This page is part of the ACCESS Model IG v0.9.8 DRAFT (v0.9.8: Releases Draft) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

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: Unalignment Request Example

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{
  "resourceType" : "Parameters",
  "id" : "UnalignmentRequestExample",
  "meta" : {
    "profile" : [
      🔗 "https://dsacms.github.io/cmmi-access-model/StructureDefinition/access-unalign-in"
    ]
  },
  "language" : "en",
  "parameter" : [
    {
      "name" : "participantID",
      "valueIdentifier" : {
        "system" : "https://dsacms.github.io/cmmi-access-model/participant-id",
        "value" : "ACCES12345"
      }
    },
    {
      "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" : "PatientExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient|6.1.0"
          ]
        },
        "language" : "en",
        "text" : {
          "status" : "generated",
          "div" : "<div xml:lang=\"en\" xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en\">Patient John Doe, male, born 1950-01-01, Medicare ID: 1EG4TE5MK73</div>"
        },
        "identifier" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                  "code" : "MC"
                }
              ]
            },
            "system" : "http://terminology.hl7.org/NamingSystem/cmsMBI",
            "value" : "1EG4TE5MK73"
          }
        ],
        "name" : [
          {
            "family" : "Doe",
            "given" : [
              "John"
            ]
          }
        ],
        "gender" : "male",
        "birthDate" : "1950-01-01"
      }
    },
    {
      "name" : "track",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSTrackCS",
            "code" : "CKM",
            "display" : "Cardio-kidney-metabolic track"
          }
        ]
      }
    },
    {
      "name" : "reason",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSUnalignmentReasonCS",
            "code" : "geographic-relocated",
            "display" : "Geographic relocated"
          }
        ]
      }
    }
  ]
}