diff --git a/backend/pkg/auth/utils.go b/backend/pkg/auth/utils.go deleted file mode 100644 index 77709b7e..00000000 --- a/backend/pkg/auth/utils.go +++ /dev/null @@ -1,56 +0,0 @@ -package auth - -import ( - "errors" - "github.com/golang-jwt/jwt" - "time" -) - -//TODO: this should match the ID and username for the user. -type JWTClaim struct { - Username string `json:"username"` - UserId string `json:"user_id"` - Email string `json:"email"` - jwt.StandardClaims -} - -func GenerateJWT(encryptionKey string, username string, userId string) (tokenString string, err error) { - expirationTime := time.Now().Add(2 * time.Hour) - claims := &JWTClaim{ - Username: username, - Email: username, - UserId: userId, - StandardClaims: jwt.StandardClaims{ - ExpiresAt: expirationTime.Unix(), - }, - } - token := jwt.NewWithClaims(jwt.SigningMethodHS256, claims) - tokenString, err = token.SignedString([]byte(encryptionKey)) - return -} - -func ValidateToken(encryptionKey string, signedToken string) (*JWTClaim, error) { - token, err := jwt.ParseWithClaims( - signedToken, - &JWTClaim{}, - func(token *jwt.Token) (interface{}, error) { - if jwt.SigningMethodHS256 != token.Method { - return nil, errors.New("Invalid signing algorithm") - } - return []byte(encryptionKey), nil - }, - ) - if err != nil { - return nil, err - } - claims, ok := token.Claims.(*JWTClaim) - if !ok { - err = errors.New("couldn't parse claims") - return nil, err - } - if claims.ExpiresAt < time.Now().Local().Unix() { - err = errors.New("token expired") - return nil, err - } - return claims, nil -} diff --git a/backend/pkg/config/config.go b/backend/pkg/config/config.go index e79fee66..189ea40b 100644 --- a/backend/pkg/config/config.go +++ b/backend/pkg/config/config.go @@ -27,6 +27,12 @@ func (c *configuration) Init() error { c.SetDefault("web.src.frontend.path", "/opt/fasten/web") c.SetDefault("web.database.location", "/opt/fasten/db/fasten.db") //TODO: should be /opt/fasten/fasten.db + c.SetDefault("web.couchdb.scheme", "http") + c.SetDefault("web.couchdb.host", "localhost") + c.SetDefault("web.couchdb.port", "5984") + c.SetDefault("web.couchdb.admin_username", "admin") + c.SetDefault("web.couchdb.admin_password", "mysecretpassword") + c.SetDefault("log.level", "INFO") c.SetDefault("log.file", "") diff --git a/backend/pkg/database/couchdb_repository.go b/backend/pkg/database/couchdb_repository.go new file mode 100644 index 00000000..92ac650e --- /dev/null +++ b/backend/pkg/database/couchdb_repository.go @@ -0,0 +1,88 @@ +package database + +import ( + "context" + "fmt" + "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" + "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" + "github.com/go-kivik/couchdb/v3" + _ "github.com/go-kivik/couchdb/v3" // The CouchDB driver + "github.com/go-kivik/kivik/v3" + "github.com/sirupsen/logrus" +) + +func NewRepository(appConfig config.Interface, globalLogger logrus.FieldLogger) (DatabaseRepository, error) { + //backgroundContext := context.Background() + + //////////////////////////////////////////////////////////////////////////////////////////////////////////////////// + // Gorm/SQLite setup + //////////////////////////////////////////////////////////////////////////////////////////////////////////////////// + globalLogger.Infof("Trying to connect to sqlite db: %s\n", appConfig.GetString("web.database.location")) + + // When a transaction cannot lock the database, because it is already locked by another one, + // SQLite by default throws an error: database is locked. This behavior is usually not appropriate when + // concurrent access is needed, typically when multiple processes write to the same database. + // PRAGMA busy_timeout lets you set a timeout or a handler for these events. When setting a timeout, + // SQLite will try the transaction multiple times within this timeout. + // fixes #341 + // https://rsqlite.r-dbi.org/reference/sqlitesetbusyhandler + // retrying for 30000 milliseconds, 30seconds - this would be unreasonable for a distributed multi-tenant application, + // but should be fine for local usage. + + couchdbUrl := fmt.Sprintf("%s://%s:%s", appConfig.GetString("web.couchdb.scheme"), appConfig.GetString("web.couchdb.host"), appConfig.GetString("web.couchdb.port")) + database, err := kivik.New("couch", couchdbUrl) + if err != nil { + return nil, fmt.Errorf("Failed to connect to database! - %v", err) + } + + err = database.Authenticate(context.Background(), + couchdb.BasicAuth( + appConfig.GetString("web.couchdb.admin_username"), + appConfig.GetString("web.couchdb.admin_password")), + ) + + if err != nil { + return nil, fmt.Errorf("Failed to authenticate to database! - %v", err) + } + globalLogger.Infof("Successfully connected to coubdb: %s\n", couchdbUrl) + + deviceRepo := couchdbRepository{ + appConfig: appConfig, + logger: globalLogger, + client: database, + } + return &deviceRepo, nil +} + +type couchdbRepository struct { + appConfig config.Interface + logger logrus.FieldLogger + + client *kivik.Client +} + +type couchDbUser struct { + ID string `json:"_id"` + Name string `json:"name"` + Type string `json:"type"` + Roles []string `json:"roles"` + Password string `json:"password"` +} + +func (cr *couchdbRepository) CreateUser(ctx context.Context, user *models.User) error { + + newUser := &couchDbUser{ + ID: fmt.Sprintf("%s%s", kivik.UserPrefix, user.Username), + Name: user.Username, + Type: "user", + Roles: []string{}, + Password: user.Password, + } + db := cr.client.DB(ctx, "_users") + _, err := db.Put(ctx, newUser.ID, newUser) + return err +} + +func (cr *couchdbRepository) Close() error { + return nil +} diff --git a/backend/pkg/database/interface.go b/backend/pkg/database/interface.go index 7b009f1f..b5ec98ae 100644 --- a/backend/pkg/database/interface.go +++ b/backend/pkg/database/interface.go @@ -10,21 +10,4 @@ type DatabaseRepository interface { Close() error CreateUser(context.Context, *models.User) error - GetUserByEmail(context.Context, string) (*models.User, error) - GetCurrentUser(context.Context) *models.User - - GetSummary(ctx context.Context) (*models.Summary, error) - - UpsertResource(context.Context, *models.ResourceFhir) error - GetResourceBySourceType(context.Context, string, string) (*models.ResourceFhir, error) - GetResourceBySourceId(context.Context, string, string) (*models.ResourceFhir, error) - ListResources(context.Context, models.ListResourceQueryOptions) ([]models.ResourceFhir, error) - GetPatientForSources(ctx context.Context) ([]models.ResourceFhir, error) - //UpsertProfile(context.Context, *models.Profile) error - //UpsertOrganziation(context.Context, *models.Organization) error - - CreateSource(context.Context, *models.Source) error - GetSource(context.Context, string) (*models.Source, error) - GetSourceSummary(context.Context, string) (*models.SourceSummary, error) - GetSources(context.Context) ([]models.Source, error) } diff --git a/backend/pkg/database/sqlite_repository.go b/backend/pkg/database/sqlite_repository.go deleted file mode 100644 index d8354c76..00000000 --- a/backend/pkg/database/sqlite_repository.go +++ /dev/null @@ -1,378 +0,0 @@ -package database - -import ( - "context" - "encoding/json" - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/gin-gonic/gin" - "github.com/glebarez/sqlite" - "github.com/google/uuid" - "github.com/sirupsen/logrus" - "gorm.io/gorm" - "net/url" -) - -func NewRepository(appConfig config.Interface, globalLogger logrus.FieldLogger) (DatabaseRepository, error) { - //backgroundContext := context.Background() - - //////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - // Gorm/SQLite setup - //////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - globalLogger.Infof("Trying to connect to sqlite db: %s\n", appConfig.GetString("web.database.location")) - - // When a transaction cannot lock the database, because it is already locked by another one, - // SQLite by default throws an error: database is locked. This behavior is usually not appropriate when - // concurrent access is needed, typically when multiple processes write to the same database. - // PRAGMA busy_timeout lets you set a timeout or a handler for these events. When setting a timeout, - // SQLite will try the transaction multiple times within this timeout. - // fixes #341 - // https://rsqlite.r-dbi.org/reference/sqlitesetbusyhandler - // retrying for 30000 milliseconds, 30seconds - this would be unreasonable for a distributed multi-tenant application, - // but should be fine for local usage. - pragmaStr := sqlitePragmaString(map[string]string{ - "busy_timeout": "30000", - "foreign_keys": "ON", - }) - database, err := gorm.Open(sqlite.Open(appConfig.GetString("web.database.location")+pragmaStr), &gorm.Config{ - //TODO: figure out how to log database queries again. - //Logger: logger - DisableForeignKeyConstraintWhenMigrating: true, - }) - if err != nil { - return nil, fmt.Errorf("Failed to connect to database! - %v", err) - } - globalLogger.Infof("Successfully connected to scrutiny sqlite db: %s\n", appConfig.GetString("web.database.location")) - - //TODO: automigrate for now - err = database.AutoMigrate( - &models.User{}, - &models.Source{}, - &models.ResourceFhir{}, - ) - if err != nil { - return nil, fmt.Errorf("Failed to automigrate! - %v", err) - } - - // create/update admin user - adminUser := models.User{} - err = database.FirstOrCreate(&adminUser, models.User{Username: "admin"}).Error - if err != nil { - return nil, fmt.Errorf("Failed to create admin user! - %v", err) - } - - deviceRepo := sqliteRepository{ - appConfig: appConfig, - logger: globalLogger, - gormClient: database, - } - return &deviceRepo, nil -} - -type sqliteRepository struct { - appConfig config.Interface - logger logrus.FieldLogger - - gormClient *gorm.DB -} - -func (sr *sqliteRepository) Close() error { - return nil -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// User -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - -func (sr *sqliteRepository) CreateUser(ctx context.Context, user *models.User) error { - if err := user.HashPassword(user.Password); err != nil { - return err - } - record := sr.gormClient.Create(user) - if record.Error != nil { - return record.Error - } - return nil -} -func (sr *sqliteRepository) GetUserByEmail(ctx context.Context, username string) (*models.User, error) { - var foundUser models.User - result := sr.gormClient.Where(models.User{Username: username}).First(&foundUser) - return &foundUser, result.Error -} - -func (sr *sqliteRepository) GetCurrentUser(ctx context.Context) *models.User { - ginCtx := ctx.(*gin.Context) - var currentUser models.User - sr.gormClient.First(¤tUser, models.User{Username: ginCtx.MustGet("AUTH_USERNAME").(string)}) - - return ¤tUser -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// User -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - -func (sr *sqliteRepository) GetSummary(ctx context.Context) (*models.Summary, error) { - - // we want a count of all resources for this user by type - var resourceCountResults []map[string]interface{} - - //group by resource type and return counts - // SELECT source_resource_type as resource_type, COUNT(*) as count FROM resource_fhirs WHERE source_id = "53c1e930-63af-46c9-b760-8e83cbc1abd9" GROUP BY source_resource_type; - result := sr.gormClient.WithContext(ctx). - Model(models.ResourceFhir{}). - Select("source_id, source_resource_type as resource_type, count(*) as count"). - Group("source_resource_type"). - Where(models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - }). - Scan(&resourceCountResults) - if result.Error != nil { - return nil, result.Error - } - - // we want a list of all sources (when they were last updated) - sources, err := sr.GetSources(ctx) - if err != nil { - return nil, err - } - - // we want the main Patient for each source - patients, err := sr.GetPatientForSources(ctx) - if err != nil { - return nil, err - } - - summary := &models.Summary{ - Sources: sources, - ResourceTypeCounts: resourceCountResults, - Patients: patients, - } - - return summary, nil -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Resource -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - -func (sr *sqliteRepository) UpsertResource(ctx context.Context, resourceModel *models.ResourceFhir) error { - sr.logger.Infof("insert/update (%T) %v", resourceModel, resourceModel) - - if sr.gormClient.Debug().WithContext(ctx). - Where(models.OriginBase{ - SourceID: resourceModel.GetSourceID(), - SourceResourceID: resourceModel.GetSourceResourceID(), - SourceResourceType: resourceModel.GetSourceResourceType(), //TODO: and UpdatedAt > old UpdatedAt - }).Updates(resourceModel).RowsAffected == 0 { - sr.logger.Infof("resource does not exist, creating: %s %s %s", resourceModel.GetSourceID(), resourceModel.GetSourceResourceID(), resourceModel.GetSourceResourceType()) - return sr.gormClient.Debug().Create(resourceModel).Error - } - return nil -} - -func (sr *sqliteRepository) ListResources(ctx context.Context, queryOptions models.ListResourceQueryOptions) ([]models.ResourceFhir, error) { - - queryParam := models.ResourceFhir{ - OriginBase: models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - }, - } - - if len(queryOptions.SourceResourceType) > 0 { - queryParam.OriginBase.SourceResourceType = queryOptions.SourceResourceType - } - - if len(queryOptions.SourceID) > 0 { - sourceUUID, err := uuid.Parse(queryOptions.SourceID) - if err != nil { - return nil, err - } - - queryParam.OriginBase.SourceID = sourceUUID - } - - manifestJson, _ := json.MarshalIndent(queryParam, "", " ") - sr.logger.Infof("THE QUERY OBJECT===========> %v", string(manifestJson)) - - var wrappedResourceModels []models.ResourceFhir - results := sr.gormClient.WithContext(ctx). - Where(queryParam). - Find(&wrappedResourceModels) - - return wrappedResourceModels, results.Error -} - -func (sr *sqliteRepository) GetResourceBySourceType(ctx context.Context, sourceResourceType string, sourceResourceId string) (*models.ResourceFhir, error) { - queryParam := models.ResourceFhir{ - OriginBase: models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - SourceResourceType: sourceResourceType, - SourceResourceID: sourceResourceId, - }, - } - - var wrappedResourceModel models.ResourceFhir - results := sr.gormClient.WithContext(ctx). - Where(queryParam). - First(&wrappedResourceModel) - - return &wrappedResourceModel, results.Error -} - -func (sr *sqliteRepository) GetResourceBySourceId(ctx context.Context, sourceId string, sourceResourceId string) (*models.ResourceFhir, error) { - sourceIdUUID, err := uuid.Parse(sourceId) - if err != nil { - return nil, err - } - - queryParam := models.ResourceFhir{ - OriginBase: models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - SourceID: sourceIdUUID, - SourceResourceID: sourceResourceId, - }, - } - - var wrappedResourceModel models.ResourceFhir - results := sr.gormClient.WithContext(ctx). - Where(queryParam). - First(&wrappedResourceModel) - - return &wrappedResourceModel, results.Error -} - -// Get the patient for each source (for the current user) -func (sr *sqliteRepository) GetPatientForSources(ctx context.Context) ([]models.ResourceFhir, error) { - - //SELECT * FROM resource_fhirs WHERE user_id = "" and source_resource_type = "Patient" GROUP BY source_id - - //var sourceCred models.Source - //results := sr.gormClient.WithContext(ctx). - // Where(models.Source{UserID: sr.GetCurrentUser(ctx).ID, ModelBase: models.ModelBase{ID: sourceUUID}}). - // First(&sourceCred) - - var wrappedResourceModels []models.ResourceFhir - results := sr.gormClient.WithContext(ctx). - Model(models.ResourceFhir{}). - Group("source_id"). - Where(models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - SourceResourceType: "Patient", - }). - Find(&wrappedResourceModels) - - return wrappedResourceModels, results.Error -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Source -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - -func (sr *sqliteRepository) CreateSource(ctx context.Context, sourceCreds *models.Source) error { - sourceCreds.UserID = sr.GetCurrentUser(ctx).ID - - if sr.gormClient.WithContext(ctx). - Where(models.Source{ - UserID: sourceCreds.UserID, - SourceType: sourceCreds.SourceType, - PatientId: sourceCreds.PatientId}).Updates(sourceCreds).RowsAffected == 0 { - return sr.gormClient.WithContext(ctx).Create(sourceCreds).Error - } - return nil -} - -func (sr *sqliteRepository) GetSource(ctx context.Context, sourceId string) (*models.Source, error) { - sourceUUID, err := uuid.Parse(sourceId) - if err != nil { - return nil, err - } - - var sourceCred models.Source - results := sr.gormClient.WithContext(ctx). - Where(models.Source{UserID: sr.GetCurrentUser(ctx).ID, ModelBase: models.ModelBase{ID: sourceUUID}}). - First(&sourceCred) - - return &sourceCred, results.Error -} - -func (sr *sqliteRepository) GetSourceSummary(ctx context.Context, sourceId string) (*models.SourceSummary, error) { - sourceUUID, err := uuid.Parse(sourceId) - if err != nil { - return nil, err - } - - sourceSummary := &models.SourceSummary{} - - source, err := sr.GetSource(ctx, sourceId) - if err != nil { - return nil, err - } - sourceSummary.Source = source - - //group by resource type and return counts - // SELECT source_resource_type as resource_type, COUNT(*) as count FROM resource_fhirs WHERE source_id = "53c1e930-63af-46c9-b760-8e83cbc1abd9" GROUP BY source_resource_type; - - var resourceTypeCounts []map[string]interface{} - - result := sr.gormClient.WithContext(ctx). - Model(models.ResourceFhir{}). - Select("source_id, source_resource_type as resource_type, count(*) as count"). - Group("source_resource_type"). - Where(models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - SourceID: sourceUUID, - }). - Scan(&resourceTypeCounts) - - if result.Error != nil { - return nil, result.Error - } - - sourceSummary.ResourceTypeCounts = resourceTypeCounts - - //set patient - var wrappedPatientResourceModel models.ResourceFhir - results := sr.gormClient.WithContext(ctx). - Where(models.OriginBase{ - UserID: sr.GetCurrentUser(ctx).ID, - SourceResourceType: "Patient", - SourceID: sourceUUID, - }). - First(&wrappedPatientResourceModel) - - if results.Error != nil { - return nil, result.Error - } - sourceSummary.Patient = &wrappedPatientResourceModel - - return sourceSummary, nil -} - -func (sr *sqliteRepository) GetSources(ctx context.Context) ([]models.Source, error) { - - var sourceCreds []models.Source - results := sr.gormClient.WithContext(ctx). - Where(models.Source{UserID: sr.GetCurrentUser(ctx).ID}). - Find(&sourceCreds) - - return sourceCreds, results.Error -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Utilities -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// - -func sqlitePragmaString(pragmas map[string]string) string { - q := url.Values{} - for key, val := range pragmas { - q.Add("_pragma", key+"="+val) - } - - queryStr := q.Encode() - if len(queryStr) > 0 { - return "?" + queryStr - } - return "" -} diff --git a/backend/pkg/hub/README.md b/backend/pkg/hub/README.md deleted file mode 100644 index 773704d4..00000000 --- a/backend/pkg/hub/README.md +++ /dev/null @@ -1,12 +0,0 @@ -# Hub - -The Fasten Hub is a semi stand-alone application that can retrieve data from various Medical Providers, transform it, and -store it in the database. This code will eventually be moved into its own repository. - -# Types - -There are multiple protocols used by the Medical Provider industry to transfer patient data, the following mechanisms are the -ones that Fasten supports - -### FHIR - diff --git a/backend/pkg/hub/factory.go b/backend/pkg/hub/factory.go deleted file mode 100644 index b863bdf4..00000000 --- a/backend/pkg/hub/factory.go +++ /dev/null @@ -1,58 +0,0 @@ -package hub - -import ( - "context" - "errors" - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/aetna" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/athena" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/bluebutton" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/careevolution" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/cerner" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/cigna" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/epic" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/healthit" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/logica" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/manual" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -func NewClient(sourceType pkg.SourceType, ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, credentials models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - - var sourceClient base.Client - var updatedSource *models.Source - var err error - switch sourceType { - case pkg.SourceTypeAetna: - sourceClient, updatedSource, err = aetna.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeAthena: - sourceClient, updatedSource, err = athena.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeAnthem: - sourceClient, updatedSource, err = cigna.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeBlueButtonMedicare: - sourceClient, updatedSource, err = bluebutton.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeCareEvolution: - sourceClient, updatedSource, err = careevolution.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeCerner: - sourceClient, updatedSource, err = cerner.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeCigna: - sourceClient, updatedSource, err = cigna.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeEpic: - sourceClient, updatedSource, err = epic.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeHealthIT: - sourceClient, updatedSource, err = healthit.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeLogica: - sourceClient, updatedSource, err = logica.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - case pkg.SourceTypeManual: - sourceClient, updatedSource, err = manual.NewClient(ctx, appConfig, globalLogger, credentials, testHttpClient...) - default: - return nil, updatedSource, errors.New(fmt.Sprintf("Unknown Source Type: %s", sourceType)) - } - - return sourceClient, updatedSource, err -} diff --git a/backend/pkg/hub/internal/fhir/aetna/client.go b/backend/pkg/hub/internal/fhir/aetna/client.go deleted file mode 100644 index c5f6d219..00000000 --- a/backend/pkg/hub/internal/fhir/aetna/client.go +++ /dev/null @@ -1,49 +0,0 @@ -package aetna - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type AetnaClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - return AetnaClient{ - baseClient, - }, updatedSource, err -} - -//Overrides - -func (c AetnaClient) SyncAll(db database.DatabaseRepository) error { - - bundle, err := c.GetResourceBundle("Patient") - if err != nil { - c.Logger.Infof("An error occurred while getting patient bundle %s", c.Source.PatientId) - return err - } - - wrappedResourceModels, err := c.ProcessBundle(bundle) - if err != nil { - c.Logger.Infof("An error occurred while processing patient bundle %s", c.Source.PatientId) - return err - } - //todo, create the resources in dependency order - - for _, apiModel := range wrappedResourceModels { - err = db.UpsertResource(context.Background(), &apiModel) - if err != nil { - c.Logger.Info("An error occurred while upserting resource") - return err - } - } - return nil -} diff --git a/backend/pkg/hub/internal/fhir/athena/client.go b/backend/pkg/hub/internal/fhir/athena/client.go deleted file mode 100644 index 33d54727..00000000 --- a/backend/pkg/hub/internal/fhir/athena/client.go +++ /dev/null @@ -1,49 +0,0 @@ -package athena - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type AthenaClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - return AthenaClient{ - baseClient, - }, updatedSource, err -} - -func (c AthenaClient) SyncAll(db database.DatabaseRepository) error { - supportedResources := []string{ - "AllergyIntolerance", - //"Binary", - "CarePlan", - "CareTeam", - "Condition", - "Device", - "DiagnosticReport", - "DocumentReference", - "Encounter", - "Goal", - "Immunization", - //"Location", - //"Medication", - //"MedicationRequest", - "Observation", - //"Organization", - //"Patient", - //"Practitioner", - "Procedure", - //"Provenance", - } - - return c.SyncAllByResourceName(db, supportedResources) -} diff --git a/backend/pkg/hub/internal/fhir/base/base_client.go b/backend/pkg/hub/internal/fhir/base/base_client.go deleted file mode 100644 index a2b3565c..00000000 --- a/backend/pkg/hub/internal/fhir/base/base_client.go +++ /dev/null @@ -1,154 +0,0 @@ -package base - -import ( - "context" - "encoding/json" - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "golang.org/x/oauth2" - "io" - "log" - "net/http" - "net/url" - "os" - "strings" - "time" -) - -type BaseClient struct { - Context context.Context - AppConfig config.Interface - Logger logrus.FieldLogger - - OauthClient *http.Client - Source models.Source - Headers map[string]string -} - -func (c *BaseClient) SyncAllBundle(db database.DatabaseRepository, bundleFile *os.File) error { - panic("SyncAllBundle functionality is not available on this client") -} - -func NewBaseClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (*BaseClient, *models.Source, error) { - var httpClient *http.Client - var updatedSource *models.Source - if len(testHttpClient) == 0 { - //check if we need to refresh the access token - //https://github.com/golang/oauth2/issues/84#issuecomment-520099526 - // https://chromium.googlesource.com/external/github.com/golang/oauth2/+/8f816d62a2652f705144857bbbcc26f2c166af9e/oauth2.go#239 - conf := &oauth2.Config{ - ClientID: source.ClientId, - ClientSecret: "", - Endpoint: oauth2.Endpoint{ - AuthURL: source.OauthAuthorizationEndpoint, - TokenURL: source.OauthTokenEndpoint, - }, - //RedirectURL: "", - //Scopes: nil, - } - token := &oauth2.Token{ - TokenType: "Bearer", - RefreshToken: source.RefreshToken, - AccessToken: source.AccessToken, - Expiry: time.Unix(source.ExpiresAt, 0), - } - if token.Expiry.Before(time.Now()) { // expired so let's update it - log.Println("access token expired, refreshing...") - src := conf.TokenSource(ctx, token) - newToken, err := src.Token() // this actually goes and renews the tokens - if err != nil { - return nil, nil, err - } - if newToken.AccessToken != token.AccessToken { - token = newToken - - // update the "source" credential with new data (which will need to be sent - updatedSource = &source - updatedSource.AccessToken = newToken.AccessToken - updatedSource.ExpiresAt = newToken.Expiry.Unix() - // Don't overwrite `RefreshToken` with an empty value - // if this was a token refreshing request. - if newToken.RefreshToken != "" { - updatedSource.RefreshToken = newToken.RefreshToken - } - - } - } - - // OLD CODE - httpClient = oauth2.NewClient(ctx, oauth2.StaticTokenSource(token)) - - } else { - //Testing mode. - httpClient = testHttpClient[0] - } - - httpClient.Timeout = 10 * time.Second - - return &BaseClient{ - Context: ctx, - AppConfig: appConfig, - Logger: globalLogger, - OauthClient: httpClient, - Source: source, - Headers: map[string]string{}, - }, updatedSource, nil -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// HttpClient -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func (c *BaseClient) GetRequest(resourceSubpathOrNext string, decodeModelPtr interface{}) error { - resourceUrl, err := url.Parse(resourceSubpathOrNext) - if err != nil { - return err - } - if !resourceUrl.IsAbs() { - resourceUrl, err = url.Parse(fmt.Sprintf("%s/%s", strings.TrimRight(c.Source.ApiEndpointBaseUrl, "/"), strings.TrimLeft(resourceSubpathOrNext, "/"))) - } - if err != nil { - return err - } - - req, err := http.NewRequest(http.MethodGet, resourceUrl.String(), nil) - if err != nil { - return err - } - - for key, val := range c.Headers { - //req.Header.Add("Accept", "application/json+fhir") - req.Header.Add(key, val) - } - - //resp, err := c.OauthClient.Get(url) - resp, err := c.OauthClient.Do(req) - - if err != nil { - return err - } - defer resp.Body.Close() - - if resp.StatusCode >= 300 || resp.StatusCode < 200 { - b, _ := io.ReadAll(resp.Body) - return fmt.Errorf("An error occurred during request %s - %d - %s [%s]", resourceUrl, resp.StatusCode, resp.Status, string(b)) - } - - err = ParseBundle(resp.Body, decodeModelPtr) - return err -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Helper Functions -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func ParseBundle(r io.Reader, decodeModelPtr interface{}) error { - decoder := json.NewDecoder(r) - //decoder.DisallowUnknownFields() //make sure we throw an error if unknown fields are present. - err := decoder.Decode(decodeModelPtr) - if err != nil { - return err - } - return err -} diff --git a/backend/pkg/hub/internal/fhir/base/fhir401_client.go b/backend/pkg/hub/internal/fhir/base/fhir401_client.go deleted file mode 100644 index 8aaab185..00000000 --- a/backend/pkg/hub/internal/fhir/base/fhir401_client.go +++ /dev/null @@ -1,208 +0,0 @@ -package base - -import ( - "context" - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/fastenhealth/gofhir-models/fhir401" - fhirutils "github.com/fastenhealth/gofhir-models/fhir401/utils" - "github.com/samber/lo" - "github.com/sirupsen/logrus" - "gorm.io/datatypes" - "net/http" -) - -type FHIR401Client struct { - *BaseClient -} - -func NewFHIR401Client(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (*FHIR401Client, *models.Source, error) { - baseClient, updatedSource, err := NewBaseClient(ctx, appConfig, globalLogger, source, testHttpClient...) - return &FHIR401Client{ - baseClient, - }, updatedSource, err -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Sync -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func (c *FHIR401Client) SyncAll(db database.DatabaseRepository) error { - - bundle, err := c.GetPatientBundle(c.Source.PatientId) - if err != nil { - return err - } - - wrappedResourceModels, err := c.ProcessBundle(bundle) - if err != nil { - c.Logger.Infof("An error occurred while processing patient bundle %s", c.Source.PatientId) - return err - } - //todo, create the resources in dependency order - - for _, apiModel := range wrappedResourceModels { - err = db.UpsertResource(context.Background(), &apiModel) - if err != nil { - return err - } - } - return nil -} - -//TODO, find a way to sync references that cannot be searched by patient ID. -func (c *FHIR401Client) SyncAllByResourceName(db database.DatabaseRepository, resourceNames []string) error { - - //Store the Patient - patientResource, err := c.GetPatient(c.Source.PatientId) - if err != nil { - return err - } - patientJson, err := patientResource.MarshalJSON() - if err != nil { - return err - } - - patientResourceType, patientResourceId := patientResource.ResourceRef() - patientResourceFhir := models.ResourceFhir{ - OriginBase: models.OriginBase{ - UserID: c.Source.UserID, - SourceID: c.Source.ID, - SourceResourceType: patientResourceType, - SourceResourceID: *patientResourceId, - }, - Payload: datatypes.JSON(patientJson), - } - db.UpsertResource(context.Background(), &patientResourceFhir) - - //error map storage. - syncErrors := map[string]error{} - - //Store all other resources. - for _, resourceType := range resourceNames { - bundle, err := c.GetResourceBundle(fmt.Sprintf("%s?patient=%s", resourceType, c.Source.PatientId)) - if err != nil { - syncErrors[resourceType] = err - continue - } - wrappedResourceModels, err := c.ProcessBundle(bundle) - if err != nil { - c.Logger.Infof("An error occurred while processing %s bundle %s", resourceType, c.Source.PatientId) - syncErrors[resourceType] = err - continue - } - for _, apiModel := range wrappedResourceModels { - err = db.UpsertResource(context.Background(), &apiModel) - if err != nil { - syncErrors[resourceType] = err - continue - } - } - } - - if len(syncErrors) > 0 { - return fmt.Errorf("%d error(s) occurred during sync: %v", len(syncErrors), syncErrors) - } - return nil -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// FHIR -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func (c *FHIR401Client) GetResourceBundle(relativeResourcePath string) (fhir401.Bundle, error) { - - // https://www.hl7.org/fhir/patient-operation-everything.html - bundle := fhir401.Bundle{} - err := c.GetRequest(relativeResourcePath, &bundle) - if err != nil { - return bundle, err - } - var next string - var prev string - var self string - for _, link := range bundle.Link { - if link.Relation == "next" { - next = link.Url - } else if link.Relation == "self" { - self = link.Url - } else if link.Relation == "previous" { - prev = link.Url - } - } - - for len(next) > 0 && next != self && next != prev { - c.Logger.Debugf("Paginated request => %s", next) - nextBundle := fhir401.Bundle{} - err := c.GetRequest(next, &nextBundle) - if err != nil { - return bundle, nil //ignore failures when paginating? - } - bundle.Entry = append(bundle.Entry, nextBundle.Entry...) - - next = "" //reset the pointers - self = "" - prev = "" - for _, link := range nextBundle.Link { - if link.Relation == "next" { - next = link.Url - } else if link.Relation == "self" { - self = link.Url - } else if link.Relation == "previous" { - prev = link.Url - } - } - } - - return bundle, err - -} - -func (c *FHIR401Client) GetPatientBundle(patientId string) (fhir401.Bundle, error) { - return c.GetResourceBundle(fmt.Sprintf("Patient/%s/$everything", patientId)) -} - -func (c *FHIR401Client) GetPatient(patientId string) (fhir401.Patient, error) { - - patient := fhir401.Patient{} - err := c.GetRequest(fmt.Sprintf("Patient/%s", patientId), &patient) - return patient, err -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Process Bundles -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func (c *FHIR401Client) ProcessBundle(bundle fhir401.Bundle) ([]models.ResourceFhir, error) { - - //process each entry in bundle - wrappedResourceModels := lo.FilterMap[fhir401.BundleEntry, models.ResourceFhir](bundle.Entry, func(bundleEntry fhir401.BundleEntry, _ int) (models.ResourceFhir, bool) { - originalResource, _ := fhirutils.MapToResource(bundleEntry.Resource, false) - - resourceType, resourceId := originalResource.