce696f2cfd0",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 71,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c51c-17a7d18a2b7b",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c51c-17a7d18a2b7b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 14,
        "unit": "/min",
        "system": "http://unitsofmeasure.org",
        "code": "/min"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8a73-1d754b955e87",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-8a73-1d754b955e87",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2339-0",
          "display": "Glucose [Mass/volume] in Blood"
        } ],
        "text": "Glucose [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 95.670,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-3e94-fb00dc59d8ac",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-3e94-fb00dc59d8ac",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6299-2",
          "display": "Urea nitrogen [Mass/volume] in Blood"
        } ],
        "text": "Urea nitrogen [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 10.25,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-f763-669733034547",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-f763-669733034547",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "38483-4",
          "display": "Creatinine [Mass/volume] in Blood"
        } ],
        "text": "Creatinine [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 1.3700,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1a89-fe85c0cad83d",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-1a89-fe85c0cad83d",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "49765-1",
          "display": "Calcium [Mass/volume] in Blood"
        } ],
        "text": "Calcium [Mass/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 9.5200,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-5916-381fbbef6db2",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-5916-381fbbef6db2",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2947-0",
          "display": "Sodium [Moles/volume] in Blood"
        } ],
        "text": "Sodium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 137.24,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c3ba-4dfdea23f1df",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c3ba-4dfdea23f1df",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "6298-4",
          "display": "Potassium [Moles/volume] in Blood"
        } ],
        "text": "Potassium [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 3.9000,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-ba8b-bd3aa5322b7f",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-ba8b-bd3aa5322b7f",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2069-3",
          "display": "Chloride [Moles/volume] in Blood"
        } ],
        "text": "Chloride [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 108.81,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-c464-cd8129d41aa3",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-c464-cd8129d41aa3",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "20565-8",
          "display": "Carbon dioxide, total [Moles/volume] in Blood"
        } ],
        "text": "Carbon dioxide, total [Moles/volume] in Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 22.310,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-bbe5-e282d5eaa3ac",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-bbe5-e282d5eaa3ac",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2093-3",
          "display": "Cholesterol [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Cholesterol [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 192.23,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1bb6-a2bd21948cc1",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-1bb6-a2bd21948cc1",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2571-8",
          "display": "Triglyceride [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Triglyceride [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 142.5,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-a47a-49101b572026",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-a47a-49101b572026",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "18262-6",
          "display": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
        } ],
        "text": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 105.22,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-d944-c3924fc9e70a",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-d944-c3924fc9e70a",
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://hl7.org/fhir/observation-category",
          "code": "laboratory",
          "display": "laboratory"
        } ]
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2085-9",
          "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
        } ],
        "text": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "valueQuantity": {
        "value": 58.520,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-750a-04dbc8eef3c2",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-750a-04dbc8eef3c2",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+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:9a57c612-581f-1c85-f8a6-f62180a29736",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-f8a6-f62180a29736",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T13:28:40+00:00",
      "issued": "2025-06-26T13:28:40.549+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": "LA6568-5",
            "display": "Not at all"
          } ],
          "text": "Not at all"
        }
      }, {
        "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": 7688,
          "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": "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": "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": "455 Harvey Crossroad Suite 55"
      }, {
        "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:9a57c612-581f-1c85-41d7-f50d7524ca78",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-41d7-f50d7524ca78",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T14:02:26+00:00",
      "issued": "2025-06-26T14:02:26.549+00:00",
      "valueQuantity": {
        "value": 2,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6153-fa824bc7f2c0",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-6153-fa824bc7f2c0",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T14:39:20+00:00",
      "issued": "2025-06-26T14:39:20.549+00:00",
      "valueQuantity": {
        "value": 1,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-2236-b6e1b8d062d4",
    "resource": {
      "resourceType": "Observation",
      "id": "9a57c612-581f-1c85-2236-b6e1b8d062d4",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T15:22:33+00:00",
      "issued": "2025-06-26T15:22:33.549+00:00",
      "valueQuantity": {
        "value": 3,
        "unit": "{score}",
        "system": "http://unitsofmeasure.org",
        "code": "{score}"
      }
    },
    "request": {
      "method": "POST",
      "url": "Observation"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-056e-616e0337d0b2",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-056e-616e0337d0b2",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "performedPeriod": {
        "start": "2025-06-26T12:49:30+00:00",
