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fastenhealth / fasten-sources

The Fasten Sources is a library that defines medical provider metadata (definitions - OpenID Metadata documents) and http clients (OAuth2/Smart-on-FHIR clients) which can be used to retrieve data from various Medical Providers (clients).
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EOB Contained Resources need to be processed and stored in the DB. #12

Closed AnalogJ closed 8 months ago

AnalogJ commented 9 months ago 
{
    "resourceType": "ExplanationOfBenefit",
    "id": "carrier--10000930037917",
    "meta": {
        "lastUpdated": "2023-06-14T12:31:42.354-04:00",
        "profile": [
            "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
        ]
    },
    "contained": [
        {
            "resourceType": "Observation",
            "id": "line-observation-1",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-2",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-3",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-4",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-5",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-6",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-7",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-8",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-9",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-10",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-11",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-12",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-13",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        },
        {
            "resourceType": "Observation",
            "id": "line-observation-14",
            "status": "unknown",
            "code": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_type_cd",
                        "code": "R1",
                        "display": "Hemoglobin Test"
                    }
                ]
            },
            "valueQuantity": {
                "value": 0
            }
        }
    ],
    "extension": [
        {
            "url": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
            "valueCoding": {
                "system": "https://bluebutton.cms.gov/resources/variables/nch_near_line_rec_ident_cd",
                "code": "O",
                "display": "Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)"
            }
        },
        {
            "url": "https://bluebutton.cms.gov/resources/variables/carr_num",
            "valueIdentifier": {
                "system": "https://bluebutton.cms.gov/resources/variables/carr_num",
                "value": "00510"
            }
        },
        {
            "url": "https://bluebutton.cms.gov/resources/variables/carr_clm_cntl_num",
            "valueIdentifier": {
                "system": "https://bluebutton.cms.gov/resources/variables/carr_clm_cntl_num",
                "value": "-700301157"
            }
        },
        {
            "url": "https://bluebutton.cms.gov/resources/variables/carr_clm_pmt_dnl_cd",
            "valueCoding": {
                "system": "https://bluebutton.cms.gov/resources/variables/carr_clm_pmt_dnl_cd",
                "code": "1",
                "display": "Physician/supplier"
            }
        },
        {
            "url": "https://bluebutton.cms.gov/resources/variables/asgmntcd",
            "valueCoding": {
                "system": "https://bluebutton.cms.gov/resources/variables/asgmntcd",
                "code": "A",
                "display": "Assigned claim"
            }
        },
        {
            "url": "https://bluebutton.cms.gov/resources/variables/carr_clm_entry_cd",
            "valueCoding": {
                "system": "https://bluebutton.cms.gov/resources/variables/carr_clm_entry_cd",
                "code": "1",
                "display": "Original debit; void of original debit (If CLM_DISP_CD = 3, code 1 means voided original debit)"
            }
        }
    ],
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                        "code": "uc",
                        "display": "Unique Claim ID"
                    }
                ]
            },
            "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
            "value": "-10000930037917"
        },
        {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                        "code": "uc",
                        "display": "Unique Claim ID"
                    }
                ]
            },
            "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
            "value": "-1632178264"
        }
    ],
    "status": "active",
    "type": {
        "coding": [
            {
                "system": "https://bluebutton.cms.gov/resources/variables/nch_clm_type_cd",
                "code": "71",
                "display": "Local carrier non-durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claim"
            },
            {
                "system": "https://bluebutton.cms.gov/resources/codesystem/eob-type",
                "code": "CARRIER"
            },
            {
                "system": "http://terminology.hl7.org/CodeSystem/claim-type",
                "code": "professional",
                "display": "Professional"
            }
        ]
    },
    "use": "claim",
    "patient": {
        "reference": "Patient/-10000010254618"
    },
    "billablePeriod": {
        "start": "2017-10-09",
        "end": "2017-10-09"
    },
    "created": "2023-10-04T16:40:16-04:00",
    "insurer": {
        "identifier": {
            "value": "CMS"
        }
    },
    "provider": {
        "identifier": {
            "system": "https://bluebutton.cms.gov/resources/variables/carr_clm_blg_npi_num",
            "value": "1063654341"
        }
    },
    "referral": {
        "identifier": {
            "type": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                        "code": "npi",
                        "display": "National Provider Identifier"
                    }
                ]
            },
            "value": "9999971093"
        }
    },
    "outcome": "complete",
    "disposition": "1",
    "careTeam": [
        {
            "sequence": 1,
            "provider": {
                "identifier": {
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "npi",
                                "display": "National Provider Identifier"
                            }
                        ]
                    },
                    "value": "9999971093"
                }
            },
            "role": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
                        "code": "referring",
                        "display": "Referring"
                    }
                ]
            }
        },
        {
            "sequence": 2,
            "provider": {
                "identifier": {
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "npi",
                                "display": "National Provider Identifier"
                            }
                        ]
                    }
                }
            },
            "role": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
                        "code": "referring",
                        "display": "Referring"
                    }
                ]
            }
        },
        {
            "extension": [
                {
                    "url": "https://bluebutton.cms.gov/resources/variables/carr_line_prvdr_type_cd",
                    "valueCoding": {
                        "system": "https://bluebutton.cms.gov/resources/variables/carr_line_prvdr_type_cd",
                        "code": "0"
                    }
                },
                {
                    "url": "https://bluebutton.cms.gov/resources/variables/prtcptng_ind_cd",
                    "valueCoding": {
                        "system": "https://bluebutton.cms.gov/resources/variables/prtcptng_ind_cd",
                        "code": "3",
                        "display": "Assignment accepted/non-participating"
                    }
                }
            ],
            "sequence": 3,
            "provider": {
                "identifier": {
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "npi",
                                "display": "National Provider Identifier"
                            }
