@smarttracker/blue-button-generate
Version:
Blue Button CCDA Generator.
1,352 lines • 78.1 kB
JSON
{
"data": {
"demographics": {
"name": {
"middle": [
"Isa"
],
"last": "Jones",
"first": "Isabella"
},
"dob": {
"point": {
"date": "1975-05-01T00:00:00.000Z",
"precision": "day"
}
},
"gender": "Female",
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.99999.2",
"extension": "998991"
},
{
"identifier": "2.16.840.1.113883.4.1",
"extension": "111-00-2330"
}
],
"marital_status": "Married",
"addresses": [
{
"street_lines": [
"1357 Amber Drive"
],
"city": "Beaverton",
"state": "OR",
"zip": "97867",
"country": "US",
"use": "primary home"
}
],
"phone": [
{
"number": "(816)276-6909",
"type": "primary home"
}
],
"race": "White",
"ethnicity": "Not Hispanic or Latino",
"languages": [
{
"language": "en",
"preferred": true,
"mode": "Expressed spoken",
"proficiency": "Good"
}
],
"religion": "Christian (non-Catholic, non-specific)",
"birthplace": {
"city": "Beaverton",
"state": "OR",
"zip": "97867",
"country": "US"
},
"guardians": [
{
"relation": "Parent",
"addresses": [
{
"street_lines": [
"1357 Amber Drive"
],
"city": "Beaverton",
"state": "OR",
"zip": "97867",
"country": "US",
"use": "primary home"
}
],
"names": [
{
"last": "Jones",
"first": "Ralph"
}
],
"phone": [
{
"number": "(816)276-6909",
"type": "primary home"
}
]
}
]
},
"vitals": [
{
"identifiers": [
{
"identifier": "c6f88321-67ad-11db-bd13-0800200c9a66"
}
],
"vital": {
"name": "Height",
"code": "8302-2",
"code_system_name": "LOINC"
},
"status": "completed",
"date_time": {
"point": {
"date": "1999-11-14T00:00:00.000Z",
"precision": "day"
}
},
"interpretations": [
"Normal"
],
"value": 177,
"unit": "cm"
},
{
"identifiers": [
{
"identifier": "c6f88321-67ad-11db-bd13-0800200c9a66"
}
],
"vital": {
"name": "Patient Body Weight - Measured",
"code": "3141-9",
"code_system_name": "LOINC"
},
"status": "completed",
"date_time": {
"point": {
"date": "1999-11-14T00:00:00.000Z",
"precision": "day"
}
},
"interpretations": [
"Normal"
],
"value": 86,
"unit": "kg"
},
{
"identifiers": [
{
"identifier": "c6f88321-67ad-11db-bd13-0800200c9a66"
}
],
"vital": {
"name": "Intravascular Systolic",
"code": "8480-6",
"code_system_name": "LOINC"
},
"status": "completed",
"date_time": {
"point": {
"date": "1999-11-14T00:00:00.000Z",
"precision": "day"
}
},
"interpretations": [
"Normal"
],
"value": 132,
"unit": "mm[Hg]"
},
{
"identifiers": [
{
"identifier": "c6f88321-67ad-11db-bd13-0800200c9a66"
}
],
"vital": {
"name": "Height",
"code": "8302-2",
"code_system_name": "LOINC"
},
"status": "completed",
"date_time": {
"point": {
"date": "2000-04-07T00:00:00.000Z",
"precision": "day"
}
},
"interpretations": [
"Normal"
],
"value": 177,
"unit": "cm"
},
{
"identifiers": [
{