        "end": "2025-06-26T13:28:40+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-9593-a5dc376de08b",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-9593-a5dc376de08b",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "performedPeriod": {
        "start": "2025-06-26T13:28:40+00:00",
        "end": "2025-06-26T14:02:26+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-50d2-cadb7d638b45",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-50d2-cadb7d638b45",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "performedPeriod": {
        "start": "2025-06-26T14:02:26+00:00",
        "end": "2025-06-26T14:15:58+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-eeae-b1534852e4a9",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-eeae-b1534852e4a9",
      "status": "completed",
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "171207006",
          "display": "Depression screening (procedure)"
        } ],
        "text": "Depression screening (procedure)"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "performedPeriod": {
        "start": "2025-06-26T14:15:58+00:00",
        "end": "2025-06-26T14:39:20+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-1d7d-077201e2b220",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-1d7d-077201e2b220",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "performedPeriod": {
        "start": "2025-06-26T14:39:20+00:00",
        "end": "2025-06-26T14:53:46+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-cbb0-6155cffdc8a0",
    "resource": {
      "resourceType": "Procedure",
      "id": "9a57c612-581f-1c85-cbb0-6155cffdc8a0",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "performedPeriod": {
        "start": "2025-06-26T14:53:46+00:00",
        "end": "2025-06-26T15:22:33+00:00"
      }
    },
    "request": {
      "method": "POST",
      "url": "Procedure"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-03bd-0d9842872631",
    "resource": {
      "resourceType": "Immunization",
      "id": "9a57c612-581f-1c85-03bd-0d9842872631",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "encounter": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "date": "2025-06-26T12:49:30+00:00",
      "primarySource": true
    },
    "request": {
      "method": "POST",
      "url": "Immunization"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-6bf2-0620229c26f5",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-6bf2-0620229c26f5",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "51990-0",
          "display": "Basic metabolic panel - Blood"
        } ],
        "text": "Basic metabolic panel - Blood"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-8a73-1d754b955e87",
        "display": "Glucose [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-3e94-fb00dc59d8ac",
        "display": "Urea nitrogen [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-f763-669733034547",
        "display": "Creatinine [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-1a89-fe85c0cad83d",
        "display": "Calcium [Mass/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-5916-381fbbef6db2",
        "display": "Sodium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-c3ba-4dfdea23f1df",
        "display": "Potassium [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-ba8b-bd3aa5322b7f",
        "display": "Chloride [Moles/volume] in Blood"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-c464-cd8129d41aa3",
        "display": "Carbon dioxide, total [Moles/volume] in Blood"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0603-79591c6d3676",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-0603-79591c6d3676",
      "status": "final",
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "57698-3",
          "display": "Lipid panel with direct LDL - Serum or Plasma"
        } ],
        "text": "Lipid panel with direct LDL - Serum or Plasma"
      },
      "subject": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T12:49:30+00:00",
      "issued": "2025-06-26T12:49:30.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-bbe5-e282d5eaa3ac",
        "display": "Cholesterol [Mass/volume] in Serum or Plasma"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-1bb6-a2bd21948cc1",
        "display": "Triglyceride [Mass/volume] in Serum or Plasma"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-a47a-49101b572026",
        "display": "Cholesterol in LDL [Mass/volume] in Serum or Plasma by Direct assay"
      }, {
        "reference": "urn:uuid:9a57c612-581f-1c85-d944-c3924fc9e70a",
        "display": "Cholesterol in HDL [Mass/volume] in Serum or Plasma"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8cb3-4d327e1bd66c",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-8cb3-4d327e1bd66c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T14:02:26+00:00",
      "issued": "2025-06-26T14:02:26.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-41d7-f50d7524ca78",
        "display": "Total score [HARK]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-0e7b-309f44cb3ff3",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-0e7b-309f44cb3ff3",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T14:39:20+00:00",
      "issued": "2025-06-26T14:39:20.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-6153-fa824bc7f2c0",
        "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-8e1c-7ee8caf85b3c",
    "resource": {
      "resourceType": "DiagnosticReport",
      "id": "9a57c612-581f-1c85-8e1c-7ee8caf85b3c",
      "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "context": {
        "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
      },
      "effectiveDateTime": "2025-06-26T15:22:33+00:00",
      "issued": "2025-06-26T15:22:33.549+00:00",
      "result": [ {
        "reference": "urn:uuid:9a57c612-581f-1c85-2236-b6e1b8d062d4",
        "display": "Total score [AUDIT-C]"
      } ]
    },
    "request": {
      "method": "POST",
      "url": "DiagnosticReport"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-4b8c-899e075dca6d",
    "resource": {
      "resourceType": "SupplyDelivery",
      "id": "9a57c612-581f-1c85-4b8c-899e075dca6d",
      "status": "completed",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "type": {
        "coding": [ {
          "system": "http://hl7.org/fhir/supply-item-type",
          "code": "device",
          "display": "Device"
        } ]
      },
      "suppliedItem": {
        "quantity": {
          "value": 50
        },
        "itemCodeableConcept": {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "337388004",
            "display": "Blood glucose testing strips (physical object)"
          } ],
          "text": "Blood glucose testing strips (physical object)"
        }
      },
      "occurrenceDateTime": "2025-06-26T12:49:30+00:00"
    },
    "request": {
      "method": "POST",
      "url": "SupplyDelivery"
    }
  }, {
    "fullUrl": "urn:uuid:9a57c612-581f-1c85-37b6-7933391db8b2",
    "resource": {
      "resourceType": "Claim",
      "id": "9a57c612-581f-1c85-37b6-7933391db8b2",
      "status": "active",
      "use": "complete",
      "patient": {
        "reference": "urn:uuid:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "billablePeriod": {
        "start": "2025-06-26T12:49:30+00:00",
        "end": "2025-06-26T13:28:40+00:00"
      },
      "organization": {
