{ "resourceType" : "Bundle", "id" : "pharmacy-benefits-request-phi", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle|2.0.0-ballot"] }, "type" : "message", "timestamp" : "2026-10-20T14:00:00Z", "entry" : [{ "fullUrl" : "https://app.example.test/fhir/MessageHeader/phi-request", "resource" : { "resourceType" : "MessageHeader", "id" : "phi-request", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader|2.0.0-ballot"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: MessageHeader phi-request

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

-NameEndpoint
*Example apphttps://app.example.test

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

" }, "eventCoding" : { "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type", "code" : "rtpbc-request", "display" : "RTPBC Request" }, "source" : { "name" : "Example app", "endpoint" : "https://app.example.test" }, "focus" : [{ "reference" : "Claim/phi-claim" }], "definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request" } }, { "fullUrl" : "https://app.example.test/fhir/Claim/phi-claim", "resource" : { "resourceType" : "Claim", "id" : "phi-claim", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim|2.0.0-ballot"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim phi-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

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

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

prescription: MedicationRequest: status = draft; intent = proposal; medication[x] = lisinopril 5 MG Oral Tablet; authoredOn = 2026-10-20

CareTeams

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

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active; subscriberId = EX0000001; relationship = Self

Items

-SequenceCareTeamSequenceProductOrServiceQuantity
*11lisinopril 5 MG Oral Tablet30 {Each} (Details: UCUM code{Each} = '{Each}')
" }, "identifier" : [{ "value" : "benefit-check-0001" }], "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy", "display" : "Pharmacy" }] }, "use" : "predetermination", "patient" : { "reference" : "Patient/phi-patient" }, "created" : "2026-10-20T14:00:00Z", "provider" : { "reference" : "Organization/phi-pharmacy" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal", "display" : "Normal" }] }, "prescription" : { "reference" : "MedicationRequest/phi-prescription" }, "careTeam" : [{ "sequence" : 1, "provider" : { "reference" : "Practitioner/phi-prescriber" } }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/phi-coverage" } }], "item" : [{ "sequence" : 1, "careTeamSequence" : [1], "productOrService" : { "coding" : [{ "system" : "http://www.nlm.nih.gov/research/umls/rxnorm", "code" : "311354", "display" : "lisinopril 5 MG Oral Tablet" }] }, "quantity" : { "value" : 30, "unit" : "{Each}", "system" : "http://unitsofmeasure.org", "code" : "{Each}" } }] } }, { "fullUrl" : "https://app.example.test/fhir/Patient/phi-patient", "resource" : { "resourceType" : "Patient", "id" : "phi-patient", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient|2.0.0-ballot"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Patient phi-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)

" }, "identifier" : [{ "system" : "https://app.example.test/patients", "value" : "example-0001" }], "name" : [{ "family" : "Lin", "given" : ["Mei"] }], "gender" : "female", "birthDate" : "1958-03-14" } }, { "fullUrl" : "https://app.example.test/fhir/Coverage/phi-coverage", "resource" : { "resourceType" : "Coverage", "id" : "phi-coverage", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage|2.0.0-ballot"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Coverage phi-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

payor: Example Health Plan (Identifier: https://payers.example.test/EXAMPLE-PAYER)

class

type: RX BIN

value: 000000

class

type: RX PCN

value: EXAMPLE

class

type: RX Group

value: EXGROUP01

class

type: RX Id

value: EX0000001

" }, "status" : "active", "subscriberId" : "EX0000001", "beneficiary" : { "reference" : "Patient/phi-patient" }, "relationship" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship", "code" : "self" }] }, "payor" : [{ "identifier" : { "system" : "https://payers.example.test", "value" : "EXAMPLE-PAYER" }, "display" : "Example Health Plan" }], "class" : [{ "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxbin" }] }, "value" : "000000" }, { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxpcn" }] }, "value" : "EXAMPLE" }, { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxgroup" }] }, "value" : "EXGROUP01" }, { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/coverage-class", "code" : "rxid" }] }, "value" : "EX0000001" }] } }, { "fullUrl" : "https://app.example.test/fhir/MedicationRequest/phi-prescription", "resource" : { "resourceType" : "MedicationRequest", "id" : "phi-prescription", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest|2.0.0-ballot"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: MedicationRequest phi-prescription

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

status: Draft

intent: Proposal

medication: lisinopril 5 MG Oral Tablet

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

-ValueUnitSystemCode
*30dayshttp://unitsofmeasure.orgd

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

Substitutions

-Allowed[x]
*true
" }, "status" : "draft", "intent" : "proposal", "medicationCodeableConcept" : { "coding" : [{ "system" : "http://www.nlm.nih.gov/research/umls/rxnorm", "code" : "311354", "display" : "lisinopril 5 MG Oral Tablet" }] }, "subject" : { "reference" : "Patient/phi-patient" }, "authoredOn" : "2026-10-20", "requester" : { "reference" : "Practitioner/phi-prescriber" }, "dispenseRequest" : { "quantity" : { "value" : 30, "unit" : "{Each}", "system" : "http://unitsofmeasure.org", "code" : "{Each}" }, "expectedSupplyDuration" : { "value" : 30, "unit" : "days", "system" : "http://unitsofmeasure.org", "code" : "d" }, "performer" : { "reference" : "Organization/phi-pharmacy" } }, "substitution" : { "allowedBoolean" : true } } }, { "fullUrl" : "https://app.example.test/fhir/Practitioner/phi-prescriber", "resource" : { "resourceType" : "Practitioner", "id" : "phi-prescriber", "meta" : { "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|8.0.1"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner phi-prescriber

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)

" }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "2900000011" }], "name" : [{ "family" : "Okafor", "given" : ["Ada"], "suffix" : ["MD"] }] } }, { "fullUrl" : "https://app.example.test/fhir/Organization/phi-pharmacy", "resource" : { "resourceType" : "Organization", "id" : "phi-pharmacy", "meta" : { "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization|2.0.0-ballot"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Organization phi-pharmacy

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)

Active:true
Type:Retail
Contact Detail
  • ph: 305-555-0100
  • 100 Example Street Miami FL 33131 US
" }, "identifier" : [{ "system" : "http://hl7.org/fhir/sid/us-npi", "value" : "2900000003" }], "active" : true, "type" : [{ "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType", "code" : "R", "display" : "Retail" }] }], "name" : "Example Pharmacy", "telecom" : [{ "system" : "phone", "value" : "305-555-0100" }], "address" : [{ "line" : ["100 Example Street"], "city" : "Miami", "state" : "FL", "postalCode" : "33131", "country" : "US" }] } }] }