"identifier": "c6f88321-67ad-11db-bd13-0800200c9a66"
}
],
"vital": {
"name": "Patient Body Weight - Measured",
"code": "3141-9",
"code_system_name": "LOINC"
},
"status": "completed",
"date_time": {
"point": {
"date": "2000-04-07T00:00:00.000Z",
"precision": "day"
}
},
"interpretations": [
"Normal"
],
"value": 88,
"unit": "kg"
},
{
"identifiers": [
{
"identifier": "c6f88321-67ad-11db-bd13-0800200c9a66"
}
],
"vital": {
"name": "Intravascular Systolic",
"code": "8480-6",
"code_system_name": "LOINC"
},
"status": "completed",
"date_time": {
"point": {
"date": "2000-04-07T00:00:00.000Z",
"precision": "day"
}
},
"interpretations": [
"Normal"
],
"value": 145,
"unit": "mm[Hg]"
}
],
"results": [
{
"identifiers": [
{
"identifier": "7d5a02b0-67a4-11db-bd13-0800200c9a66"
}
],
"result_set": {
"name": "CBC WO DIFFERENTIAL",
"code": "43789009",
"code_system_name": "SNOMED CT"
},
"results": [
{
"identifiers": [
{
"identifier": "107c2dc0-67a5-11db-bd13-0800200c9a66"
}
],
"result": {
"name": "HGB",
"code": "30313-1",
"code_system_name": "LOINC"
},
"date_time": {
"point": {
"date": "2000-03-23T00:00:00.000Z",
"precision": "day"
}
},
"status": "completed",
"reference_range": {
"range": "M 13-18 g/dl; F 12-16 g/dl"
},
"interpretations": [
"Normal"
],
"value": 13.2,
"unit": "g/dl"
},
{
"identifiers": [
{
"identifier": "107c2dc0-67a5-11db-bd13-0800200c9a66"
}
],
"result": {
"name": "WBC",
"code": "33765-9",
"code_system_name": "LOINC"
},
"date_time": {
"point": {
"date": "2000-03-23T00:00:00.000Z",
"precision": "day"
}
},
"status": "completed",
"reference_range": {
"low": "4.3",
"high": "10.8",
"unit": "10+3/ul"
},
"interpretations": [
"Normal"
],
"value": 6.7,
"unit": "10+3/ul"
},
{
"identifiers": [
{
"identifier": "107c2dc0-67a5-11db-bd13-0800200c9a66"
}
],
"result": {
"name": "PLT",
"code": "26515-7",
"code_system_name": "LOINC"
},
"date_time": {
"point": {
"date": "2000-03-23T00:00:00.000Z",
"precision": "day"
}
},
"status": "completed",
"reference_range": {
"low": "150",
"high": "350",
"unit": "10+3/ul"
},
"interpretations": [
"Low"
],
"value": 123,
"unit": "10+3/ul"
}
]
}
],
"medications": [
{
"date_time": {
"low": {
"date": "2007-01-03T00:00:00.000Z",
"precision": "day"
},
"high": {
"date": "2012-05-15T00:00:00.000Z",
"precision": "day"
}
},
"identifiers": [
{
"identifier": "cdbd33f0-6cde-11db-9fe1-0800200c9a66"
}
],
"status": "Completed",
"sig": "Proventil HFA",
"product": {
"identifiers": [
{
"identifier": "2a620155-9d11-439e-92b3-5d9815ff4ee8"
}
],
"unencoded_name": "Proventil HFA",
"product": {
"name": "Proventil HFA",
"code": "219483",
"translations": [
{
"name": "Proventil 0.09 MG/ACTUAT inhalant solution",
"code": "573621",
"code_system_name": "RXNORM"
}
],
"code_system_name": "RXNORM"
},
"manufacturer": "Medication Factory Inc."