(ResourceInterface).ResourceRef() - - // TODO find a way to safely/consistently get the resource updated date (and other metadata) which shoudl be added to the model. - //if originalResource.Meta != nil && originalResource.Meta.LastUpdated != nil { - // if parsed, err := time.Parse(time.RFC3339Nano, *originalResource.Meta.LastUpdated); err == nil { - // patientProfile.UpdatedAt = parsed - // } - //} - if resourceId == nil { - //no resourceId present for this resource, we'll ignore it. - return models.ResourceFhir{}, false - } - - wrappedResourceModel := models.ResourceFhir{ - OriginBase: models.OriginBase{ - ModelBase: models.ModelBase{}, - UserID: c.Source.UserID, - SourceID: c.Source.ID, - SourceResourceID: *resourceId, - SourceResourceType: resourceType, - }, - Payload: datatypes.JSON(bundleEntry.Resource), - } - - return wrappedResourceModel, true - }) - return wrappedResourceModels, nil -} diff --git a/backend/pkg/hub/internal/fhir/base/fhir401_client_test.go b/backend/pkg/hub/internal/fhir/base/fhir401_client_test.go deleted file mode 100644 index f306995f..00000000 --- a/backend/pkg/hub/internal/fhir/base/fhir401_client_test.go +++ /dev/null @@ -1,80 +0,0 @@ -package base - -import ( - "context" - "encoding/json" - mock_config "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config/mock" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/fastenhealth/gofhir-models/fhir401" - "github.com/golang/mock/gomock" - "github.com/sirupsen/logrus" - "github.com/stretchr/testify/require" - "io/ioutil" - "net/http" - "os" - "testing" -) - -// helpers -func readTestFixture(path string) ([]byte, error) { - jsonFile, err := os.Open(path) - if err != nil { - return nil, err - } - defer jsonFile.Close() - return ioutil.ReadAll(jsonFile) -} - -func TestNewFHIR401Client(t *testing.T) { - t.Parallel() - //setup - mockCtrl := gomock.NewController(t) - defer mockCtrl.Finish() - fakeConfig := mock_config.NewMockInterface(mockCtrl) - - testLogger := logrus.WithFields(logrus.Fields{ - "type": "test", - }) - - //test - client, _, err := NewFHIR401Client(context.Background(), fakeConfig, testLogger, models.Source{ - RefreshToken: "test-refresh-token", - AccessToken: "test-access-token", - }, &http.Client{}) - - //assert - require.NoError(t, err) - require.Equal(t, client.Source.AccessToken, "test-access-token") - require.Equal(t, client.Source.RefreshToken, "test-refresh-token") -} - -func TestFHIR401Client_ProcessBundle(t *testing.T) { - t.Parallel() - //setup - mockCtrl := gomock.NewController(t) - defer mockCtrl.Finish() - fakeConfig := mock_config.NewMockInterface(mockCtrl) - testLogger := logrus.WithFields(logrus.Fields{ - "type": "test", - }) - client, _, err := NewFHIR401Client(context.Background(), fakeConfig, testLogger, models.Source{ - RefreshToken: "test-refresh-token", - AccessToken: "test-access-token", - }, &http.Client{}) - require.NoError(t, err) - - jsonBytes, err := readTestFixture("testdata/fixtures/401-R4/bundle/cigna_syntheticuser05-everything.json") - require.NoError(t, err) - var bundle fhir401.Bundle - err = json.Unmarshal(jsonBytes, &bundle) - require.NoError(t, err) - - // test - wrappedResourceModels, err := client.ProcessBundle(bundle) - //log.Printf("%v", wrappedResourceModels) - - //assert - require.NoError(t, err) - require.Equal(t, 11, len(wrappedResourceModels)) - //require.Equal(t, "A00000000000005", profile.SourceResourceID) -} diff --git a/backend/pkg/hub/internal/fhir/base/fhir430_client.go b/backend/pkg/hub/internal/fhir/base/fhir430_client.go deleted file mode 100644 index 2f134fc4..00000000 --- a/backend/pkg/hub/internal/fhir/base/fhir430_client.go +++ /dev/null @@ -1,81 +0,0 @@ -package base - -import ( - "context" - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/fastenhealth/gofhir-models/fhir430" - fhirutils "github.com/fastenhealth/gofhir-models/fhir430/utils" - "github.com/samber/lo" - "github.com/sirupsen/logrus" - "gorm.io/datatypes" - "net/http" -) - -type FHIR430Client struct { - *BaseClient -} - -func NewFHIR430Client(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (*FHIR430Client, *models.Source, error) { - baseClient, updatedSource, err := NewBaseClient(ctx, appConfig, globalLogger, source, testHttpClient...) - return &FHIR430Client{ - baseClient, - }, updatedSource, err -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// FHIR -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func (c *FHIR430Client) GetPatientEverything(patientId string) (*fhir430.Bundle, error) { - - // https://www.hl7.org/fhir/patient-operation-everything.html - bundle := fhir430.Bundle{} - err := c.GetRequest(fmt.Sprintf("Patient/%s/$everything", patientId), &bundle) - return &bundle, err -} - -func (c *FHIR430Client) GetPatient(patientId string) (*fhir430.Patient, error) { - - patient := fhir430.Patient{} - err := c.GetRequest(fmt.Sprintf("Patient/%s", patientId), &patient) - return &patient, err -} - -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -// Process Bundles -//////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -func (c *FHIR430Client) ProcessBundle(bundle fhir430.Bundle) ([]models.ResourceFhir, error) { - - //process each entry in bundle - wrappedResourceModels := lo.FilterMap[fhir430.BundleEntry, models.ResourceFhir](bundle.Entry, func(bundleEntry fhir430.BundleEntry, _ int) (models.ResourceFhir, bool) { - originalResource, _ := fhirutils.MapToResource(bundleEntry.Resource, false) - - resourceType, resourceId := originalResource.(ResourceInterface).ResourceRef() - - // TODO find a way to safely/consistently get the resource updated date (and other metadata) which shoudl be added to the model. - //if originalResource.Meta != nil && originalResource.Meta.LastUpdated != nil { - // if parsed, err := time.Parse(time.RFC3339Nano, *originalResource.Meta.LastUpdated); err == nil { - // patientProfile.UpdatedAt = parsed - // } - //} - if resourceId == nil { - //no resourceId present for this resource, we'll ignore it. - return models.ResourceFhir{}, false - } - - wrappedResourceModel := models.ResourceFhir{ - OriginBase: models.OriginBase{ - ModelBase: models.ModelBase{}, - UserID: c.Source.UserID, - SourceID: c.Source.ID, - SourceResourceID: *resourceId, - SourceResourceType: resourceType, - }, - Payload: datatypes.JSON(bundleEntry.Resource), - } - - return wrappedResourceModel, true - }) - return wrappedResourceModels, nil -} diff --git a/backend/pkg/hub/internal/fhir/base/interface.go b/backend/pkg/hub/internal/fhir/base/interface.go deleted file mode 100644 index b9559811..00000000 --- a/backend/pkg/hub/internal/fhir/base/interface.go +++ /dev/null @@ -1,19 +0,0 @@ -package base - -import ( - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "os" -) - -//go:generate mockgen -source=interface.go -destination=mock/mock_client.go -type Client interface { - GetRequest(resourceSubpath string, decodeModelPtr interface{}) error - SyncAll(db database.DatabaseRepository) error - - //Manual client ONLY functions - SyncAllBundle(db database.DatabaseRepository, bundleFile *os.File) error -} - -type ResourceInterface interface { - ResourceRef() (string, *string) -} diff --git a/backend/pkg/hub/internal/fhir/base/mock/mock_client.go b/backend/pkg/hub/internal/fhir/base/mock/mock_client.go deleted file mode 100644 index 3e4c3dc7..00000000 --- a/backend/pkg/hub/internal/fhir/base/mock/mock_client.go +++ /dev/null @@ -1,116 +0,0 @@ -// Code generated by MockGen. DO NOT EDIT. -// Source: interface.go - -// Package mock_base is a generated GoMock package. -package mock_base - -import ( - os "os" - reflect "reflect" - - database "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - gomock "github.com/golang/mock/gomock" -) - -// MockClient is a mock of Client interface. -type MockClient struct { - ctrl *gomock.Controller - recorder *MockClientMockRecorder -} - -// MockClientMockRecorder is the mock recorder for MockClient. -type MockClientMockRecorder struct { - mock *MockClient -} - -// NewMockClient creates a new mock instance. -func NewMockClient(ctrl *gomock.Controller) *MockClient { - mock := &MockClient{ctrl: ctrl} - mock.recorder = &MockClientMockRecorder{mock} - return mock -} - -// EXPECT returns an object that allows the caller to indicate expected use. -func (m *MockClient) EXPECT() *MockClientMockRecorder { - return m.recorder -} - -// GetRequest mocks base method. -func (m *MockClient) GetRequest(resourceSubpath string, decodeModelPtr interface{}) error { - m.ctrl.T.Helper() - ret := m.ctrl.Call(m, "GetRequest", resourceSubpath, decodeModelPtr) - ret0, _ := ret[0].(error) - return ret0 -} - -// GetRequest indicates an expected call of GetRequest. -func (mr *MockClientMockRecorder) GetRequest(resourceSubpath, decodeModelPtr interface{}) *gomock.Call { - mr.mock.ctrl.T.Helper() - return mr.mock.ctrl.RecordCallWithMethodType(mr.mock, "GetRequest", reflect.TypeOf((*MockClient)(nil).GetRequest), resourceSubpath, decodeModelPtr) -} - -// SyncAll mocks base method. -func (m *MockClient) SyncAll(db database.DatabaseRepository) error { - m.ctrl.T.Helper() - ret := m.ctrl.Call(m, "SyncAll", db) - ret0, _ := ret[0].(error) - return ret0 -} - -// SyncAll indicates an expected call of SyncAll. -func (mr *MockClientMockRecorder) SyncAll(db interface{}) *gomock.Call { - mr.mock.ctrl.T.Helper() - return mr.mock.ctrl.RecordCallWithMethodType(mr.mock, "SyncAll", reflect.TypeOf((*MockClient)(nil).SyncAll), db) -} - -// SyncAllBundle mocks base method. -func (m *MockClient) SyncAllBundle(db database.DatabaseRepository, bundleFile *os.File) error { - m.ctrl.T.Helper() - ret := m.ctrl.Call(m, "SyncAllBundle", db, bundleFile) - ret0, _ := ret[0].(error) - return ret0 -} - -// SyncAllBundle indicates an expected call of SyncAllBundle. -func (mr *MockClientMockRecorder) SyncAllBundle(db, bundleFile interface{}) *gomock.Call { - mr.mock.ctrl.T.Helper() - return mr.mock.ctrl.RecordCallWithMethodType(mr.mock, "SyncAllBundle", reflect.TypeOf((*MockClient)(nil).SyncAllBundle), db, bundleFile) -} - -// MockResourceInterface is a mock of ResourceInterface interface. -type MockResourceInterface struct { - ctrl *gomock.Controller - recorder *MockResourceInterfaceMockRecorder -} - -// MockResourceInterfaceMockRecorder is the mock recorder for MockResourceInterface. -type MockResourceInterfaceMockRecorder struct { - mock *MockResourceInterface -} - -// NewMockResourceInterface creates a new mock instance. -func NewMockResourceInterface(ctrl *gomock.Controller) *MockResourceInterface { - mock := &MockResourceInterface{ctrl: ctrl} - mock.recorder = &MockResourceInterfaceMockRecorder{mock} - return mock -} - -// EXPECT returns an object that allows the caller to indicate expected use. -func (m *MockResourceInterface) EXPECT() *MockResourceInterfaceMockRecorder { - return m.recorder -} - -// ResourceRef mocks base method. -func (m *MockResourceInterface) ResourceRef() (string, *string) { - m.ctrl.T.Helper() - ret := m.ctrl.Call(m, "ResourceRef") - ret0, _ := ret[0].(string) - ret1, _ := ret[1].(*string) - return ret0, ret1 -} - -// ResourceRef indicates an expected call of ResourceRef. -func (mr *MockResourceInterfaceMockRecorder) ResourceRef() *gomock.Call { - mr.mock.ctrl.T.Helper() - return mr.mock.ctrl.RecordCallWithMethodType(mr.mock, "ResourceRef", reflect.TypeOf((*MockResourceInterface)(nil).ResourceRef)) -} diff --git a/backend/pkg/hub/internal/fhir/base/test_helpers.go b/backend/pkg/hub/internal/fhir/base/test_helpers.go deleted file mode 100644 index 3d39514d..00000000 --- a/backend/pkg/hub/internal/fhir/base/test_helpers.go +++ /dev/null @@ -1,51 +0,0 @@ -package base - -import ( - "context" - "crypto/tls" - "github.com/seborama/govcr" - "golang.org/x/oauth2" - "net/http" - "path" - "testing" -) - -func OAuthVcrSetup(t *testing.T, enableRecording bool) *http.Client { - accessToken := "PLACEHOLDER" - if enableRecording { - //this has to be disabled because CI is empty inside docker containers. - accessToken = "" - } - - ts := oauth2.StaticTokenSource( - //setting a real access token here will allow API calls to connect successfully - &oauth2.Token{AccessToken: accessToken}, - ) - - tr := http.DefaultTransport.(*http.Transport) - tr.TLSClientConfig = &tls.Config{ - InsecureSkipVerify: true, //disable certificate validation because we're playing back http requests. - } - insecureClient := http.Client{ - Transport: tr, - } - - ctx := context.WithValue(oauth2.NoContext, oauth2.HTTPClient, insecureClient) - tc := oauth2.NewClient(ctx, ts) - - vcrConfig := govcr.VCRConfig{ - Logging: true, - CassettePath: path.Join("testdata", "govcr-fixtures"), - Client: tc, - - //this line ensures that we do not attempt to create new recordings. - //Comment this out if you would like to make recordings. - DisableRecording: !enableRecording, - } - - // HTTP headers are case-insensitive - vcrConfig.RequestFilters.Add(govcr.RequestDeleteHeaderKeys("User-Agent", "user-agent")) - - vcr := govcr.NewVCR(t.Name(), &vcrConfig) - return vcr.Client -} diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/cigna_syntheticuser05-everything.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/cigna_syntheticuser05-everything.json deleted file mode 100644 index 7512cc65..00000000 --- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/cigna_syntheticuser05-everything.json +++ /dev/null @@ -1,1542 +0,0 @@ -{ - "meta": { - "source": "https://p-hi2.digitaledge.cigna.com" - }, - "entry": [{ - "fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/Patient/ifp-A00000000000005", - "resource": { - "id": "ifp-A00000000000005", - "meta": { - "lastUpdated": "2022-06-20T15:45:22.043000+00:00", - "profile": ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"], - "source": "IFP#CqP06ARvJo9XS9Cl", - "versionId": "1" - }, - "text": { - "div": "
Felecita MONAHAN
IdentifierA00000000000005
Date of birth12 January 2013
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Care Plan for Musculoskeletal care.
