<?xml version="1.0" encoding="UTF-8"?>

<Bundle xmlns="http://hl7.org/fhir">
  <id value="pharmacy-benefits-request-non-phi"/>
  <meta>
    <profile value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle-non-phi|2.0.0-ballot"/>
  </meta>
  <type value="message"/>
  <timestamp value="2026-10-20T14:00:00Z"/>
  <entry>
    <fullUrl value="https://app.example.test/fhir/MessageHeader/non-phi-request"/>
    <resource>
      <MessageHeader>
        <id value="non-phi-request"/>
        <meta>
          <profile value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader-non-phi|2.0.0-ballot"/>
        </meta>
        <text>
          <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_non-phi-request"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader non-phi-request</b></p><a name="non-phi-request"> </a><a name="hcnon-phi-request"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <code>http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader-non-phi|2.0.0-ballot</code></p></div><p><b>event</b>: rtpbc-event-type: rtpbc-request-non-phi (RTPBC Non-PHI Request)</p><h3>Sources</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style="display: none">*</td><td>Example app</td><td><a href="https://app.example.test">https://app.example.test</a></td></tr></table><p><b>focus</b>: <a href="Bundle-pharmacy-benefits-request-non-phi.html#https-//app.example.test/fhir/Claim/non-phi-claim">Claim: identifier = price-check-0001; status = active; type = Pharmacy; use = predetermination; created = 2026-10-20 14:00:00+0000; priority = Normal</a></p><p><b>definition</b>: <code>http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request-non-phi</code></p></div>
        </text>
        <eventCoding>
          <system value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type"/>
          <code value="rtpbc-request-non-phi"/>
          <display value="RTPBC Non-PHI Request"/>
        </eventCoding>
        <source>
          <name value="Example app"/>
          <endpoint value="https://app.example.test"/>
        </source>
        <focus>
          <reference value="https://app.example.test/fhir/Claim/non-phi-claim"/>
        </focus>
        <definition value="http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request-non-phi"/>
      </MessageHeader>
    </resource>
  </entry>
  <entry>
    <fullUrl value="https://app.example.test/fhir/Claim/non-phi-claim"/>
    <resource>
      <Claim>
        <id value="non-phi-claim"/>
        <meta>
          <profile value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim-non-phi|2.0.0-ballot"/>
        </meta>
        <text>
          <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><a name="Claim_non-phi-claim"> </a><p class="res-header-id"><b>Generated Narrative: Claim non-phi-claim</b></p><a name="non-phi-claim"> </a><a name="hcnon-phi-claim"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <code>http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim-non-phi|2.0.0-ballot</code></p></div><p><b>identifier</b>: price-check-0001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}">Pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: ?rref?</p><p><b>created</b>: 2026-10-20 14:00:00+0000</p><p><b>provider</b>: ?rref?</p><p><b>priority</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}">Normal</span></p><h3>Insurances</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>false</td><td>?rref?</td></tr></table><h3>Items</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td><td><b>Quantity</b></td></tr><tr><td style="display: none">*</td><td>1</td><td><span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 311354}">lisinopril 5 mg tablet</span></td><td>30 {Each}<span style="background: LightGoldenRodYellow"> (Details: UCUM  code{Each} = '{Each}')</span></td></tr></table></div>
        </text>
        <identifier>
          <value value="price-check-0001"/>
        </identifier>
        <status value="active"/>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
            <code value="pharmacy"/>
            <display value="Pharmacy"/>
          </coding>
        </type>
        <use value="predetermination"/>
        <patient>
          <extension url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
            <valueCode value="masked"/>
          </extension>
        </patient>
        <created value="2026-10-20T14:00:00Z"/>
        <provider>
          <extension url="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferredPharmacyPostalCode">
            <valueString value="33131"/>
          </extension>
        </provider>
        <priority>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
            <code value="normal"/>
            <display value="Normal"/>
          </coding>
        </priority>
        <insurance>
          <sequence value="1"/>
          <focal value="false"/>
          <coverage>
            <extension url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
              <valueCode value="masked"/>
            </extension>
          </coverage>
        </insurance>
        <item>
          <sequence value="1"/>
          <productOrService>
            <coding>
              <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
              <code value="311354"/>
              <display value="lisinopril 5 MG Oral Tablet"/>
            </coding>
            <text value="lisinopril 5 mg tablet"/>
          </productOrService>
          <quantity>
            <value value="30"/>
            <unit value="{Each}"/>
            <system value="http://unitsofmeasure.org"/>
            <code value="{Each}"/>
          </quantity>
        </item>
      </Claim>
    </resource>
  </entry>
</Bundle>