CMS ACCESS Model API - Local Development build (v0.9.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: Unalignment Request - ESRD Example - JSON Representation

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{
  "resourceType" : "Parameters",
  "id" : "UnalignmentRequestESRDExample",
  "meta" : {
    "profile" : [
      🔗 "https://globalalliantinc.com/access/StructureDefinition/access-unalign-in"
    ]
  },
  "parameter" : [
    {
      "name" : "participantID",
      "valueIdentifier" : {
        "system" : "https://globalalliantinc.com/access/participant-id",
        "value" : "ACCESS1234"
      }
    },
    {
      "name" : "payerID",
      "valueIdentifier" : {
        "type" : {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
              "code" : "payerid",
              "display" : "Payer ID"
            }
          ]
        },
        "system" : "urn:oid:2.16.840.1.113883.3.221.5",
        "value" : "12345"
      }
    },
    {
      "name" : "patient",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "PatientESRDExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|6.1.0"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient Jane Smith, female, born 1955-06-15, Medicare ID: 9876543210B</div>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "MC"
                }
              ]
            },
            "system" : "http://terminology.hl7.org/NamingSystem/cmsMBI",
            "value" : "9876543210B"
          }
        ],
        "name" : [
          {
            "family" : "Smith",
            "given" : [
              "Jane"
            ]
          }
        ],
        "gender" : "female",
        "birthDate" : "1955-06-15"
      }
    },
    {
      "name" : "track",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://globalalliantinc.com/access/CodeSystem/ACCESSTrackCS",
            "code" : "CKM",
            "display" : "Cardio-kidney-metabolic track"
          }
        ]
      }
    },
    {
      "name" : "reason",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://globalalliantinc.com/access/CodeSystem/ACCESSUnalignmentReasonCS",
            "code" : "no-longer-clinically-eligible",
            "display" : "No longer clinically eligible"
          }
        ],
        "text" : "Patient has developed end-stage renal disease (ESRD) requiring dialysis, which makes them ineligible for the ACCESS Model."
      }
    },
    {
      "name" : "condition",
      "resource" : {
        "resourceType" : "Condition",
        "id" : "ESRDConditionExample",
        "meta" : {
          "profile" : [
            🔗 "https://globalalliantinc.com/access/StructureDefinition/access-clinical-exclusion-condition"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">End stage renal disease (ESRD)</div>"
        },
        "clinicalStatus" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/condition-clinical",
              "code" : "active",
              "display" : "Active"
            }
          ]
        },
        "verificationStatus" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
              "code" : "confirmed",
              "display" : "Confirmed"
            }
          ]
        },
        "category" : [
          {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
                "code" : "problem-list-item",
                "display" : "Problem List Item"
              }
            ]
          }
        ],
        "code" : {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/sid/icd-10-cm",
              "code" : "N18.6",
              "display" : "End stage renal disease"
            }
          ]
        },
        "subject" : {
          🔗 "reference" : "Patient/PatientESRDExample"
        },
        "onsetDateTime" : "2026-01-15"
      }
    }
  ]
}