Activities:
Care plan is meant to treat Localized, primary osteoarthritis of the hand.
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Care Plan for Lifestyle education regarding hypertension.
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"productOrService": { - "coding": [ - { - "system": "http://hl7.org/fhir/sid/cvx", - "code": "140", - "display": "Influenza, seasonal, injectable, preservative free" - } - ], - "text": "Influenza, seasonal, injectable, preservative free" - }, - "servicedPeriod": { - "start": "2018-12-23T14:48:37-05:00", - "end": "2018-12-23T15:03:37-05:00" - }, - "locationCodeableConcept": { - "coding": [ - { - "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace", - "code": "19", - "display": "Off Campus-Outpatient Hospital" - } - ] - }, - "net": { - "value": 140.52, - "currency": "USD" - }, - "adjudication": [ - { - "category": { - "coding": [ - { - "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", - "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt", - "display": "Line Beneficiary Coinsurance Amount" - } - ] - }, - "amount": { - "value": 28.104000000000003, - "currency": "USD" - } - }, - { - "category": { - "coding": [ - { - "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", - "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt", - "display": "Line Provider Payment Amount" - } - ] - }, - "amount": { - "value": 112.41600000000001, - "currency": "USD" - } - }, - { - "category": { - "coding": [ - { - "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", - "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt", - "display": "Line Submitted Charge Amount" - } - ] - }, - "amount": { - "value": 140.52, - "currency": "USD" - } - }, - { - "category": { - "coding": [ - { - "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", - "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt", - "display": "Line Allowed Charge Amount" - } - ] - }, - "amount": { - "value": 140.52, - "currency": "USD" - } - }, - { - "category": { - "coding": [ - { - "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", - "code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt", - "display": "Line Beneficiary Part B Deductible Amount" - } - ] - }, - "amount": { - "value": 0, - "currency": "USD" - } - }, - { - "category": { - "coding": [ - { - "system": "https://bluebutton.cms.gov/resources/codesystem/adjudication", - "code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd", - "display": "Line Processing Indicator Code" - } - ] - } - } - ] - } - ], - "total": [ - { - "category": { - "coding": [ - { - "system": "http://terminology.hl7.org/CodeSystem/adjudication", - "code": "submitted", - "display": "Submitted Amount" - } - ], - "text": "Submitted Amount" - }, - "amount": { - "value": 129.16, - "currency": "USD" - } - } - ], - "payment": { - "amount": { - "value": 112.41600000000001, - "currency": "USD" - } - } - }, - "request": { - "method": "POST", - "url": "ExplanationOfBenefit" - } - } - ] -} diff --git a/backend/pkg/hub/internal/fhir/bluebutton/client.go b/backend/pkg/hub/internal/fhir/bluebutton/client.go deleted file mode 100644 index a1b86a1f..00000000 --- a/backend/pkg/hub/internal/fhir/bluebutton/client.go +++ /dev/null @@ -1,31 +0,0 @@ -package bluebutton - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type BlueButtonClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - return BlueButtonClient{ - baseClient, - }, updatedSource, err -} - -func (c BlueButtonClient) SyncAll(db database.DatabaseRepository) error { - - supportedResources := []string{ - "ExplanationOfBenefit", - "Coverage", - } - return c.SyncAllByResourceName(db, supportedResources) -} diff --git a/backend/pkg/hub/internal/fhir/careevolution/client.go b/backend/pkg/hub/internal/fhir/careevolution/client.go deleted file mode 100644 index da409648..00000000 --- a/backend/pkg/hub/internal/fhir/careevolution/client.go +++ /dev/null @@ -1,22 +0,0 @@ -package careevolution - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type CareEvolutionClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - baseClient.Headers["Accept"] = "application/json+fhir" - return CareEvolutionClient{ - baseClient, - }, updatedSource, err -} diff --git a/backend/pkg/hub/internal/fhir/cerner/client.go b/backend/pkg/hub/internal/fhir/cerner/client.go deleted file mode 100644 index 1a5e4f64..00000000 --- a/backend/pkg/hub/internal/fhir/cerner/client.go +++ /dev/null @@ -1,53 +0,0 @@ -package cerner - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type CernerClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - baseClient.Headers["Accept"] = "application/json+fhir" - return CernerClient{ - baseClient, - }, updatedSource, err -} - -func (c CernerClient) SyncAll(db database.DatabaseRepository) error { - - supportedResources := []string{ - "AllergyIntolerance", - "CarePlan", - "CareTeam", - "Condition", - "Consent", - "Device", - "Encounter", - "FamilyMemberHistory", - "Goal", - "Immunization", - "InsurancePlan", - "MedicationRequest", - "NutritionOrder", - "Observation", - "Person", - "Procedure", - "Provenance", - "Questionnaire", - "QuestionnaireResponse", - "RelatedPerson", - "Schedule", - "ServiceRequest", - "Slot", - } - return c.SyncAllByResourceName(db, supportedResources) -} diff --git a/backend/pkg/hub/internal/fhir/cigna/client.go b/backend/pkg/hub/internal/fhir/cigna/client.go deleted file mode 100644 index f7142f94..00000000 --- a/backend/pkg/hub/internal/fhir/cigna/client.go +++ /dev/null @@ -1,21 +0,0 @@ -package cigna - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type CignaClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - return CignaClient{ - baseClient, - }, updatedSource, err -} diff --git a/backend/pkg/hub/internal/fhir/cigna/client_test.go b/backend/pkg/hub/internal/fhir/cigna/client_test.go deleted file mode 100644 index 738ec554..00000000 --- a/backend/pkg/hub/internal/fhir/cigna/client_test.go +++ /dev/null @@ -1,48 +0,0 @@ -package cigna - -import ( - "context" - mock_config "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config/mock" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/golang/mock/gomock" - "github.com/sirupsen/logrus" - "github.com/stretchr/testify/require" - "io/ioutil" - "os" - "testing" -) - -func TestCignaClient_SyncAll(t *testing.T) { - t.Parallel() - //setup - mockCtrl := gomock.NewController(t) - defer mockCtrl.Finish() - fakeConfig := mock_config.NewMockInterface(mockCtrl) - - testDatabase, err := ioutil.TempFile("testdata", "fasten.db") - require.NoError(t, err) - defer os.Remove(testDatabase.Name()) - fakeConfig.EXPECT().GetString("web.database.location").AnyTimes().Return(testDatabase.Name()) - testLogger := logrus.WithFields(logrus.Fields{ - "type": "test", - }) - httpClient := base.OAuthVcrSetup(t, false) - client, _, err := NewClient(context.Background(), fakeConfig, testLogger, models.Source{ - SourceType: "cigna", - PatientId: "A00000000000005", - ApiEndpointBaseUrl: "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal", - ClientId: "e434426c-2aaf-413a-a39a-8f5f6130f287", - }, httpClient) - - db, err := database.NewRepository(fakeConfig, testLogger) - require.NoError(t, err) - - //test - err = client.SyncAll(db) - require.NoError(t, err) - - //assert - require.NoError(t, err) -} diff --git a/backend/pkg/hub/internal/fhir/cigna/testdata/govcr-fixtures/TestCignaClient_SyncAll.cassette b/backend/pkg/hub/internal/fhir/cigna/testdata/govcr-fixtures/TestCignaClient_SyncAll.cassette deleted file mode 100644 index c648c11d..00000000 --- a/backend/pkg/hub/internal/fhir/cigna/testdata/govcr-fixtures/TestCignaClient_SyncAll.cassette +++ /dev/null @@ -1,1101 +0,0 @@ -{ - "Name": "TestCignaClient_SyncAll", - "Tracks": [ - { - "Request": { - "Method": "GET", - "URL": { - "Scheme": "https", - "Opaque": "", - "User": null, - "Host": "p-hi2.digitaledge.cigna.com", - "Path": "/PatientAccess/v1-devportal/Patient/A00000000000005/$everything", - "RawPath": "", - "ForceQuery": false, - "RawQuery": "", - "Fragment": "", - "RawFragment": "" - }, - "Header": {}, - "Body": "" - }, - "Response": { - "Status": "200 OK", - "StatusCode": 200, - "Proto": "HTTP/2.0", - "ProtoMajor": 2, - "ProtoMinor": 0, - "Header": { - "Access-Control-Allow-Origin": [ - "*" - ], - "Cache-Control": [ - "no-store, no-cache" - ], - "Content-Length": [ - "29617" - ], - "Content-Security-Policy": [ - "default-src 'self'" - ], - "Content-Type": [ - "application/json" - ], - "Date": [ - "Thu, 01 Sep 2022 22:28:33 GMT" - ], - "Pragma": [ - "no-cache" - ], - "Referrer-Policy": [ - "no-referrer" - ], - "Strict-Transport-Security": [ - "max-age=31536000; includeSubDomains" - ], - "X-Amz-Apigw-Id": [ - "XzTCxFrJoAMFbTQ=" - ], - "X-Amzn-Requestid": [ - "7b3d2796-acc0-4f28-885e-194076e64c7d" - ], - "X-Amzn-Trace-Id": [ - "Root=1-63113211-0fe0195607ec3be656b70f76;Sampled=0" - ], - "X-Content-Type-Options": [ - "nosniff" - ], - "X-Frame-Options": [ - "DENY" - ], - "X-Request-Id": [ - "1ef80a22-daa0-4872-9a11-67a70f7ef8b9" - ], - "X-Xss-Protection": [ - "1; mode=block" - ] - }, - "Body": "{"meta": {"source": "https://p-hi2.digitaledge.cigna.com"}, "entry": [{"fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/Patient/ifp-A00000000000005", "resource": {"id": "ifp-A00000000000005", "meta": {"lastUpdated": "2022-06-20T15:45:22.043000+00:00", "profile": ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"], "source": "IFP#CqP06ARvJo9XS9Cl", "versionId": "1"}, "text": {"div": "<div 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"OCSPResponse": null, - "TLSUnique": "uRDxMw0NqFZwym3Y" - } - }, - "ErrType": "", - "ErrMsg": "" - } - ] -} \ No newline at end of file diff --git a/backend/pkg/hub/internal/fhir/epic/client.go b/backend/pkg/hub/internal/fhir/epic/client.go deleted file mode 100644 index 5a41e0e1..00000000 --- a/backend/pkg/hub/internal/fhir/epic/client.go +++ /dev/null @@ -1,54 +0,0 @@ -package epic - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type EpicClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - baseClient.Headers["Accept"] = "application/json+fhir" - - return EpicClient{ - baseClient, - }, updatedSource, err -} - -func (c EpicClient) SyncAll(db database.DatabaseRepository) error { - - supportedResources := []string{ - "AllergyIntolerance", - "CarePlan", - "CareTeam", - "Condition", - "Consent", - "Device", - "Encounter", - "FamilyMemberHistory", - "Goal", - "Immunization", - "InsurancePlan", - "MedicationRequest", - "NutritionOrder", - "Observation", - "Person", - "Procedure", - "Provenance", - "Questionnaire", - "QuestionnaireResponse", - "RelatedPerson", - "Schedule", - "ServiceRequest", - "Slot", - } - return c.SyncAllByResourceName(db, supportedResources) -} diff --git a/backend/pkg/hub/internal/fhir/healthit/client.go b/backend/pkg/hub/internal/fhir/healthit/client.go deleted file mode 100644 index e5c5ced8..00000000 --- a/backend/pkg/hub/internal/fhir/healthit/client.go +++ /dev/null @@ -1,54 +0,0 @@ -package healthit - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type HealthItClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - baseClient.Headers["Accept"] = "application/json+fhir" - - return HealthItClient{ - baseClient, - }, updatedSource, err -} - -func (c HealthItClient) SyncAll(db database.DatabaseRepository) error { - - supportedResources := []string{ - "AllergyIntolerance", - "CarePlan", - "CareTeam", - "Condition", - "Consent", - "Device", - "Encounter", - "FamilyMemberHistory", - "Goal", - "Immunization", - "InsurancePlan", - "MedicationRequest", - "NutritionOrder", - "Observation", - "Person", - "Procedure", - "Provenance", - "Questionnaire", - "QuestionnaireResponse", - "RelatedPerson", - "Schedule", - "ServiceRequest", - "Slot", - } - return c.SyncAllByResourceName(db, supportedResources) -} diff --git a/backend/pkg/hub/internal/fhir/logica/client.go b/backend/pkg/hub/internal/fhir/logica/client.go deleted file mode 100644 index e58d81af..00000000 --- a/backend/pkg/hub/internal/fhir/logica/client.go +++ /dev/null @@ -1,21 +0,0 @@ -package logica - -import ( - "context" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/sirupsen/logrus" - "net/http" -) - -type LogicaClient struct { - *base.FHIR401Client -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - baseClient, updatedSource, err := base.NewFHIR401Client(ctx, appConfig, globalLogger, source, testHttpClient...) - return LogicaClient{ - baseClient, - }, updatedSource, err -} diff --git a/backend/pkg/hub/internal/fhir/logica/client_test.go b/backend/pkg/hub/internal/fhir/logica/client_test.go deleted file mode 100644 index 0dd84af3..00000000 --- a/backend/pkg/hub/internal/fhir/logica/client_test.go +++ /dev/null @@ -1,49 +0,0 @@ -package logica - -import ( - "context" - mock_config "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config/mock" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/golang/mock/gomock" - "github.com/sirupsen/logrus" - "github.com/stretchr/testify/require" - "io/ioutil" - "os" - "testing" -) - -func TestLogicaClient_SyncAll(t *testing.T) { - t.Parallel() - //setup - mockCtrl := gomock.NewController(t) - defer mockCtrl.Finish() - fakeConfig := mock_config.NewMockInterface(mockCtrl) - - testDatabase, err := ioutil.TempFile("", "fasten.db") - require.NoError(t, err) - defer os.Remove(testDatabase.Name()) - fakeConfig.EXPECT().GetString("web.database.location").AnyTimes().Return(testDatabase.Name()) - testLogger := logrus.WithFields(logrus.Fields{ - "type": "test", - }) - httpClient := base.OAuthVcrSetup(t, false) - client, _, err := NewClient(context.Background(), fakeConfig, testLogger, models.Source{ - SourceType: "logica", - PatientId: "smart-1288992", - ApiEndpointBaseUrl: "https://api.logicahealth.org/fastenhealth/data", - ClientId: "12b14c49-a4da-42f7-9e6f-2f19db622962", - }, httpClient) - require.NoError(t, err) - - db, err := database.NewRepository(fakeConfig, testLogger) - require.NoError(t, err) - - //test - err = client.SyncAll(db) - require.NoError(t, err) - - //assert - require.NoError(t, err) -} diff --git a/backend/pkg/hub/internal/fhir/logica/testdata/govcr-fixtures/TestLogicaClient_SyncAll.cassette b/backend/pkg/hub/internal/fhir/logica/testdata/govcr-fixtures/TestLogicaClient_SyncAll.cassette deleted file mode 100644 index 360cc2b3..00000000 --- a/backend/pkg/hub/internal/fhir/logica/testdata/govcr-fixtures/TestLogicaClient_SyncAll.cassette +++ /dev/null @@ -1,6617 +0,0 @@ -{ - "Name": "TestLogicaClient_SyncAll", - "Tracks": [ - { - "Request": { - "Method": "GET", - "URL": { - "Scheme": "https", - "Opaque": "", - "User": null, - "Host": "api.logicahealth.org", - "Path": "/fastenhealth/data/Patient/smart-1288992/$everything", - "RawPath": 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"Tue, 27 Sep 2022 03:13:28 GMT" - ], - "Expires": [ - "0" - ], - "Last-Modified": [ - "Tue, 27 Sep 2022 03:12:39 GMT" - ], - "Pragma": [ - "no-cache" - ], - "Strict-Transport-Security": [ - "max-age=31536000 ; includeSubDomains" - ], - "X-Content-Type-Options": [ - "nosniff" - ], - "X-Frame-Options": [ - "DENY" - ], - "X-Powered-By": [ - "HAPI FHIR 5.2.0 REST Server (FHIR Server; FHIR 4.0.1/R4)" - ], - "X-Request-Id": [ - "GCkMg6g1WEZdqJQr" - ], - "X-Xss-Protection": [ - "1; mode=block" - ] - }, - "Body": "{
  "resourceType": "Bundle",
  "id": "2b87e9ea-0af9-429f-abf2-0a72b2e33ad1",
  "meta": {
    "lastUpdated": "2022-09-27T03:12:39.870+00:00"
  },
  "type": "searchset",
  "link": [ {
    "relation": "self",
    "url": "https://api.logicahealth.org/fastenhealth/data/Patient/smart-1288992/$everything"
  }, {
    "relation": "next",
    "url": "https://api.logicahealth.org/fastenhealth/data?_getpages=2b87e9ea-0af9-429f-abf2-0a72b2e33ad1&_getpagesoffset=50&_count=50&_pretty=true&_bundletype=searchset"
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      "meta": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Daniel Adams</div>"
      },
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        "use": "official",
        "type": {
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "MR",
            "display": "Medical Record Number"
          } ],
          "text": "Medical Record Number"
        },
        "system": "http://hospital.smarthealthit.org",
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      } ],
      "active": true,
      "name": [ {
        "use": "official",
        "family": "Adams",
        "given": [ "Daniel", "X" ]
      } ],
      "telecom": [ {
        "system": "email",
        "value": "daniel.adams@example.com"
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      "gender": "male",
      "birthDate": "1925-12-23",
      "address": [ {
        "use": "home",
        "line": [ "1 Hill Ave" ],
        "city": "Tulsa",
        "state": "OK",
        "postalCode": "74117",
        "country": "USA"
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    "search": {
      "mode": "match"
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        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: temperature = 37.0 Cel</div>"
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        "use": "official",
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
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        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "1999-12-21",
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        "reference": "Practitioner/SMART-1234"
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        "value": 37.0,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-197-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-197-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: height = 165.862 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-197-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
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      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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        "value": 165.862,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-180-weight",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: weight = 96.34302 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
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        "unit": "kg",
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        "code": "kg"
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    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-163-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-163-heartrate",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: heart_rate = 43.0 {beats}/min</div>"
      },
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        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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          "display": "Vital Signs"
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        "text": "Vital Signs"
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        "coding": [ {
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        "reference": "Practitioner/SMART-1234"
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        "unit": "{beats}/min",
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        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-247-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-247-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-23: heart_rate = 35.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-247-heartrate"
      } ],
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-278-weight",
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      "resourceType": "Observation",
      "id": "smart-278-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: weight = 89.31234 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-278-weight"
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        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2009-04-08",
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        "code": "kg"
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    "search": {
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    }
  }, {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-23: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-252-oxygensaturation"
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        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-170-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-170-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: heart_rate = 53.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-170-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-20",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 53.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-201-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-201-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: weight = 94.25649 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-201-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 94.25649,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-253-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-253-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: height = 166.624 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-253-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 166.624,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-852",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-852",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-29: Blood pressure 120/72 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-10-29",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 120,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 72,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-851",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-851",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-28: Blood pressure 132/79 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-28",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 132,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 79,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-281-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-281-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: height = 163.322 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-281-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 163.322,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-850",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-850",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-27: Blood pressure 71/43 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-27",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 71,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 43,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-156-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-156-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: heart_rate = 67.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-156-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 67.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-223-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-223-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: bmi = 34.4 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-223-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 34.4,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-246-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-246-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-23: height = 166.624 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-246-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 166.624,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-854",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-854",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-12-01: Blood pressure 100/60 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-12-01",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 100,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 60,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-853",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-853",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-30: Blood pressure 40/25 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-10-30",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 40,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 25,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-241-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-241-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: respiratory_rate = 22.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-241-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 22.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-287-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-287-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-287-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-291-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-291-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-23: temperature = 36.88889 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-291-temperature"
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          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
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          "code": "8310-5",
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        "text": "temperature"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-161-oxygensaturation",
    "resource": {
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        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
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        "text": "oxygen_saturation"
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      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "1997-05-01",
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        "reference": "Practitioner/SMART-1234"
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    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-172-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-172-temperature",
      "meta": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
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        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: temperature = 37.05556 Cel</div>"
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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        "text": "temperature"
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        "reference": "Patient/smart-1288992"
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        "unit": "Cel",
