{
  "resourceType": "Bundle",
  "id": "syn-onc-0007-core",
  "meta": {
    "security": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  },
  "type": "collection",
  "timestamp": "2026-07-27T12:00:00-04:00",
  "entry": [
    {
      "fullUrl": "https://rwednesdays.com/fhir/Patient/syn-onc-0007",
      "resource": {
        "resourceType": "Patient",
        "id": "syn-onc-0007",
        "extension": [
          {
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
            "extension": [
              {
                "url": "ombCategory",
                "valueCoding": {
                  "system": "urn:oid:2.16.840.1.113883.6.238",
                  "code": "2054-5",
                  "display": "Black or African American"
                }
              },
              {
                "url": "text",
                "valueString": "Black or African American"
              }
            ]
          },
          {
            "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
            "extension": [
              {
                "url": "ombCategory",
                "valueCoding": {
                  "system": "urn:oid:2.16.840.1.113883.6.238",
                  "code": "2186-5",
                  "display": "Not Hispanic or Latino"
                }
              },
              {
                "url": "text",
                "valueString": "Not Hispanic or Latino"
              }
            ]
          }
        ],
        "identifier": [
          {
            "system": "https://rwednesdays.com/fhir/naming/ehr-patient-token",
            "value": "ehrtok_9b7a2d"
          },
          {
            "system": "https://rwednesdays.com/fhir/naming/claims-patient-token",
            "value": "clmtok_51fd90"
          }
        ],
        "gender": "female",
        "address": [
          {
            "postalCode": "303",
            "state": "US-South",
            "country": "US"
          }
        ],
        "communication": [
          {
            "language": {
              "coding": [
                {
                  "system": "urn:ietf:bcp:47",
                  "code": "en",
                  "display": "English"
                }
              ]
            },
            "preferred": true
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Condition/cond-1",
      "resource": {
        "resourceType": "Condition",
        "id": "cond-1",
        "clinicalStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
              "code": "active"
            }
          ]
        },
        "verificationStatus": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
              "code": "confirmed"
            }
          ]
        },
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/condition-category",
                "code": "problem-list-item",
                "display": "Problem List Item"
              }
            ]
          }
        ],
        "code": {
          "coding": [
            {
              "system": "http://hl7.org/fhir/sid/icd-10-cm",
              "code": "C34.11",
              "display": "Malignant neoplasm of upper lobe, right bronchus or lung"
            }
          ],
          "text": "Lung adenocarcinoma, right upper lobe"
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "onsetDateTime": "2024-01-18",
        "stage": [
          {
            "summary": {
              "text": "Stage IVB"
            },
            "type": {
              "coding": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "260998006",
                  "display": "Clinical staging"
                }
              ]
            }
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Encounter/enc-6",
      "resource": {
        "resourceType": "Encounter",
        "id": "enc-6",
        "status": "finished",
        "class": {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "EMER",
          "display": "emergency"
        },
        "priority": {
          "text": "ESI 2"
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "period": {
          "start": "2024-07-21T18:42:00-04:00",
          "end": "2024-07-21T23:58:00-04:00"
        },
        "reasonCode": [
          {
            "text": "shortness of breath and right-sided pleuritic chest pain"
          }
        ],
        "location": [
          {
            "location": {
              "display": "Hospital ED"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Encounter/enc-7",
      "resource": {
        "resourceType": "Encounter",
        "id": "enc-7",
        "status": "finished",
        "class": {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "IMP",
          "display": "inpatient encounter"
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "period": {
          "start": "2024-07-21",
          "end": "2024-07-24"
        },
        "reasonCode": [
          {
            "coding": [
              {
                "system": "http://hl7.org/fhir/sid/icd-10-cm",
                "code": "J91.0",
                "display": "Malignant pleural effusion"
              }
            ]
          }
        ],
        "hospitalization": {
          "admitSource": {
            "text": "emergency department"
          },
          "dischargeDisposition": {
            "text": "home with home health"
          }
        },
        "location": [
          {
            "location": {
              "display": "7 East oncology floor"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Encounter/enc-8",
      "resource": {
        "resourceType": "Encounter",
        "id": "enc-8",
        "status": "finished",
        "class": {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code": "IMP",
          "display": "inpatient encounter"
        },
        "serviceType": {
          "text": "interventional radiology"
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "period": {
          "start": "2024-07-22",
          "end": "2024-07-22"
        },
        "reasonCode": [
          {
            "text": "ultrasound-guided thoracentesis"
          }
        ],
        "location": [
          {
            "location": {
              "display": "IR procedure suite"
            }
          }
        ],
        "partOf": {
          "reference": "Encounter/enc-7"
        }
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/MedicationRequest/medrx-1",
      "resource": {
        "resourceType": "MedicationRequest",
        "id": "medrx-1",
        "extension": [
          {
            "url": "https://rwednesdays.com/fhir/StructureDefinition/line-of-therapy",
            "valueInteger": 1
          }
        ],
        "status": "stopped",
        "statusReason": {
