Bundle pharmacy-benefits-request-phi of type message

Entry 1 - fullUrl = https://app.example.test/fhir/MessageHeader/phi-request

Resource MessageHeader:

Profile: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader|2.0.0-ballot

event: rtpbc-event-type: rtpbc-request (RTPBC Request)

Sources

-	Name
*	Example app

focus: Claim: identifier = benefit-check-0001; status = active; type = Pharmacy; use = predetermination; created = 2026-10-20 14:00:00+0000; priority = Normal

definition: http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request

Entry 2 - fullUrl = https://app.example.test/fhir/Claim/phi-claim

Resource Claim:

Profile: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim|2.0.0-ballot

identifier: benefit-check-0001

status: Active

type: Pharmacy

use: Predetermination

created: 2026-10-20 14:00:00+0000

provider: Example Pharmacy (Retail) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#2900000003)

priority: Normal

CareTeams

-	Sequence	Provider
*	1	Ada Okafor (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#2900000011)

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage: status = active; subscriberId = EX0000001; relationship = Self

Items

-	Sequence	CareTeamSequence	ProductOrService	Quantity
*	1	1	lisinopril 5 MG Oral Tablet	30 {Each} (Details: UCUM code{Each} = '{Each}')

Entry 3 - fullUrl = https://app.example.test/fhir/Patient/phi-patient

Resource Patient:

Profile: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient|2.0.0-ballot

Mei Lin Female, DoB: 1958-03-14 ( https://app.example.test/patients#example-0001)

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Entry 4 - fullUrl = https://app.example.test/fhir/Coverage/phi-coverage

Resource Coverage:

Profile: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage|2.0.0-ballot

status: Active

subscriberId: EX0000001

beneficiary: Mei Lin Female, DoB: 1958-03-14 ( https://app.example.test/patients#example-0001)

relationship: Self

class

type: RX BIN

value: 000000

class

type: RX PCN

value: EXAMPLE

class

type: RX Group

value: EXGROUP01

class

type: RX Id

value: EX0000001

Entry 5 - fullUrl = https://app.example.test/fhir/MedicationRequest/phi-prescription

Resource MedicationRequest:

Profile: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest|2.0.0-ballot

status: Draft

intent: Proposal

subject: Mei Lin Female, DoB: 1958-03-14 ( https://app.example.test/patients#example-0001)

authoredOn: 2026-10-20

requester: Ada Okafor (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#2900000011)

dispenseRequest

quantity: 30 {Each} (Details: UCUM code{Each} = '{Each}')

ExpectedSupplyDurations

-	Value	Unit	System	Code
*	30	days	http://unitsofmeasure.org	d

Substitutions

-	Allowed[x]
*	true

Entry 6 - fullUrl = https://app.example.test/fhir/Practitioner/phi-prescriber

Resource Practitioner:

Profile: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|8.0.1

Ada Okafor (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#2900000011)

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Entry 7 - fullUrl = https://app.example.test/fhir/Organization/phi-pharmacy

Resource Organization:

Profile: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization|2.0.0-ballot

Example Pharmacy (Retail) (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#2900000003)

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Active:	true
Type:	Retail
Contact Detail	ph: 305-555-0100 100 Example Street Miami FL 33131 US