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        "code": "Cel"
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-153-bmi",
    "resource": {
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      "id": "smart-153-bmi",
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        "versionId": "1",
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        "source": "#N3ReKjR75As8Kjhk"
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        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-04-30: bmi = 35.8 kg/m2</div>"
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      "category": [ {
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
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        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "valueQuantity": {
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        "unit": "kg/m2",
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    },
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-188-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-188-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: bmi = 34.6 kg/m2</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
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        "text": "bmi"
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      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2001-01-19",
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      "valueQuantity": {
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        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-220-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
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      "meta": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: respiratory_rate = 20.0 {breaths}/min</div>"
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      "category": [ {
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
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          "code": "9279-1",
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        "text": "respiratory_rate"
      },
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      "valueQuantity": {
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-273-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-273-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-273-oxygensaturation"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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          "code": "2710-2",
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        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
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        "code": "%{HemoglobinSaturation}"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-286-bmi",
    "resource": {
      "resourceType": "Observation",
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        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: bmi = 34.7 kg/m2</div>"
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2009-04-14",
      "performer": [ {
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        "code": "kg/m2"
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    },
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-152-weight",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
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      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-04-30: weight = 97.52236 kg</div>"
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        } ],
        "text": "Vital Signs"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
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        "text": "weight"
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      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "1997-04-30",
      "performer": [ {
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      "valueQuantity": {
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        "code": "kg"
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    },
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-251-bmi",
    "resource": {
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        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
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        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-23: bmi = 33.8 kg/m2</div>"
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        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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          "code": "39156-5",
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        "text": "bmi"
      },
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      },
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    },
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-150-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
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      "meta": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
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      },
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
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        } ],
        "text": "respiratory_rate"
      },
      "subject": {
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      "valueQuantity": {
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        "unit": "{breaths}/min",
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-214-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-214-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
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        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: temperature = 37.05556 Cel</div>"
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
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        "text": "temperature"
      },
      "subject": {
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      "effectiveDateTime": "2001-11-01",
      "performer": [ {
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        "code": "Cel"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-277-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-277-temperature",
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        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: temperature = 36.94444 Cel</div>"
      },
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-277-temperature"
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-08",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
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        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-154-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-154-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-04-30: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-154-oxygensaturation"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-04-30",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-230-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-230-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-05: bmi = 34.2 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-230-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-05",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 34.2,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-258-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-258-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: bmi = 33.0 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-258-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.0,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-248-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-248-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-23: respiratory_rate = 22.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-248-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 22.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-225-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-225-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-05: height = 165.862 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-225-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-05",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 165.862,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-231-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-231-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-05: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-231-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-05",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-181-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-181-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: bmi = 35.2 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-181-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-21",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 35.2,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-218-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-218-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: height = 165.862 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-218-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 165.862,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-289-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-289-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-23: heart_rate = 38.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-289-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 38.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-212-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-212-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: heart_rate = 85.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-212-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 85.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-269-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-269-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-269-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-196-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-196-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-24: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-196-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-166-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-166-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: weight = 99.01921 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-166-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 99.01921,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-853",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-853",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-30: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-10-30",
        "end": "2009-10-30"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-852",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-852",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-29: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-10-29",
        "end": "2009-10-29"
      }
    },
    "search": {
      "mode": "match"
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
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        "text": "temperature"
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        "reference": "Patient/smart-1288992"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-276-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: respiratory_rate = 20.0 {breaths}/min</div>"
      },
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-276-respiratoryrate"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-854",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
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      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-12-01: ambulatory encounter</div>"
      },
      "status": "finished",
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        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
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        "text": "Patient-initiated ambulatory encounter"
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      "subject": {
        "reference": "Patient/smart-1288992"
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        "start": "2009-12-01",
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    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-189-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-189-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-189-oxygensaturation"
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      "status": "unknown",
      "category": [ {
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
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        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 100.0,
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        "code": "%{HemoglobinSaturation}"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-292-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-292-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-23: weight = 86.50006 kg</div>"
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      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-292-weight"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-23",
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        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 86.50006,
        "unit": "kg",
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        "code": "kg"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-199-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-199-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-199-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-237-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-237-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-09: bmi = 32.6 kg/m2</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-237-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-09",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 32.6,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-205-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-205-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: heart_rate = 82.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-205-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-10-31",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 82.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-274-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-274-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: height = 163.322 cm</div>"
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      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-274-height"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-08",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 163.322,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-245-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-245-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-245-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-264-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-264-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: weight = 92.39677 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-264-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 92.39677,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-215-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-215-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: weight = 99.79032 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-215-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 99.79032,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-275-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-275-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: heart_rate = 72.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-275-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-08",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 72.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-265-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-265-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: bmi = 33.3 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-265-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.3,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-193-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-193-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-24: temperature = 37.05556 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-193-temperature"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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          "code": "8310-5",
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  }, {
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    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-148-height",
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-832",
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        "source": "#N3ReKjR75As8Kjhk"
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    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-280-oxygensaturation",
    "resource": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
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        } ],
        "text": "oxygen_saturation"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-839",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-839",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-05: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
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      "type": [ {
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          "display": "Patient-initiated encounter"
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        "text": "Patient-initiated ambulatory encounter"
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      "subject": {
        "reference": "Patient/smart-1288992"
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      "period": {
        "start": "2001-11-05",
        "end": "2001-11-05"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-838",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
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      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: ambulatory encounter</div>"
      },
      "status": "finished",
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      },
      "type": [ {
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        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
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      "period": {
        "start": "2001-11-02",
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    },
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-837",
    "resource": {
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      "id": "smart-837",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
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      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: ambulatory encounter</div>"
      },
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        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
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        "start": "2001-11-01",
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-836",
    "resource": {
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      "id": "smart-836",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: ambulatory encounter</div>"
      },
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      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
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        "coding": [ {
          "system": "http://snomed.info",
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      "period": {
        "start": "2001-10-31",
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        "text": "Vital Signs"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-200-temperature",
    "resource": {
      "resourceType": "Observation",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: temperature = 37.05556 Cel</div>"
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
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        "text": "temperature"
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      "valueQuantity": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-216-bmi",
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        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: bmi = 36.3 kg/m2</div>"
      },
      "identifier": [ {
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        "value": "smart-216-bmi"
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 36.3,
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        "system": "http://unitsofmeasure.org",
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-221-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-221-temperature",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: temperature = 37.05556 Cel</div>"
      },
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        "value": "smart-221-temperature"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-02",
      "performer": [ {
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        "code": "Cel"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-284-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-284-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: temperature = 36.88889 Cel</div>"
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
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          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
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      },
      "effectiveDateTime": "2009-04-14",
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      "valueQuantity": {
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        "code": "Cel"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-198-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-198-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: heart_rate = 80.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-198-heartrate"
      } ],
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      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 80.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-242-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-242-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: temperature = 36.94444 Cel</div>"
      },
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-242-temperature"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.94444,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-260-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-260-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: height = 166.624 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-260-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 166.624,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-263-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-263-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: temperature = 36.94444 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-263-temperature"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.94444,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-259-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-259-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-259-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-178-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-178-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: respiratory_rate = 19.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-178-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-09: respiratory_rate = 22.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-234-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-09",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 22.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-840",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-840",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-09: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2005-02-09",
        "end": "2005-02-09"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-846",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-846",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-04-08",
        "end": "2009-04-08"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-254-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-254-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: heart_rate = 78.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-254-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 78.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-845",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-845",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-04-07",
        "end": "2009-04-07"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-844",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-844",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2005-02-25",
        "end": "2005-02-25"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-843",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-843",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2005-02-24",
        "end": "2005-02-24"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-157-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-157-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-157-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-162-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-162-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: height = 165.1 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-162-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 165.1,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-849",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-849",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-24: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-04-24",
        "end": "2009-04-24"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-848",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-848",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-23: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-04-23",
        "end": "2009-04-23"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-847",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-847",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "2009-04-14",