          "text": "radiographic progression / non-response"
        },
        "intent": "order",
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "1721581",
              "display": "osimertinib 80 MG Oral Tablet"
            }
          ]
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "authoredOn": "2024-02-09",
        "dosageInstruction": [
          {
            "text": "80 mg oral daily"
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/MedicationDispense/disp-1",
      "resource": {
        "resourceType": "MedicationDispense",
        "id": "disp-1",
        "status": "completed",
        "medicationCodeableConcept": {
          "coding": [
            {
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "1721581",
              "display": "osimertinib 80 MG Oral Tablet"
            }
          ]
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "authorizingPrescription": [
          {
            "reference": "MedicationRequest/medrx-1"
          }
        ],
        "quantity": {
          "value": 30,
          "unit": "tablet",
          "system": "http://unitsofmeasure.org",
          "code": "{tbl}"
        },
        "daysSupply": {
          "value": 30,
          "unit": "days",
          "system": "http://unitsofmeasure.org",
          "code": "d"
        },
        "whenHandedOver": "2024-02-09"
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Observation/lab-2",
      "resource": {
        "resourceType": "Observation",
        "id": "lab-2",
        "status": "final",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory"
              }
            ]
          }
        ],
        "code": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "2039-6",
              "display": "Carcinoembryonic Ag [Mass/volume] in Serum or Plasma"
            }
          ],
          "text": "CEA"
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "effectiveDateTime": "2024-07-15",
        "valueQuantity": {
          "value": 21.4,
          "unit": "ng/mL",
          "system": "http://unitsofmeasure.org",
          "code": "ng/mL"
        },
        "interpretation": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation",
                "code": "H",
                "display": "High"
              }
            ]
          }
        ],
        "referenceRange": [
          {
            "low": {
              "value": 0.0,
              "unit": "ng/mL"
            },
            "high": {
              "value": 3.0,
              "unit": "ng/mL"
            }
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Observation/ecog-1",
      "resource": {
        "resourceType": "Observation",
        "id": "ecog-1",
        "status": "final",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "survey"
              }
            ]
          }
        ],
        "code": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "89247-1",
              "display": "ECOG Performance Status score"
            }
          ]
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "effectiveDateTime": "2024-02-09",
        "valueInteger": 1,
        "interpretation": [
          {
            "coding": [
              {
                "system": "http://loinc.org",
                "code": "LA9623-5",
                "display": "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature"
              }
            ]
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Observation/egfr-1",
      "resource": {
        "resourceType": "Observation",
        "id": "egfr-1",
        "status": "final",
        "category": [
          {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/observation-category",
                "code": "laboratory"
              }
            ]
          }
        ],
        "code": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "69548-6",
              "display": "Genetic variant assessment"
            }
          ],
          "text": "EGFR exon 19 deletion"
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "effectiveDateTime": "2024-02-02",
        "valueCodeableConcept": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "LA9633-4",
              "display": "Present"
            }
          ]
        },
        "note": [
          {
            "text": "Tumor NGS panel: EGFR exon 19 deletion detected. Source record anc-path-1."
          }
        ]
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Procedure/proc-1",
      "resource": {
        "resourceType": "Procedure",
        "id": "proc-1",
        "status": "completed",
        "code": {
          "coding": [
            {
              "system": "http://www.ama-assn.org/go/cpt",
              "code": "32555",
              "display": "Thoracentesis with imaging guidance"
            }
          ]
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "performedDateTime": "2024-07-22",
        "encounter": {
          "reference": "Encounter/enc-8"
        }
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/Coverage/cov-1",
      "resource": {
        "resourceType": "Coverage",
        "id": "cov-1",
        "status": "active",
        "type": {
          "text": "commercial"
        },
        "subscriberId": "sub_44fd19",
        "beneficiary": {
          "reference": "Patient/syn-onc-0007"
        },
        "period": {
          "start": "2023-12-01",
          "end": "2024-12-31"
        },
        "payor": [
          {
            "display": "Synthetic Commercial Health Plan"
          }
        ],
        "relationship": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code": "self"
            }
          ]
        }
      }
    },
    {
      "fullUrl": "https://rwednesdays.com/fhir/DocumentReference/docref-1",
      "resource": {
        "resourceType": "DocumentReference",
        "id": "docref-1",
        "status": "current",
        "type": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "11506-3",
              "display": "Progress note"
            }
          ]
        },
        "subject": {
          "reference": "Patient/syn-onc-0007"
        },
        "date": "2024-08-05T17:58:00-04:00",
        "author": [
          {
            "display": "Thoracic medical oncology attending (synthetic)"
          }
        ],
        "description": "Oncology progress note, progression visit (full text)",
        "content": [
          {
            "attachment": {
              "contentType": "text/plain",
              "language": "en",
              "data": "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",
              "title": "Oncology progress note 2024-08-05"
            }
          }
        ]
      }
    }
  ]
}