},
"supply": {
"date_time": {
"low": {
"date": "2007-01-03T00:00:00.000Z",
"precision": "day"
}
},
"repeatNumber": "1",
"quantity": "75",
"author": {
"identifiers": [
{
"identifier": "2a620155-9d11-439e-92b3-5d9815fe4de8"
}
],
"name": {
"prefix": "Dr.",
"last": "Seven",
"first": "Henry"
}
}
},
"administration": {
"route": {
"name": "RESPIRATORY (INHALATION)",
"code": "C38216",
"code_system_name": "Medication Route FDA"
},
"form": {
"name": "INHALANT",
"code": "C42944",
"code_system_name": "Medication Route FDA"
},
"dose": {
"value": 1,
"unit": "mg/actuat"
},
"rate": {
"value": 90,
"unit": "ml/min"
},
"interval": {
"period": {
"value": 6,
"unit": "h"
},
"frequency": true
}
},
"performer": {
"organization": [
{
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.1393"
}
],
"name": [
"Community Health and Hospitals"
]
}
]
},
"drug_vehicle": {
"name": "Aerosol",
"code": "324049",
"code_system_name": "RXNORM"
},
"precondition": {
"code": {
"code": "ASSERTION",
"code_system_name": "ActCode"
},
"value": {
"name": "Wheezing",
"code": "56018004",
"code_system_name": "SNOMED CT"
}
},
"indication": {
"identifiers": [
{
"identifier": "db734647-fc99-424c-a864-7e3cda82e703",
"extension": "45665"
}
],
"code": {
"name": "Finding",
"code": "404684003",
"code_system_name": "SNOMED CT"
},
"date_time": {
"low": {
"date": "2007-01-03T00:00:00.000Z",
"precision": "day"
}
},
"value": {
"name": "Pneumonia",
"code": "233604007",
"code_system_name": "SNOMED CT"
}
},
"dispense": {
"identifiers": [
{
"identifier": "1.2.3.4.56789.1",
"extension": "cb734647-fc99-424c-a864-7e3cda82e704"
}
],
"performer": {
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.456",
"extension": "2981823"
}
],
"address": [
{
"street_lines": [
"1001 Village Avenue"
],
"city": "Portland",
"state": "OR",
"zip": "99123",
"country": "US"
}
],
"organization": [
{
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.1393"
}
],
"name": [
"Community Health and Hospitals"
]
}
]
}
}
}
],
"encounters": [
{
"encounter": {
"name": "Office outpatient visit 15 minutes",
"code": "99213",
"code_system_name": "CPT",
"translations": [
{
"name": "Ambulatory",
"code": "AMB",
"code_system_name": "ActCode"
}
]
},
"identifiers": [
{
"identifier": "2a620155-9d11-439e-92b3-5d9815ff4de8"
}
],
"date_time": {
"point": {
"date": "2009-02-27T08:00:00.000Z",
"precision": "second"
}
},
"performers": [
{
"identifiers": [
{
"identifier": "PseduoMD-3"
}
],
"code": [
{
"name": "General Physician",
"code": "59058001",
"code_system_name": "SNOMED CT"
}
]
}
],
"locations": [
{
"name": "Community Urgent Care Center",
"location_type": {
"name": "Urgent Care Center",
"code": "1160-1",
"code_system_name": "HealthcareServiceLocation"
},
"address": [
{
"street_lines": [
"17 Daws Rd."
],
"city": "Blue Bell",
"state": "MA",
"zip": "02368",
"country": "US"
}
]
}
],
"findings": [
{
"identifiers": [
{
"identifier": "db734647-fc99-424c-a864-7e3cda82e703",
"extension": "45665"
}
],
"value": {
"name": "Pneumonia",
"code": "233604007",
"code_system_name": "SNOMED CT"
},
"date_time": {
"low": {
"date": "2007-01-03T00:00:00.000Z",
"precision": "day"
}
}
}
]
}
],
"allergies": [
{
"identifiers": [
{
"identifier": "36e3e930-7b14-11db-9fe1-0800200c9a66"
}
],
"date_time": {
"point": {
"date": "2007-05-01T00:00:00.000Z",
"precision": "day"
}
},
"observation": {
"identifiers": [
{
"identifier": "4adc1020-7b14-11db-9fe1-0800200c9a66"
}
],
"allergen": {
"name": "ALLERGENIC EXTRACT, PENICILLIN",
"code": "314422",
"code_system_name": "RXNORM"
},
"intolerance": {
"name": "Propensity to adverse reactions to drug",
"code": "419511003",
"code_system_name": "SNOMED CT"
},
"date_time": {
"low": {
"date": "2007-05-01T00:00:00.000Z",
"precision": "day"
}
},
"status": {
"name": "Inactive",
"code": "73425007",
"code_system_name": "SNOMED CT"
},
"reactions": [
{
"identifiers": [
{
"identifier": "4adc1020-7b14-11db-9fe1-0800200c9a64"
}
],
"date_time": {
"low": {
