{
  "resourceType" : "Parameters",
  "id" : "provider-member-match-request-001",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-parameters-multi-member-match-bundle-in"]
  },
  "parameter" : [{
    "name" : "MemberBundle",
    "part" : [{
      "name" : "MemberPatient",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "patient-prov-001",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Robert Michael Johnson - DOB: 1965-08-15, Male</p></div>"
        },
        "identifier" : [{
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code" : "MB"
            }]
          },
          "system" : "http://example.org/provider-org/patient-ids",
          "value" : "PAT-001",
          "assigner" : {
            "display" : "Provider Organization"
          }
        }],
        "name" : [{
          "use" : "official",
          "family" : "Johnson",
          "given" : ["Robert",
          "Michael"]
        }],
        "telecom" : [{
          "system" : "phone",
          "value" : "555-123-4567"
        }],
        "gender" : "male",
        "birthDate" : "1965-08-15",
        "address" : [{
          "use" : "home",
          "line" : ["123 Main Street"],
          "city" : "Springfield",
          "state" : "IL",
          "postalCode" : "62701"
        }]
      }
    },
    {
      "name" : "CoverageToMatch",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "coverage-to-match-001",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Coverage for Robert Johnson - Subscriber ID: 12345678, Previous Health Plan, PPO-GOLD</p></div>"
        },
        "status" : "draft",
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "HIP",
            "display" : "health insurance plan policy"
          }]
        },
        "subscriber" : {
          "reference" : "Patient/patient-prov-001"
        },
        "subscriberId" : "12345678",
        "beneficiary" : {
          "reference" : "Patient/patient-prov-001"
        },
        "relationship" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
            "code" : "self"
          }]
        },
        "period" : {
          "start" : "2023-01-01",
          "end" : "2023-12-31"
        },
        "payor" : [{
          "identifier" : {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "9876543210"
          },
          "display" : "Previous Health Plan"
        }],
        "class" : [{
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code" : "group"
            }]
          },
          "value" : "EMPLOY-12345"
        },
        {
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code" : "plan"
            }]
          },
          "value" : "PPO-GOLD"
        }]
      }
    },
    {
      "name" : "Consent",
      "resource" : {
        "resourceType" : "Consent",
        "id" : "treatment-attestation-001",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Treatment Attestation by Dr. Susan Smith for Robert Johnson - Treatment relationship since 2024-01-15</p></div>"
        },
        "status" : "active",
        "scope" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
            "code" : "patient-privacy"
          }]
        },
        "category" : [{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "IDSCL",
            "display" : "Information Disclosure"
          }]
        },
        {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "64292-6",
            "display" : "Release of information consent"
          }]
        }],
        "patient" : {
          "reference" : "Patient/patient-prov-001"
        },
        "dateTime" : "2024-12-10T14:30:00Z",
        "performer" : [{
          "identifier" : {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1234567893"
          },
          "display" : "Dr. Susan Smith, MD"
        }],
        "organization" : [{
          "identifier" : {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1982947230"
          },
          "display" : "Springfield Medical Center"
        }],
        "sourceReference" : {
          "reference" : "DocumentReference/treatment-attestation-form-001",
          "display" : "Provider Attestation Form"
        },
        "policy" : [{
          "authority" : "https://example.org/compliance",
          "uri" : "https://example.org/provider-attestation-policy"
        }],
        "provision" : {
          "type" : "permit",
          "period" : {
            "start" : "2024-01-15"
          },
          "actor" : [{
            "role" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                "code" : "IRCP",
                "display" : "information recipient"
              }]
            },
            "reference" : {
              "identifier" : {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "1234567893"
              },
              "display" : "Dr. Susan Smith"
            }
          }],
          "purpose" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
            "code" : "TREAT",
            "display" : "treatment"
          }]
        }
      }
    }]
  },
  {
    "name" : "MemberBundle",
    "part" : [{
      "name" : "MemberPatient",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "patient-prov-002",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Sarah Elizabeth Williams - DOB: 1978-03-22, Female</p></div>"
        },
        "identifier" : [{
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code" : "MB"
            }]
          },
          "system" : "http://example.org/provider-org/patient-ids",
          "value" : "PAT-002",
          "assigner" : {
            "display" : "Provider Organization"
          }
        }],
        "name" : [{
          "use" : "official",
          "family" : "Williams",
          "given" : ["Sarah",
          "Elizabeth"]
        }],
        "telecom" : [{
          "system" : "phone",
          "value" : "555-987-6543"
        }],
        "gender" : "female",
        "birthDate" : "1978-03-22",
        "address" : [{
          "use" : "home",
          "line" : ["456 Oak Avenue"],
          "city" : "Columbus",
          "state" : "OH",
          "postalCode" : "43085"
        }]
      }
    },
    {
      "name" : "CoverageToMatch",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "coverage-to-match-002",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Coverage for Sarah Williams - Subscriber ID: 87654321, Another Health Plan, HMO-BASIC</p></div>"
        },
        "status" : "draft",
        "type" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "HIP",
            "display" : "health insurance plan policy"
          }]
        },
        "subscriber" : {
          "reference" : "Patient/patient-prov-002"
        },
        "subscriberId" : "87654321",
        "beneficiary" : {
          "reference" : "Patient/patient-prov-002"
        },
        "relationship" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
            "code" : "self"
          }]
        },
        "period" : {
          "start" : "2023-06-01",
          "end" : "2024-05-31"
        },
        "payor" : [{
          "identifier" : {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1111111111"
          },
          "display" : "Another Health Plan"
        }],
        "class" : [{
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code" : "group"
            }]
          },
          "value" : "EMPLOY-67890"
        },
        {
          "type" : {
            "coding" : [{
              "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
              "code" : "plan"
            }]
          },
          "value" : "HMO-BASIC"
        }]
      }
    },
    {
      "name" : "Consent",
      "resource" : {
        "resourceType" : "Consent",
        "id" : "treatment-attestation-002",
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Treatment Attestation by Dr. James Brown for Sarah Williams - Treatment relationship since 2024-02-01</p></div>"
        },
        "status" : "active",
        "scope" : {
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
            "code" : "patient-privacy"
          }]
        },
        "category" : [{
          "coding" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "IDSCL",
            "display" : "Information Disclosure"
          }]
        },
        {
          "coding" : [{
            "system" : "http://loinc.org",
            "code" : "64292-6",
            "display" : "Release of information consent"
          }]
        }],
        "patient" : {
          "reference" : "Patient/patient-prov-002"
        },
        "dateTime" : "2024-12-09T10:15:00Z",
        "performer" : [{
          "identifier" : {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "9876543210"
          },
          "display" : "Dr. James Brown, MD"
        }],
        "organization" : [{
          "identifier" : {
            "system" : "http://hl7.org/fhir/sid/us-npi",
            "value" : "1122334455"
          },
          "display" : "Columbus Clinic"
        }],
        "sourceReference" : {
          "reference" : "DocumentReference/treatment-attestation-form-002",
          "display" : "Provider Attestation Form"
        },
        "policy" : [{
          "uri" : "https://example.org/provider-attestation-policy"
        }],
        "provision" : {
          "type" : "permit",
          "period" : {
            "start" : "2024-02-01"
          },
          "actor" : [{
            "role" : {
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                "code" : "IRCP",
                "display" : "information recipient"
              }]
            },
            "reference" : {
              "identifier" : {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "9876543210"
              },
              "display" : "Dr. James Brown"
            }
          }],
          "purpose" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
            "code" : "TREAT",
            "display" : "treatment"
          }]
        }
      }
    }]
  }]
}