        "end": "2009-04-14"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-213-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-213-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-213-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-210-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-210-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-210-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-10-31",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-244-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-244-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: bmi = 33.6 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-244-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.6,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-240-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-240-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: heart_rate = 58.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-240-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 58.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-187-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-187-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: weight = 95.0276 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-187-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 95.0276,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-155-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-155-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: height = 164.846 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-155-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 164.846,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-167-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-167-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: bmi = 36.4 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-167-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.4,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-288-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-288-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-23: height = 163.068 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-288-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 163.068,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-255-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-255-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: respiratory_rate = 22.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-255-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 22.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-177-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-177-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: heart_rate = 81.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-177-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-21",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 81.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-272-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-272-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: bmi = 33.9 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-272-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.9,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-283-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-283-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-283-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-279-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-279-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: bmi = 33.5 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-279-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-08",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.5,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-208-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-208-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: weight = 93.30395 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-208-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-10-31",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 93.30395,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-203-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-203-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-203-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-271-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-271-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: weight = 90.26488 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-271-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 90.26488,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-224-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-224-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-224-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-828",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-828",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-04-30: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "1997-04-30",
        "end": "1997-04-30"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-184-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-184-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: heart_rate = 69.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-184-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 69.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-160-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-160-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: bmi = 36.6 kg/m2</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 36.6,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-233-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-233-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-09: heart_rate = 66.0 {beats}/min</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-233-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2005-02-09",
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      "valueQuantity": {
        "value": 66.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-190-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-190-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-24: height = 165.608 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-190-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 165.608,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-829",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-829",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: ambulatory encounter</div>"
      },
      "status": "finished",
      "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "AMB"
      },
      "type": [ {
        "coding": [ {
          "system": "http://snomed.info",
          "code": "270427003",
          "display": "Patient-initiated encounter"
        } ],
        "text": "Patient-initiated ambulatory encounter"
      } ],
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "period": {
        "start": "1997-05-01",
        "end": "1997-05-01"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-164-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-164-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-164-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-211-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-211-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: height = 165.862 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-211-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 165.862,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-204-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-204-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: height = 165.862 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-204-height"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-10-31",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 165.862,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-171-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-171-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: respiratory_rate = 19.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-171-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-20",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 19.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-268-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-268-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: heart_rate = 29.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-268-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 29.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-206-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-206-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-206-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-10-31",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-191-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-191-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-24: heart_rate = 63.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-191-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 63.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-238-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-238-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-09: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-238-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-09",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-168-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-168-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-168-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-227-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-227-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-05: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-227-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
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        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 93.48539,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-174-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-174-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: bmi = 35.4 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-174-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-20",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 35.4,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-829",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-829",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: Blood pressure 107/67 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 107,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 67,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-828",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-828",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-04-30: Blood pressure 87/75 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-04-30",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 87,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 75,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-182-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-182-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-182-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-21",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-217-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-217-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-217-oxygensaturation"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-158-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-158-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: temperature = 37.0 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-158-temperature"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 37.0,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-267-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-267-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: height = 163.322 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-267-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 163.322,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-262-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-262-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: respiratory_rate = 22.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-262-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 22.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-222-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-222-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: weight = 94.57401 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-222-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 94.57401,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-239-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-239-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: height = 166.878 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-239-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 166.878,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-185-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-185-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-185-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-183-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-183-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: height = 165.862 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-183-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 165.862,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-257-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-257-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: weight = 91.62566 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-257-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 91.62566,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-266-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-266-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
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        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
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        "text": "oxygen_saturation"
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        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-841",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: Blood pressure 97/58 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
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        "text": "Blood pressure"
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            "display": "Systolic blood pressure"
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          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 97,
          "unit": "mmHg",
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          "code": "mm[Hg]"
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          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
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        "valueQuantity": {
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          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
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      } ]
    },
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-840",
    "resource": {
      "resourceType": "Observation",
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        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-09: Blood pressure 109/66 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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        "text": "Blood pressure"
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      "subject": {
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      "effectiveDateTime": "2005-02-09",
      "performer": [ {
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        "code": {
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            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 109,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
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      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 66,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
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      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-159-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-159-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-01: weight = 99.60888 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-159-weight"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "valueQuantity": {
        "value": 99.60888,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-845",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-845",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-07: Blood pressure 48/29 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
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      "component": [ {
        "code": {
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            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 48,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 29,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-844",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-844",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-25: Blood pressure 109/66 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-25",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
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      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 109,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 66,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-173-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-173-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: weight = 96.93269 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-173-weight"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-20",
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        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 96.93269,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-843",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-843",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-24: Blood pressure 128/78 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-24",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 128,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 78,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-842",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-842",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-23: Blood pressure 60/35 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
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        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 60,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 35,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-169-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-169-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: height = 165.608 cm</div>"
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      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-169-height"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-20",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 165.608,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-849",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-849",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-24: Blood pressure 105/63 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-24",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 105,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 63,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-848",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-848",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-23: Blood pressure 63/38 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-23",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
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      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 63,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 38,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-847",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-847",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: Blood pressure 125/75 mmHg</div>"
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          "code": "vital-signs",
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        "text": "Vital Signs"
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      "code": {
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        "text": "Blood pressure"
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            "code": "8480-6",
            "display": "Systolic blood pressure"
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          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 125,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
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            "code": "8462-4",
            "display": "Diastolic blood pressure"
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          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 75,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-846",
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-08: Blood pressure 120/72 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
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          "code": "55284-4",
          "display": "Blood pressure"
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        "text": "Blood pressure"
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      "subject": {
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      "effectiveDateTime": "2009-04-08",
      "performer": [ {
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            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 120,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 72,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-285-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-285-weight",
      "meta": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-14: weight = 92.39677 kg</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-285-weight"
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      "status": "unknown",
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
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        "text": "weight"
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        "reference": "Practitioner/SMART-1234"
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        "code": "kg"
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    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-830",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-830",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1997-05-07: Blood pressure 68/43 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 68,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 43,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-834",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-834",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-24: Blood pressure 100/63 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-24",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 100,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 63,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-833",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-833",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-19: Blood pressure 110/69 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 110,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 69,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-832",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-832",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-21: Blood pressure 128/81 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-21",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 128,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 81,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-831",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-831",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: Blood pressure 83/53 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-20",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 83,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 53,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-838",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-838",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-02: Blood pressure 85/54 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 85,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 54,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-837",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-837",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: Blood pressure 138/85 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 138,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 85,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-836",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-836",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-10-31: Blood pressure 133/82 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-10-31",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 133,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      }, {
        "code": {
          "coding": [ {
            "system": "http://loinc.org",
            "code": "8462-4",
            "display": "Diastolic blood pressure"
          } ],
          "text": "Diastolic blood pressure"
        },
        "valueQuantity": {
          "value": 82,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-835",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-835",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-01-25: Blood pressure 129/80 mmHg</div>"
      },
      "status": "final",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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      "resourceType": "Observation",
      "id": "smart-108-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Cholest SerPl-mCnc = 160 mg/dL</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-108-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2093-3",
          "display": "Cholest SerPl-mCnc"
        } ],
        "text": "Cholest SerPl-mCnc"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 160.0,
        "unit": "mg/dL",