"date": "2007-05-01T00:00:00.000Z",
"precision": "day"
},
"high": {
"date": "2009-02-27T08:00:00.000Z",
"precision": "second"
}
},
"reaction": {
"name": "Nausea",
"code": "422587007",
"code_system_name": "SNOMED CT"
},
"severity": {
"code": {
"name": "Mild",
"code": "255604002",
"code_system_name": "SNOMED CT"
},
"interpretation": {
"name": "Suceptible",
"code": "S",
"code_system_name": "Observation Interpretation"
}
}
}
],
"severity": {
"code": {
"name": "Moderate to severe",
"code": "371924009",
"code_system_name": "SNOMED CT"
},
"interpretation": {
"name": "Normal",
"code": "N",
"code_system_name": "Observation Interpretation"
}
}
}
},
{
"identifiers": [
{
"identifier": "36e3e930-7b14-11db-9fe1-0800200c9a66"
}
],
"date_time": {
"point": {
"date": "2006-05-01T00:00:00.000Z",
"precision": "day"
}
},
"observation": {
"identifiers": [
{
"identifier": "4adc1020-7b14-11db-9fe1-0800200c9a66"
}
],
"allergen": {
"name": "Codeine",
"code": "2670",
"code_system_name": "RXNORM"
},
"intolerance": {
"name": "Propensity to adverse reactions to drug",
"code": "419511003",
"code_system_name": "SNOMED CT"
},
"date_time": {
"low": {
"date": "2006-05-01T00:00:00.000Z",
"precision": "day"
}
},
"status": {
"name": "Active",
"code": "55561003",
"code_system_name": "SNOMED CT"
},
"reactions": [
{
"identifiers": [
{
"identifier": "4adc1020-7b14-11db-9fe1-0800200c9a64"
}
],
"date_time": {
"low": {
"date": "2006-05-01T00:00:00.000Z",
"precision": "day"
},
"high": {
"date": "2009-02-27T08:00:00.000Z",
"precision": "second"
}
},
"reaction": {
"name": "Wheezing",
"code": "56018004",
"code_system_name": "SNOMED CT"
},
"severity": {
"code": {
"name": "Mild",
"code": "255604002",
"code_system_name": "SNOMED CT"
},
"interpretation": {
"name": "Suceptible",
"code": "S",
"code_system_name": "Observation Interpretation"
}
}
}
],
"severity": {
"code": {
"name": "Moderate",
"code": "6736007",
"code_system_name": "SNOMED CT"
},
"interpretation": {
"name": "Normal",
"code": "N",
"code_system_name": "Observation Interpretation"
}
}
}
},
{
"identifiers": [
{
"identifier": "36e3e930-7b14-11db-9fe1-0800200c9a66"
}
],
"date_time": {
"point": {
"date": "2008-05-01T00:00:00.000Z",
"precision": "day"
}
},
"observation": {
"identifiers": [
{
"identifier": "4adc1020-7b14-11db-9fe1-0800200c9a66"
}
],
"allergen": {
"name": "Aspirin",
"code": "1191",
"code_system_name": "RXNORM"
},
"intolerance": {
"name": "Drug intolerance",
"code": "59037007",
"code_system_name": "SNOMED CT"
},
"date_time": {
"low": {
"date": "2008-05-01T00:00:00.000Z",
"precision": "day"
}
},
"status": {
"name": "Active",
"code": "55561003",
"code_system_name": "SNOMED CT"
},
"reactions": [
{
"identifiers": [
{
"identifier": "4adc1020-7b14-11db-9fe1-0800200c9a64"
}
],
"date_time": {
"low": {
"date": "2008-05-01T00:00:00.000Z",
"precision": "day"
},
"high": {
"date": "2009-02-27T08:00:00.000Z",
"precision": "second"
}
},
"reaction": {
"name": "Hives",
"code": "247472004",
"code_system_name": "SNOMED CT"
},
"severity": {
"code": {
"name": "Mild to moderate",
"code": "371923003",
"code_system_name": "SNOMED CT"
},
"interpretation": {
"name": "Suceptible",
"code": "S",
"code_system_name": "Observation Interpretation"
}
}
}
],
"severity": {
"code": {
"name": "Mild to moderate",
"code": "371923003",
"code_system_name": "SNOMED CT"
},
"interpretation": {
"name": "Normal",
"code": "N",
"code_system_name": "Observation Interpretation"
}
}
}
}
],
"immunizations": [
{
"date_time": {
"point": {
"date": "1999-11-01T00:00:00.000Z",
"precision": "month"
}
},
"identifiers": [
{
"identifier": "e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"
}
],
"status": "complete",
"product": {
"product": {
"name": "Influenza virus vaccine",
"code": "88",
"code_system_name": "CVX",
"translations": [
{
"name": "Influenza, seasonal, injectable",
"code": "141",
"code_system_name": "CVX"
}
]
},
"lot_number": "1",
"manufacturer": "Health LS - Immuno Inc."
