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 - XML Representation

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