        "system": "http://unitsofmeasure.org",
        "code": "mg/dL"
      },
      "referenceRange": [ {
        "low": {
          "value": 0.0,
          "unit": "mg/dL",
          "system": "http://unitsofmeasure.org",
          "code": "mg/dL"
        },
        "high": {
          "value": 200.0,
          "unit": "mg/dL",
          "system": "http://unitsofmeasure.org",
          "code": "mg/dL"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-326-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-326-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-30: temperature = 36.94444 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-326-temperature"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-10-30",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.94444,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-72-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-72-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Nitrite Ur Ql Strip = Negative </div>"
      },
      "extension": [ {
        "url": "http://fhir-registry.smarthealthit.org/StructureDefinition/labs#value-range",
        "valueString": "Positive"
      } ],
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-72-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "5802-4",
          "display": "Nitrite Ur Ql Strip"
        } ],
        "text": "Nitrite Ur Ql Strip"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueString": "Negative"
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-89-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-89-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: MCHC RBC Auto-mCnc = 32.4 g/dL</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-89-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "786-4",
          "display": "MCHC RBC Auto-mCnc"
        } ],
        "text": "MCHC RBC Auto-mCnc"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 32.4,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
      },
      "referenceRange": [ {
        "low": {
          "value": 32.0,
          "unit": "g/dL",
          "system": "http://unitsofmeasure.org",
          "code": "g/dL"
        },
        "high": {
          "value": 36.0,
          "unit": "g/dL",
          "system": "http://unitsofmeasure.org",
          "code": "g/dL"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-302-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-302-height",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-27: height = 163.322 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-302-height"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8302-2",
          "display": "height"
        } ],
        "text": "height"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-27",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 163.322,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-332-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-332-respiratoryrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-12-01: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-332-respiratoryrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-12-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-97-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-97-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: ALT SerPl-cCnc = 13 U/L</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-97-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "1742-6",
          "display": "ALT SerPl-cCnc"
        } ],
        "text": "ALT SerPl-cCnc"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 13.0,
        "unit": "U/L",
        "system": "http://unitsofmeasure.org",
        "code": "U/L"
      },
      "referenceRange": [ {
        "low": {
          "value": 0.0,
          "unit": "U/L",
          "system": "http://unitsofmeasure.org",
          "code": "U/L"
        },
        "high": {
          "value": 45.0,
          "unit": "U/L",
          "system": "http://unitsofmeasure.org",
          "code": "U/L"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-335-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-335-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-12-01: bmi = 34.4 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-335-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-12-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 34.4,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-300-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-300-bmi",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-24: bmi = 33.7 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-300-bmi"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "39156-5",
          "display": "bmi"
        } ],
        "text": "bmi"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.7,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-324-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-324-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-30: heart_rate = 25.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-324-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-10-30",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 25.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-334-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-334-weight",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-12-01: weight = 91.53494 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-334-weight"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-12-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 91.53494,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-79-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-79-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Neutrophils NFr Bld Auto = 59 %</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-79-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "770-8",
          "display": "Neutrophils NFr Bld Auto"
        } ],
        "text": "Neutrophils NFr Bld Auto"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 59.0,
        "unit": "%",
        "system": "http://unitsofmeasure.org",
        "code": "%"
      },
      "referenceRange": [ {
        "low": {
          "value": 50.0,
          "unit": "%",
          "system": "http://unitsofmeasure.org",
          "code": "%"
        },
        "high": {
          "value": 75.0,
          "unit": "%",
          "system": "http://unitsofmeasure.org",
          "code": "%"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/AllergyIntolerance/smart-AllergyIntolerance-28",
    "resource": {
      "resourceType": "AllergyIntolerance",
      "id": "smart-AllergyIntolerance-28",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Sensitivity to sulfonamide antibacterial</div>"
      },
      "clinicalStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical",
          "code": "active"
        } ]
      },
      "verificationStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
          "code": "confirmed"
        } ]
      },
      "category": [ "medication" ],
      "criticality": "low",
      "code": {
        "coding": [ {
          "system": "http://rxnav.nlm.nih.gov/REST/Ndfrt",
          "code": "N0000175503",
          "display": "sulfonamide antibacterial"
        } ],
        "text": "sulfonamide antibacterial"
      },
      "patient": {
        "reference": "Patient/smart-1288992"
      },
      "reaction": [ {
        "manifestation": [ {
          "coding": [ {
            "system": "http://snomed.info/sct",
            "code": "271807003",
            "display": "skin rash"
          } ],
          "text": "skin rash"
        } ],
        "severity": "mild"
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-82-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-82-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Sp Gr Ur Strip = 1.022 </div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-82-lab"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "5811-5",
          "display": "Sp Gr Ur Strip"
        } ],
        "text": "Sp Gr Ur Strip"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 1.022,
        "system": "http://unitsofmeasure.org"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/MedicationRequest/smart-MedicationRequest-139",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "smart-MedicationRequest-139",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Lisinopril 20 MG Oral Tablet (rxnorm: 314077)</div>"
      },
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "314077",
          "display": "Lisinopril 20 MG Oral Tablet"
        } ],
        "text": "Lisinopril 20 MG Oral Tablet"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "dosageInstruction": [ {
        "text": "1 daily",
        "timing": {
          "repeat": {
            "boundsPeriod": {
              "start": "2008-08-13"
            },
            "frequency": 1,
            "period": 1,
            "periodUnit": "d"
          }
        }
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      "dispenseRequest": {
        "numberOfRepeatsAllowed": 1,
        "quantity": {
          "value": 90.0,
          "unit": "{tablet}",
          "system": "http://unitsofmeasure.org",
          "code": "{tablet}"
        },
        "expectedSupplyDuration": {
          "value": 90,
          "unit": "days",
          "system": "http://unitsofmeasure.org",
          "code": "d"
        }
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-70-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-70-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: RBC #/area UrnS HPF = 0 /[HPF]</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-70-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "13945-1",
          "display": "RBC #/area UrnS HPF"
        } ],
        "text": "RBC #/area UrnS HPF"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 0.0,
        "unit": "/[HPF]",
        "system": "http://unitsofmeasure.org",
        "code": "/[HPF]"
      },
      "referenceRange": [ {
        "low": {
          "value": 0.0,
          "unit": "/[HPF]",
          "system": "http://unitsofmeasure.org",
          "code": "/[HPF]"
        },
        "high": {
          "value": 2.0,
          "unit": "/[HPF]",
          "system": "http://unitsofmeasure.org",
          "code": "/[HPF]"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-106-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-106-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Mucous Threads UrnS Ql Micro = Occasional </div>"
      },
      "extension": [ {
        "url": "http://fhir-registry.smarthealthit.org/StructureDefinition/labs#value-range",
        "valueString": "Many"
      } ],
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-106-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8247-9",
          "display": "Mucous Threads UrnS Ql Micro"
        } ],
        "text": "Mucous Threads UrnS Ql Micro"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueString": "Occasional"
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-95-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-95-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Sodium SerPl-sCnc = 139 mmol/L</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-95-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2951-2",
          "display": "Sodium SerPl-sCnc"
        } ],
        "text": "Sodium SerPl-sCnc"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 139.0,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
      },
      "referenceRange": [ {
        "low": {
          "value": 135.0,
          "unit": "mmol/L",
          "system": "http://unitsofmeasure.org",
          "code": "mmol/L"
        },
        "high": {
          "value": 145.0,
          "unit": "mmol/L",
          "system": "http://unitsofmeasure.org",
          "code": "mmol/L"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-301-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-301-oxygensaturation",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-24: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-301-oxygensaturation"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-317-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-317-heartrate",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-29: heart_rate = 72.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-317-heartrate"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-10-29",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 72.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-77-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-77-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Hyaline Casts #/area UrnS LPF = 9 /[LPF]</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-77-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "5796-8",
          "display": "Hyaline Casts #/area UrnS LPF"
        } ],
        "text": "Hyaline Casts #/area UrnS LPF"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 9.0,
        "unit": "/[LPF]",
        "system": "http://unitsofmeasure.org",
        "code": "/[LPF]"
      },
      "referenceRange": [ {
        "low": {
          "value": 0.0,
          "unit": "/[LPF]",
          "system": "http://unitsofmeasure.org",
          "code": "/[LPF]"
        },
        "high": {
          "value": 2.0,
          "unit": "/[LPF]",
          "system": "http://unitsofmeasure.org",
          "code": "/[LPF]"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/MedicationRequest/smart-MedicationRequest-142",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "smart-MedicationRequest-142",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Hydrochlorothiazide 50 MG Oral Tablet (rxnorm: 197770)</div>"
      },
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "197770",
          "display": "Hydrochlorothiazide 50 MG Oral Tablet"
        } ],
        "text": "Hydrochlorothiazide 50 MG Oral Tablet"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "dosageInstruction": [ {
        "text": "1 daily",
        "timing": {
          "repeat": {
            "boundsPeriod": {
              "start": "2008-08-14"
            },
            "frequency": 1,
            "period": 1,
            "periodUnit": "d"
          }
        }
      } ],
      "dispenseRequest": {
        "numberOfRepeatsAllowed": 1,
        "quantity": {
          "value": 90.0,
          "unit": "{tablet}",
          "system": "http://unitsofmeasure.org",
          "code": "{tablet}"
        },
        "expectedSupplyDuration": {
          "value": 90,
          "unit": "days",
          "system": "http://unitsofmeasure.org",
          "code": "d"
        }
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/MedicationRequest/smart-MedicationRequest-143",
    "resource": {
      "resourceType": "MedicationRequest",
      "id": "smart-MedicationRequest-143",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">potassium citrate 10 MEQ Extended Release Tablet (rxnorm: 199381)</div>"
      },
      "status": "active",
      "intent": "order",
      "medicationCodeableConcept": {
        "coding": [ {
          "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
          "code": "199381",
          "display": "potassium citrate 10 MEQ Extended Release Tablet"
        } ],
        "text": "potassium citrate 10 MEQ Extended Release Tablet"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "dosageInstruction": [ {
        "text": "1 daily",
        "timing": {
          "repeat": {
            "boundsPeriod": {
              "start": "2008-09-30"
            },
            "frequency": 1,
            "period": 1,
            "periodUnit": "d"
          }
        }
      } ],
      "dispenseRequest": {
        "numberOfRepeatsAllowed": 1,
        "quantity": {
          "value": 200.0,
          "unit": "{tablet}",
          "system": "http://unitsofmeasure.org",
          "code": "{tablet}"
        },
        "expectedSupplyDuration": {
          "value": 90,
          "unit": "days",
          "system": "http://unitsofmeasure.org",
          "code": "d"
        }
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-319-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-319-temperature",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-29: temperature = 36.94444 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-319-temperature"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
          "display": "Vital Signs"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-10-29",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 36.94444,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-85-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-85-lab",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: TB Wheal 3D p 5 TU Diam = 0.4 mm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-85-lab"
      } ],
      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "laboratory",
          "display": "Laboratory"
        } ],
        "text": "Laboratory"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "1648-5",
          "display": "TB Wheal 3D p 5 TU Diam"
        } ],
        "text": "TB Wheal 3D p 5 TU Diam"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 0.4,
        "unit": "mm",
        "system": "http://unitsofmeasure.org",
        "code": "mm"
      },
      "referenceRange": [ {
        "low": {
          "value": 0.1,
          "unit": "mm",
          "system": "http://unitsofmeasure.org",
          "code": "mm"
        },
        "high": {
          "value": 1.3,
          "unit": "mm",
          "system": "http://unitsofmeasure.org",
          "code": "mm"
        },
        "type": {
          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
            "code": "normal",
            "display": "Normal Range"
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          "text": "Normal Range"
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      } ]
    },
    "search": {
      "mode": "match"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-68-lab",
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        "text": "Glucose SerPl-mCnc"
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            "display": "Normal Range"
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          "text": "Normal Range"
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      } ]
    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-93-lab",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Calcium SerPl-mCnc = 9.2 mg/dL</div>"
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        "text": "Laboratory"
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        "text": "Calcium SerPl-mCnc"
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            "display": "Normal Range"
          } ],
          "text": "Normal Range"
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      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/MedicationRequest/smart-MedicationRequest-140",
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        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Memantine 10 MG Oral Tablet [Namenda] (rxnorm: 404673)</div>"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/MedicationRequest/smart-MedicationRequest-141",
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        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">donepezil 10 MG Oral Tablet [Aricept] (rxnorm: 153357)</div>"
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        "text": "donepezil 10 MG Oral Tablet [Aricept]"
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          "code": "d"
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    "search": {
      "mode": "match"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-316-height",
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      "id": "smart-316-height",
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      "status": "unknown",
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
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          "code": "8302-2",
          "display": "height"
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        "text": "height"
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      "effectiveDateTime": "2009-10-29",
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        "system": "http://unitsofmeasure.org",
        "code": "cm"
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    },
    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-76-lab",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-76-lab",
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        "source": "#HlAvi5DuW7UVsttc"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: RDW RBC-Rto = 14.5 %</div>"
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      "identifier": [ {
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        "text": "Laboratory"
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      "code": {
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        "text": "RDW RBC-Rto"
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          "value": 11.5,
          "unit": "%",
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          "text": "Normal Range"
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    },
    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-110-lab",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: RBC # Bld Auto = 5.32 10*6/uL</div>"
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      "identifier": [ {
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        "text": "Laboratory"
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      "code": {
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          "code": "789-8",
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        "text": "RBC # Bld Auto"
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      "valueQuantity": {
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        "code": "10*6/uL"
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      "referenceRange": [ {
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        "high": {
          "value": 6.0,
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          "coding": [ {
            "system": "http://hl7.org/fhir/referencerange-meaning",
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            "display": "Normal Range"
          } ],
          "text": "Normal Range"
        }
      } ]
    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Condition/smart-Condition-23",
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      "id": "smart-Condition-23",
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        "source": "#HlAvi5DuW7UVsttc"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Needs influenza immunization</div>"
      },
      "clinicalStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
          "code": "active",
          "display": "Active"
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      "code": {
        "coding": [ {
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          "display": "Needs influenza immunization"
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        "text": "Needs influenza immunization"
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      "subject": {
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      "onsetDateTime": "2008-08-08"
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    "search": {
      "mode": "match"
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-104-lab",
    "resource": {
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      "id": "smart-104-lab",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Basophils NFr Bld = 1 %</div>"
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      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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      "code": {
        "coding": [ {
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          "code": "30180-4",
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        "text": "Basophils NFr Bld"
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        "unit": "%",
        "system": "http://unitsofmeasure.org",
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      "referenceRange": [ {
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          "value": 0.0,
          "unit": "%",
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        "high": {
          "value": 2.0,
          "unit": "%",
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            "display": "Normal Range"
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          "text": "Normal Range"
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      } ]
    },
    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-327-weight",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-10-30: weight = 91.71638 kg</div>"
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      "status": "unknown",
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "3141-9",
          "display": "weight"
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        "text": "weight"
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        "system": "http://unitsofmeasure.org",
        "code": "kg"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-91-lab",
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2008-07-10: Prot SerPl-mCnc = 7.1 g/dL</div>"
      },
      "identifier": [ {
        "use": "official",
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      "status": "unknown",
      "category": [ {
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          "display": "Laboratory"
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        "text": "Laboratory"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2885-2",
          "display": "Prot SerPl-mCnc"
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        "text": "Prot SerPl-mCnc"
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      "subject": {
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      "effectiveDateTime": "2008-07-10",
      "performer": [ {
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      "valueQuantity": {
        "value": 7.1,
        "unit": "g/dL",
        "system": "http://unitsofmeasure.org",
        "code": "g/dL"
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      "referenceRange": [ {
        "low": {
          "value": 6.7,
