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)
| Name | Endpoint |
| Example app | https://app.example.test |
definition: http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-request
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
priority: Normal
prescription: MedicationRequest: status = draft; intent = proposal; medication[x] = lisinopril 5 MG Oral Tablet; authoredOn = 2026-10-20
| Sequence | Provider |
| 1 | Ada Okafor (http://hl7.org/fhir/sid/us-npi#United States National Provider Identifier#2900000011) |
| Sequence | Focal | Coverage |
| 1 | true | Coverage: status = active; subscriberId = EX0000001; relationship = Self |
| Sequence | CareTeamSequence | ProductOrService | Quantity |
| 1 | 1 | lisinopril 5 MG Oral Tablet | 30 {Each} (Details: UCUM code{Each} = '{Each}') |
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
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
Value Unit System Code 30 days http://unitsofmeasure.org d
| Allowed[x] |
| true |
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 |
| ||