                        ]
                    },
                    "value": "9999971093"
                }
            },
            "responsible": true,
            "role": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole",
                        "code": "performing",
                        "display": "Performing provider"
                    }
                ]
            },
            "qualification": {
                "coding": [
                    {
                        "system": "https://bluebutton.cms.gov/resources/variables/prvdr_spclty",
                        "code": "01",
                        "display": "General practice"
                    }
                ]
            }
        },
        {
            "sequence": 4,
            "provider": {
                "identifier": {
                    "type": {
                        "coding": [
                            {
                                "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                                "code": "npi",
                                "display": "National Provider Identifier"
                            }
                        ]
                    },
                    "value": "1063654341"
                },
                "display": "HEALTH SERVICES INC"
            },
            "role": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
                        "code": "primary",
                        "display": "Primary provider"
                    }
                ]
            }
        }
    ],
    "supportingInfo": [
        {
            "sequence": 1,
            "category": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
                        "code": "clmrecvddate",
                        "display": "Claim Received Date"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/nch_wkly_proc_dt",
                        "display": "NCH Weekly Claim Processing Date"
                    }
                ]
            },
            "timingDate": "2017-10-13"
        },
        {
            "sequence": 2,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-1"
            }
        },
        {
            "sequence": 3,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-2"
            }
        },
        {
            "sequence": 4,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-3"
            }
        },
        {
            "sequence": 5,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-4"
            }
        },
        {
            "sequence": 6,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-5"
            }
        },
        {
            "sequence": 7,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-6"
            }
        },
        {
            "sequence": 8,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-7"
            }
        },
        {
            "sequence": 9,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-8"
            }
        },
        {
            "sequence": 10,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-9"
            }
        },
        {
            "sequence": 11,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-10"
            }
        },
        {
            "sequence": 12,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-11"
            }
        },
        {
            "sequence": 13,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-12"
            }
        },
        {
            "sequence": 14,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-13"
            }
        },
        {
            "sequence": 15,
            "category": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
                        "code": "info",
                        "display": "Information"
                    },
                    {
                        "system": "https://bluebutton.cms.gov/resources/codesystem/information",
                        "code": "https://bluebutton.cms.gov/resources/variables/line_hct_hgb_rslt_num",
                        "display": "Hematocrit / Hemoglobin Test Results"
                    }
                ]
            },
            "valueReference": {
                "reference": "#line-observation-14"
            }
        }
    ],
    "diagnosis": [
        {
            "sequence": 1,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "Z591",
                        "display": "INADEQUATE HOUSING"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "Z591",
                        "display": "INADEQUATE HOUSING"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                            "code": "principal",
                            "display": "principal"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 2,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "R4689",
                        "display": "OTHER SYMPTOMS AND SIGNS INVOLVING APPEARANCE AND BEHAVIOR"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "R4689",
                        "display": "OTHER SYMPTOMS AND SIGNS INVOLVING APPEARANCE AND BEHAVIOR"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
                            "code": "principal",
                            "display": "principal"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 3,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "T7432X"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "T7432X"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 4,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "M7918"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "M7918"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 5,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "E781",
                        "display": "PURE HYPERGLYCERIDEMIA"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "E781",
                        "display": "PURE HYPERGLYCERIDEMIA"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 6,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "J329",
                        "display": "\"CHRONIC SINUSITIS, UNSPECIFIED\""
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "J329",
                        "display": "\"CHRONIC SINUSITIS, UNSPECIFIED\""
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 7,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "E119",
                        "display": "TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "E119",
                        "display": "TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 8,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "D649",
                        "display": "\"ANEMIA, UNSPECIFIED\""
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "D649",
                        "display": "\"ANEMIA, UNSPECIFIED\""
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 9,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "E849",
                        "display": "\"CYSTIC FIBROSIS, UNSPECIFIED\""
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "E849",
                        "display": "\"CYSTIC FIBROSIS, UNSPECIFIED\""
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 10,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "B965",
                        "display": "PSEUDOMONAS (MALLEI) CAUSING DISEASES CLASSD ELSWHR"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "B965",
                        "display": "PSEUDOMONAS (MALLEI) CAUSING DISEASES CLASSD ELSWHR"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        },
        {
            "sequence": 11,
            "diagnosisCodeableConcept": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10-cm",
                        "code": "E848",
                        "display": "CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS"
                    },
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "E848",
                        "display": "CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS"
                    }
                ]
            },
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType",
                            "code": "secondary",
                            "display": "Secondary"
                        }
                    ]
                }
            ]
        }
    ],
    "insurance": [
        {
            "focal": true,
            "coverage": {
                "reference": "Coverage/part-b--10000010254618"
            }
        }
    ],
   ...
}