        "reference": "Organization?identifier=https://github.com/synthetichealth/synthea|0caa0116-ef9a-3d4c-bcff-9c405a9d2bda",
        "display": "TRANQUILITY HEALTH AND WELLNESS PROFESSIONALS LLC"
      },
      "information": [ {
        "sequence": 1,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        },
        "valueReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-03bd-0d9842872631"
        }
      }, {
        "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"
          } ]
        }
      }, {
        "sequence": 5,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 6,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      }, {
        "sequence": 7,
        "category": {
          "coding": [ {
            "system": "http://hl7.org/fhir/claiminformationcategory",
            "code": "info"
          } ]
        }
      } ],
      "diagnosis": [ {
        "sequence": 1,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-7b0e-672c3f8c0af5"
        }
      }, {
        "sequence": 2,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-d661-13411d806a91"
        }
      }, {
        "sequence": 3,
        "diagnosisReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1c69-f0060447487a"
        }
      } ],
      "procedure": [ {
        "sequence": 1,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-056e-616e0337d0b2"
        }
      }, {
        "sequence": 2,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-9593-a5dc376de08b"
        }
      }, {
        "sequence": 3,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-50d2-cadb7d638b45"
        }
      }, {
        "sequence": 4,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-eeae-b1534852e4a9"
        }
      }, {
        "sequence": 5,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-1d7d-077201e2b220"
        }
      }, {
        "sequence": 6,
        "procedureReference": {
          "reference": "urn:uuid:9a57c612-581f-1c85-cbb0-6155cffdc8a0"
        }
      } ],
      "item": [ {
        "sequence": 1,
        "net": {
          "value": 136.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        },
        "encounter": [ {
          "reference": "urn:uuid:9a57c612-581f-1c85-06ab-e632d047207b"
        } ]
      }, {
        "sequence": 2,
        "informationLinkId": [ 1 ],
        "net": {
          "value": 136.00,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 3,
        "informationLinkId": [ 2 ],
        "net": {
          "value": 6.80,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 4,
        "informationLinkId": [ 3 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 5,
        "informationLinkId": [ 4 ],
        "net": {
          "value": 74.58,
          "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": "710824005"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 7,
        "diagnosisLinkId": [ 1 ]
      }, {
        "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": "866148006"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 9,
        "diagnosisLinkId": [ 2 ]
      }, {
        "sequence": 10,
        "informationLinkId": [ 5 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 11,
        "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": 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,
        "informationLinkId": [ 6 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 14,
        "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": 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": "763302001"
          } ]
        },
        "net": {
          "value": 431.40,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }, {
        "sequence": 16,
        "diagnosisLinkId": [ 3 ]
      }, {
        "sequence": 17,
        "informationLinkId": [ 7 ],
        "net": {
          "value": 74.58,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      } ],
      "total": {
        "value": 3240.90,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      }
    },
    "request": {
      "method": "POST",
      "url": "Claim"
    }
  }, {
    "fullUrl": "urn:uuid:6536bbbb-9090-e8f2-0dbb-7952317efe43",
    "resource": {
      "resourceType": "ExplanationOfBenefit",
      "id": "6536bbbb-9090-e8f2-0dbb-7952317efe43",
      "contained": [ {
        "resourceType": "Coverage",
        "id": "coverage",
        "type": {
          "text": "Dual Eligible"
        }
      } ],
      "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": "9a57c612-581f-1c85-37b6-7933391db8b2"
      }, {
        "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:9a57c612-581f-1c85-d505-c6c44e983d32"
      },
      "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": "2025-06-26T13:28:40+00:00",
        "end": "2026-06-26T13:28:40+00:00"
      },
      "provider": {
        "identifier": {
          "value": "d1271811-e160-33a3-a51d-df8588eb3512"
        }
      },
      "organization": {
        "identifier": {
          "value": "0caa0116-ef9a-3d4c-bcff-9c405a9d2bda"
        }
      },
      "careTeam": [ {
        "sequence": 1,
        "provider": {
          "identifier": {
            "system": "http://hl7.org/fhir/sid/us-npi",
            "value": "9999947192"
          }
        },
        "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:9a57c612-581f-1c85-7b0e-672c3f8c0af5"
        },
        "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:9a57c612-581f-1c85-d661-13411d806a91"
        },
        "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:9a57c612-581f-1c85-1c69-f0060447487a"
        },
        "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": 1.36,
            "system": "urn: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": 5.44,
            "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": 6.80,
            "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": 6.80,
            "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": 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": 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": 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": 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": 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": "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": 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,
        "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": 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,
        "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": "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": 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,
        "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": 14,
        "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": 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": "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": 16,
        "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": 17,
        "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": 860.16,
        "system": "urn:iso:std:iso:4217",
        "code": "USD"
      },
      "payment": {
        "amount": {
          "value": 2592.7200000000003,
          "system": "urn:iso:std:iso:4217",
          "code": "USD"
        }
      }
    },
    "request": {
      "method": "POST",
      "url": "ExplanationOfBenefit"
    }
  } ]
}