},
"administration": {
"route": {
"name": "Intramuscular injection",
"code": "C28161",
"code_system_name": "Medication Route FDA"
},
"dose": {
"value": 50,
"unit": "mcg"
}
},
"performer": {
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.456",
"extension": "2981824"
}
],
"name": [
{
"last": "Assigned",
"first": "Amanda"
}
],
"address": [
{
"street_lines": [
"1021 Health Drive"
],
"city": "Ann Arbor",
"state": "MI",
"zip": "99099",
"country": "US"
}
],
"organization": [
{
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.1394"
}
],
"name": [
"Good Health Clinic"
]
}
]
},
"instructions": {
"code": {
"name": "immunization education",
"code": "171044003",
"code_system_name": "SNOMED CT"
},
"free_text": "Possible flu-like symptoms for three days."
}
},
{
"date_time": {
"point": {
"date": "1998-12-15T00:00:00.000Z",
"precision": "day"
}
},
"identifiers": [
{
"identifier": "e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"
}
],
"status": "refused",
"product": {
"product": {
"name": "Influenza virus vaccine",
"code": "88",
"code_system_name": "CVX",
"translations": [
{
"name": "Influenza, seasonal, injectable",
"code": "141",
"code_system_name": "CVX"
}
]
},
"lot_number": "1",
"manufacturer": "Health LS - Immuno Inc."
},
"administration": {
"route": {
"name": "Intramuscular injection",
"code": "C28161",
"code_system_name": "Medication Route FDA"
},
"dose": {
"value": 50,
"unit": "mcg"
}
},
"performer": {
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.456",
"extension": "2981824"
}
],
"name": [
{
"last": "Assigned",
"first": "Amanda"
}
],
"address": [
{
"street_lines": [
"1021 Health Drive"
],
"city": "Ann Arbor",
"state": "MI",
"zip": "99099",
"country": "US"
}
],
"organization": [
{
"identifiers": [
{
"identifier": "2.16.840.1.113883.19.5.9999.1394"
}
],
"name": [
"Good Health Clinic"
]
}
]
},
"instructions": {
"code": {
"name": "immunization education",
"code": "171044003",
"code_system_name": "SNOMED CT"
},
"free_text": "Possible flu-like symptoms for three days."
}
},
{
"date_time": {
"point": {
"date": "1998-12-15T00:00:00.000Z",
"precision": "day"
}
},
"identifiers": [
{
"identifier": "e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"
}
],
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{
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}
]
},
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},
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},
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}
},
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{
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}
],
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{
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}
],
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{
"street_lines": [
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],
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}
],
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{
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{
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],
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}
]
}
},
{
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}
},
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{
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],
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"product": {
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"translations": [
{
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}
]
},
"lot_number": "1",
"manufacturer": "Health LS - Immuno Inc."
},
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},
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},
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],
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],
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],
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}
],
"organization": [
{
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}
],
"name": [
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]
}
]
},
"refusal_reason": "Patient objection"
}
],
"social_history": [
{
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},
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},
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],
"code": {
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},
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},
{
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},
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],
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},
"value": "1 pack per day"
},
{
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],
"code": {
"name": "Tobacco use and exposure",
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},
"value": "None"
},
{
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},
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],
"code": {
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},
"value": "None"
}
],
"problems": [
{
"date_time": {
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},
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],
"problem": {
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},
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}
},
"onset_age": "57",
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"status": {
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},
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}
},
"patient_status": "Alive and well",
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{
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