          "unit": "g/dL",
          "system": "http://unitsofmeasure.org",
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          "unit": "g/dL",
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        "type": {
          "coding": [ {
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            "code": "normal",
            "display": "Normal Range"
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          "text": "Normal Range"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-298-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-298-temperature",
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        "lastUpdated": "2020-07-15T02:52:52.000+00:00",
        "source": "#HlAvi5DuW7UVsttc"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-04-24: temperature = 36.94444 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-298-temperature"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
          "code": "vital-signs",
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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"OCSPResponse": null, - "TLSUnique": "KGYau2ehxG6kGY5o" - } - }, - "ErrType": "", - "ErrMsg": "" - } - ] -} \ No newline at end of file diff --git a/backend/pkg/hub/internal/fhir/manual/client.go b/backend/pkg/hub/internal/fhir/manual/client.go deleted file mode 100644 index f26308c5..00000000 --- a/backend/pkg/hub/internal/fhir/manual/client.go +++ /dev/null @@ -1,164 +0,0 @@ -package manual - -import ( - "context" - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub/internal/fhir/base" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/fastenhealth/gofhir-models/fhir401" - fhir401utils "github.com/fastenhealth/gofhir-models/fhir401/utils" - "github.com/fastenhealth/gofhir-models/fhir430" - fhir430utils "github.com/fastenhealth/gofhir-models/fhir430/utils" - "github.com/samber/lo" - "github.com/sirupsen/logrus" - "io" - "net/http" - "os" - "strings" -) - -type ManualClient struct { - Context context.Context - AppConfig config.Interface - Logger logrus.FieldLogger - - Source *models.Source -} - -func (m ManualClient) GetRequest(resourceSubpath string, decodeModelPtr interface{}) error { - panic("implement me") -} - -func (m ManualClient) SyncAll(db database.DatabaseRepository) error { - panic("implement me") -} - -func (m ManualClient) SyncAllBundle(db database.DatabaseRepository, bundleFile *os.File) error { - - // we need to find the (most populated) patient record - patientId, bundleType, err := m.ExtractPatientId(bundleFile) - if err != nil { - return fmt.Errorf("an error occurred while extracting patient id from bundle: %w", err) - } - // we need to add the patient id to the source - m.Source.PatientId = patientId - - // we need to upsert Source - err = db.CreateSource(m.Context, m.Source) - if err != nil { - return fmt.Errorf("an error occurred while creating manual source: %w", err) - } - // we need to parse the bundle into resources (might need to try a couple of different times) - var resourceFhirList []models.ResourceFhir - switch bundleType { - case "fhir430": - bundle430Data := fhir430.Bundle{} - err := base.ParseBundle(bundleFile, &bundle430Data) - if err != nil { - return fmt.Errorf("an error occurred while parsing 4.3.0 bundle: %w", err) - } - client, _, err := base.NewFHIR430Client(m.Context, m.AppConfig, m.Logger, *m.Source, http.DefaultClient) - if err != nil { - return fmt.Errorf("an error occurred while creating 4.3.0 client: %w", err) - } - resourceFhirList, err = client.ProcessBundle(bundle430Data) - if err != nil { - return fmt.Errorf("an error occurred while processing 4.3.0 resources: %w", err) - } - case "fhir401": - bundle401Data := fhir401.Bundle{} - err := base.ParseBundle(bundleFile, &bundle401Data) - if err != nil { - return fmt.Errorf("an error occurred while parsing 4.0.1 bundle: %w", err) - } - client, _, err := base.NewFHIR401Client(m.Context, m.AppConfig, m.Logger, *m.Source, http.DefaultClient) - if err != nil { - return fmt.Errorf("an error occurred while creating 4.0.1 client: %w", err) - } - resourceFhirList, err = client.ProcessBundle(bundle401Data) - if err != nil { - return fmt.Errorf("an error occurred while processing 4.0.1 resources: %w", err) - } - } - // we need to upsert all resources (and make sure they are associated with new Source) - for _, apiModel := range resourceFhirList { - err = db.UpsertResource(context.Background(), &apiModel) - if err != nil { - return fmt.Errorf("an error occurred while upserting resources: %w", err) - } - } - return nil -} - -func (m ManualClient) ExtractPatientId(bundleFile *os.File) (string, string, error) { - // try from newest format to the oldest format - bundle430Data := fhir430.Bundle{} - bundle401Data := fhir401.Bundle{} - - var patientIds []string - - bundleType := "fhir430" - if err := base.ParseBundle(bundleFile, &bundle430Data); err == nil { - patientIds = lo.FilterMap[fhir430.BundleEntry, string](bundle430Data.Entry, func(bundleEntry fhir430.BundleEntry, _ int) (string, bool) { - parsedResource, err := fhir430utils.MapToResource(bundleEntry.Resource, false) - if err != nil { - return "", false - } - typedResource := parsedResource.(base.ResourceInterface) - resourceType, resourceId := typedResource.ResourceRef() - - if resourceId == nil || len(*resourceId) == 0 { - return "", false - } - return *resourceId, resourceType == fhir430.ResourceTypePatient.String() - }) - } - bundleFile.Seek(0, io.SeekStart) - - //fallback - if patientIds == nil || len(patientIds) == 0 { - bundleType = "fhir401" - //try parsing the bundle as a 401 bundle - //TODO: find a better, more generic way to do this. - err := base.ParseBundle(bundleFile, &bundle401Data) - if err != nil { - return "", "", err - } - patientIds = lo.FilterMap[fhir401.BundleEntry, string](bundle401Data.Entry, func(bundleEntry fhir401.BundleEntry, _ int) (string, bool) { - parsedResource, err := fhir401utils.MapToResource(bundleEntry.Resource, false) - if err != nil { - return "", false - } - typedResource := parsedResource.(base.ResourceInterface) - resourceType, resourceId := typedResource.ResourceRef() - - if resourceId == nil || len(*resourceId) == 0 { - return "", false - } - return *resourceId, resourceType == fhir430.ResourceTypePatient.String() - }) - } - bundleFile.Seek(0, io.SeekStart) - - if patientIds == nil || len(patientIds) == 0 { - return "", "", fmt.Errorf("could not determine patient id") - } else { - //reset reader - - return strings.TrimLeft(patientIds[0], "Patient/"), bundleType, nil - } -} - -func NewClient(ctx context.Context, appConfig config.Interface, globalLogger logrus.FieldLogger, source models.Source, testHttpClient ...*http.Client) (base.Client, *models.Source, error) { - return ManualClient{ - Context: ctx, - AppConfig: appConfig, - Logger: globalLogger, - Source: &models.Source{ - SourceType: pkg.SourceTypeManual, - }, - }, nil, nil -} diff --git a/backend/pkg/models/base.go b/backend/pkg/models/base.go deleted file mode 100644 index 2b7fb253..00000000 --- a/backend/pkg/models/base.go +++ /dev/null @@ -1,50 +0,0 @@ -package models - -import ( - "github.com/google/uuid" - "gorm.io/gorm" - "time" -) - -type ModelBase struct { - ID uuid.UUID `json:"id" gorm:"type:uuid;primary_key;"` - CreatedAt time.Time `json:"created_at"` - UpdatedAt time.Time `json:"updated_at"` - DeletedAt *time.Time `json:"deleted_at,omitempty" gorm:"index"` -} - -//https://medium.com/@the.hasham.ali/how-to-use-uuid-key-type-with-gorm-cc00d4ec7100 - -func (base *ModelBase) BeforeCreate(tx *gorm.DB) error { - base.ID = uuid.New() - return nil -} - -type OriginBase struct { - ModelBase - User *User `json:"user,omitempty" gorm:"-"` - UserID uuid.UUID `json:"user_id"` - - Source *Source `json:"source,omitempty" gorm:"-"` - SourceID uuid.UUID `json:"source_id" gorm:"not null;index:,unique,composite:source_resource_id"` - - SourceResourceType string `json:"source_resource_type" gorm:"not null;index:,unique,composite:source_resource_id"` - SourceResourceID string `json:"source_resource_id" gorm:"not null;index:,unique,composite:source_resource_id"` -} - -func (o OriginBase) GetSourceID() uuid.UUID { - return o.SourceID -} - -func (o OriginBase) GetSourceResourceType() string { - return o.SourceResourceType -} -func (o OriginBase) GetSourceResourceID() string { - return o.SourceResourceID -} - -type OriginBaser interface { - GetSourceID() uuid.UUID - GetSourceResourceType() string - GetSourceResourceID() string -} diff --git a/backend/pkg/models/resource_fhir.go b/backend/pkg/models/resource_fhir.go deleted file mode 100644 index 49c070bd..00000000 --- a/backend/pkg/models/resource_fhir.go +++ /dev/null @@ -1,17 +0,0 @@ -package models - -import ( - "gorm.io/datatypes" -) - -type ResourceFhir struct { - OriginBase - - //embedded data - Payload datatypes.JSON `json:"payload" gorm:"payload"` -} - -type ListResourceQueryOptions struct { - SourceID string - SourceResourceType string -} diff --git a/backend/pkg/models/source.go b/backend/pkg/models/source.go deleted file mode 100644 index 9277fc9f..00000000 --- a/backend/pkg/models/source.go +++ /dev/null @@ -1,49 +0,0 @@ -package models - -import ( - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg" - "github.com/google/uuid" -) - -// Source Data/Medical Provider Credentials -type Source struct { - ModelBase - User User `json:"user,omitempty"` - UserID uuid.UUID `json:"user_id" gorm:"uniqueIndex:idx_user_source_patient"` - SourceType pkg.SourceType `json:"source_type" gorm:"uniqueIndex:idx_user_source_patient"` - PatientId string `json:"patient_id" gorm:"uniqueIndex:idx_user_source_patient"` - - //oauth endpoints - OauthAuthorizationEndpoint string `json:"oauth_authorization_endpoint"` - OauthTokenEndpoint string `json:"oauth_token_endpoint"` - OauthRegistrationEndpoint string `json:"oauth_registration_endpoint"` - OauthIntrospectionEndpoint string `json:"oauth_introspection_endpoint"` - OauthUserInfoEndpoint string `json:"oauth_userinfo_endpoint"` - OauthTokenEndpointAuthMethods string `json:"oauth_token_endpoint_auth_methods_supported"` - - ApiEndpointBaseUrl string `json:"api_endpoint_base_url"` - ClientId string `json:"client_id"` - RedirectUri string `json:"redirect_uri"` - Scopes string `json:"scopes"` - AccessToken string `json:"access_token"` - RefreshToken string `json:"refresh_token"` - IdToken string `json:"id_token"` - ExpiresAt int64 `json:"expires_at"` - CodeChallenge string `json:"code_challenge"` - CodeVerifier string `json:"code_verifier"` - - Confidential bool `json:"confidential"` -} - -/* -serverUrl: connectData.message.api_endpoint_base_url, -clientId: connectData.message.client_id, -redirectUri: connectData.message.redirect_uri, -tokenUri: `${connectData.message.oauth_endpoint_base_url}/token`, -scope: connectData.message.scopes.join(' '), -tokenResponse: payload, -expiresAt: getAccessTokenExpiration(payload, new BrowserAdapter()), -codeChallenge: codeChallenge, -codeVerifier: codeVerifier - -*/ diff --git a/backend/pkg/models/source_summary.go b/backend/pkg/models/source_summary.go deleted file mode 100644 index 8b1290a5..00000000 --- a/backend/pkg/models/source_summary.go +++ /dev/null @@ -1,7 +0,0 @@ -package models - -type SourceSummary struct { - Source *Source `json:"source,omitempty"` - ResourceTypeCounts []map[string]interface{} `json:"resource_type_counts,omitempty"` - Patient *ResourceFhir `json:"patient"` -} diff --git a/backend/pkg/models/summary.go b/backend/pkg/models/summary.go deleted file mode 100644 index be21b1f2..00000000 --- a/backend/pkg/models/summary.go +++ /dev/null @@ -1,7 +0,0 @@ -package models - -type Summary struct { - Sources []Source `json:"sources,omitempty"` - Patients []ResourceFhir `json:"patients,omitempty"` - ResourceTypeCounts []map[string]interface{} `json:"resource_type_counts,omitempty"` -} diff --git a/backend/pkg/models/user.go b/backend/pkg/models/user.go index b30da746..e9483dca 100644 --- a/backend/pkg/models/user.go +++ b/backend/pkg/models/user.go @@ -1,26 +1,6 @@ package models -import "golang.org/x/crypto/bcrypt" - type User struct { - ModelBase - Name string `json:"name"` - Username string `json:"username" gorm:"unique"` + Username string `json:"username"` Password string `json:"password"` } - -func (user *User) HashPassword(password string) error { - bytes, err := bcrypt.GenerateFromPassword([]byte(password), 14) - if err != nil { - return err - } - user.Password = string(bytes) - return nil -} -func (user *User) CheckPassword(providedPassword string) error { - err := bcrypt.CompareHashAndPassword([]byte(user.Password), []byte(providedPassword)) - if err != nil { - return err - } - return nil -} diff --git a/backend/pkg/web/handler/auth.go b/backend/pkg/web/handler/auth.go index 24d24cf0..33801753 100644 --- a/backend/pkg/web/handler/auth.go +++ b/backend/pkg/web/handler/auth.go @@ -1,9 +1,6 @@ package handler import ( - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/auth" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" "github.com/gin-gonic/gin" @@ -12,57 +9,17 @@ import ( func AuthSignup(c *gin.Context) { databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - appConfig := c.MustGet("CONFIG").(config.Interface) var user models.User if err := c.ShouldBindJSON(&user); err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) + c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) return } err := databaseRepo.CreateUser(c, &user) if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) + c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) return } - // return JWT - tokenString, err := auth.GenerateJWT(appConfig.GetString("web.jwt.encryptionkey"), user.Username, user.ID.String()) - if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - - c.JSON(http.StatusOK, gin.H{"success": true, "data": tokenString}) -} - -func AuthSignin(c *gin.Context) { - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - appConfig := c.MustGet("CONFIG").(config.Interface) - - var user models.User - if err := c.ShouldBindJSON(&user); err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - - foundUser, err := databaseRepo.GetUserByEmail(c, user.Username) - if err != nil || foundUser == nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": fmt.Sprintf("could not find user: %s", user.Username)}) - return - } - - err = foundUser.CheckPassword(user.Password) - if err != nil { - c.JSON(http.StatusUnauthorized, gin.H{"success": false, "error": fmt.Sprintf("username or password does not match: %s", user.Username)}) - return - } - - // return JWT - tokenString, err := auth.GenerateJWT(appConfig.GetString("web.jwt.encryptionkey"), user.Username, user.ID.String()) - if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": "an error occurred generating JWT token"}) - return - } - - c.JSON(http.StatusOK, gin.H{"success": true, "data": tokenString}) + c.JSON(http.StatusOK, gin.H{"success": true}) } diff --git a/backend/pkg/web/handler/hello_world.go b/backend/pkg/web/handler/hello_world.go deleted file mode 100644 index f5c05931..00000000 --- a/backend/pkg/web/handler/hello_world.go +++ /dev/null @@ -1,35 +0,0 @@ -package handler - -import ( - //"github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/gin-gonic/gin" - //"github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - //"github.com/sirupsen/logrus" - "net/http" -) - -func GetHelloWorld(c *gin.Context) { - //logger := c.MustGet("LOGGER").(*logrus.Entry) - //appConfig := c.MustGet("CONFIG").(config.Interface) - - //device, err := deviceRepo.GetDeviceDetails(c, c.Param("wwn")) - //if err != nil { - // logger.Errorln("An error occurred while retrieving device details", err) - // c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - // return - //} - // - //durationKey, exists := c.GetQuery("duration_key") - //if !exists { - // durationKey = "forever" - //} - // - //smartResults, err := deviceRepo.GetSmartAttributeHistory(c, c.Param("wwn"), durationKey, nil) - //if err != nil { - // logger.Errorln("An error occurred while retrieving device smart results", err) - // c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - // return - //} - - c.JSON(http.StatusOK, gin.H{"success": true, "data": map[string]interface{}{"hello": "world"}}) -} diff --git a/backend/pkg/web/handler/resource_fhir.go b/backend/pkg/web/handler/resource_fhir.go deleted file mode 100644 index 73d50b9e..00000000 --- a/backend/pkg/web/handler/resource_fhir.go +++ /dev/null @@ -1,51 +0,0 @@ -package handler - -import ( - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/gin-gonic/gin" - "github.com/sirupsen/logrus" - "net/http" - "strings" -) - -func ListResourceFhir(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - listResourceQueryOptions := models.ListResourceQueryOptions{} - if len(c.Query("sourceResourceType")) > 0 { - listResourceQueryOptions.SourceResourceType = c.Query("sourceResourceType") - } - if len(c.Query("sourceID")) > 0 { - listResourceQueryOptions.SourceID = c.Query("sourceID") - } - - wrappedResourceModels, err := databaseRepo.ListResources(c, listResourceQueryOptions) - - if err != nil { - logger.Errorln("An error occurred while retrieving resources", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - - c.JSON(http.StatusOK, gin.H{"success": true, "data": wrappedResourceModels}) -} - -//this endpoint retrieves a specific resource by its ID -func GetResourceFhir(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - resourceId := strings.Trim(c.Param("resourceId"), "/") - sourceId := strings.Trim(c.Param("sourceId"), "/") - wrappedResourceModel, err := databaseRepo.GetResourceBySourceId(c, sourceId, resourceId) - - if err != nil { - logger.Errorln("An error occurred while retrieving resource", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - - c.JSON(http.StatusOK, gin.H{"success": true, "data": wrappedResourceModel}) -} diff --git a/backend/pkg/web/handler/source.go b/backend/pkg/web/handler/source.go deleted file mode 100644 index 12e1b8f1..00000000 --- a/backend/pkg/web/handler/source.go +++ /dev/null @@ -1,202 +0,0 @@ -package handler - -import ( - "fmt" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/hub" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/models" - "github.com/gin-gonic/gin" - "github.com/sirupsen/logrus" - "io/ioutil" - "net/http" - "net/url" - "strings" -) - -func SourceSync(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - logger.Infof("Get Source Credentials: %v", c.Param("sourceId")) - - sourceCred, err := databaseRepo.GetSource(c, c.Param("sourceId")) - if err != nil { - logger.Errorln("An error occurred while retrieving source credential", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - - // after creating the source, we should do a bulk import - err = syncSourceResources(c, logger, databaseRepo, *sourceCred) - if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - c.JSON(http.StatusOK, gin.H{"success": true, "data": sourceCred}) -} - -func CreateManualSource(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - // single file - file, err := c.FormFile("file") - if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": "could not extract file from form"}) - return - } - fmt.Printf("Uploaded filename: %s", file.Filename) - - // create a temporary file to store this uploaded file - bundleFile, err := ioutil.TempFile("", file.Filename) - if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": "could not create temp file"}) - return - } - - // Upload the file to specific bundleFile. - err = c.SaveUploadedFile(file, bundleFile.Name()) - if err != nil { - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": "could not save temp file"}) - return - } - - // We cannot save the "Source" object yet, as we do not know the patientID - - // create a "manual" client, which we can use to parse the - manualSourceClient, _, err := hub.NewClient(pkg.SourceTypeManual, c, nil, logger, models.Source{}) - if err != nil { - logger.Errorln("An error occurred while initializing hub client using manual source without credentials", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - - err = manualSourceClient.SyncAllBundle(databaseRepo, bundleFile) - if err != nil { - logger.Errorln("An error occurred while processing bundle", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) - return - } - - c.JSON(http.StatusOK, gin.H{"success": true, "data": fmt.Sprintf("'%s' uploaded!", file.Filename)}) -} - -func GetSource(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - sourceCred, err := databaseRepo.GetSource(c, c.Param("sourceId")) - if err != nil { - logger.Errorln("An error occurred while retrieving source credential", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - c.JSON(http.StatusOK, gin.H{"success": true, "data": sourceCred}) -} - -func GetSourceSummary(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - sourceSummary, err := databaseRepo.GetSourceSummary(c, c.Param("sourceId")) - if err != nil { - logger.Errorln("An error occurred while retrieving source summary", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - c.JSON(http.StatusOK, gin.H{"success": true, "data": sourceSummary}) -} - -func ListSource(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - sourceCreds, err := databaseRepo.GetSources(c) - if err != nil { - logger.Errorln("An error occurred while listing source credentials", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - c.JSON(http.StatusOK, gin.H{"success": true, "data": sourceCreds}) -} - -func RawRequestSource(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - //!!!!!!INSECURE!!!!!!S - //We're setting the username to a user provided value, this is insecure, but required for calling databaseRepo fns - c.Set("AUTH_USERNAME", c.Param("username")) - - foundSource, err := databaseRepo.GetSource(c, c.Param("sourceId")) - if err != nil { - logger.Errorf("An error occurred while finding source credential: %v", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) - return - } - - if foundSource == nil { - logger.Errorf("Did not source credentials for %s", c.Param("sourceType")) - c.JSON(http.StatusNotFound, gin.H{"success": false, "error": err.Error()}) - return - } - - client, updatedSource, err := hub.NewClient(foundSource.SourceType, c, nil, logger, *foundSource) - if err != nil { - logger.Errorf("Could not initialize source client %v", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) - return - } - if updatedSource != nil { - err := databaseRepo.CreateSource(c, updatedSource) - if err != nil { - logger.Errorf("An error occurred while updating source credential %v", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) - return - } - } - - var resp map[string]interface{} - - parsedUrl, err := url.Parse(strings.TrimSuffix(c.Param("path"), "/")) - if err != nil { - logger.Errorf("Error parsing request, %v", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error()}) - return - } - //make sure we include all query string parameters with the raw request. - parsedUrl.RawQuery = c.Request.URL.Query().Encode() - - err = client.GetRequest(parsedUrl.String(), &resp) - if err != nil { - logger.Errorf("Error making raw request, %v", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false, "error": err.Error(), "data": resp}) - return - } - c.JSON(http.StatusOK, gin.H{"success": true, "data": resp}) -} - -////// private functions -func syncSourceResources(c *gin.Context, logger *logrus.Entry, databaseRepo database.DatabaseRepository, sourceCred models.Source) error { - // after creating the source, we should do a bulk import - sourceClient, updatedSource, err := hub.NewClient(sourceCred.SourceType, c, nil, logger, sourceCred) - if err != nil { - logger.Errorln("An error occurred while initializing hub client using source credential", err) - return err - } - if updatedSource != nil { - err := databaseRepo.CreateSource(c, updatedSource) - if err != nil { - logger.Errorln("An error occurred while updating source credential", err) - return err - } - } - - err = sourceClient.SyncAll(databaseRepo) - if err != nil { - logger.Errorln("An error occurred while bulk import of resources from source", err) - return err - } - return nil -} diff --git a/backend/pkg/web/handler/summary.go b/backend/pkg/web/handler/summary.go deleted file mode 100644 index 182b5edc..00000000 --- a/backend/pkg/web/handler/summary.go +++ /dev/null @@ -1,21 +0,0 @@ -package handler - -import ( - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/database" - "github.com/gin-gonic/gin" - "github.com/sirupsen/logrus" - "net/http" -) - -func GetSummary(c *gin.Context) { - logger := c.MustGet("LOGGER").(*logrus.Entry) - databaseRepo := c.MustGet("REPOSITORY").(database.DatabaseRepository) - - summary, err := databaseRepo.GetSummary(c) - if err != nil { - logger.Errorln("An error occurred while retrieving summary", err) - c.JSON(http.StatusInternalServerError, gin.H{"success": false}) - return - } - c.JSON(http.StatusOK, gin.H{"success": true, "data": summary}) -} diff --git a/backend/pkg/web/middleware/require_auth.go b/backend/pkg/web/middleware/require_auth.go deleted file mode 100644 index bb378acf..00000000 --- a/backend/pkg/web/middleware/require_auth.go +++ /dev/null @@ -1,47 +0,0 @@ -package middleware - -import ( - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/auth" - "github.com/fastenhealth/fastenhealth-onprem/backend/pkg/config" - "github.com/gin-gonic/gin" - "log" - "net/http" - "strings" -) - -func RequireAuth() gin.HandlerFunc { - return func(c *gin.Context) { - appConfig := c.MustGet("CONFIG").(config.Interface) - - authHeader := c.GetHeader("Authorization") - authHeaderParts := strings.Split(authHeader, " ") - - if len(authHeaderParts) != 2 { - log.Println("Authentication header is invalid: " + authHeader) - c.JSON(http.StatusUnauthorized, gin.H{"success": false, "error": "request does not contain a valid token"}) - c.Abort() - return - } - - tokenString := authHeaderParts[1] - - if tokenString == "" { - c.JSON(http.StatusUnauthorized, gin.H{"success": false, "error": "request does not contain an access token"}) - c.Abort() - return - } - claim, err := auth.ValidateToken(appConfig.GetString("web.jwt.encryptionkey"), tokenString) - if err != nil { - c.JSON(http.StatusUnauthorized, gin.H{"success": false, "error": err.Error()}) - c.Abort() - return - } - - //todo, is this shared between all sessions?? - c.Set("AUTH_TOKEN", tokenString) - c.Set("AUTH_USERNAME", claim.Username) - c.Set("AUTH_USERID", claim.UserId) - - c.Next() - } -} diff --git a/backend/pkg/web/server.go b/backend/pkg/web/server.go index 03d906f9..cfa6d1b8 100644 --- a/backend/pkg/web/server.go +++ b/backend/pkg/web/server.go @@ -41,30 +41,7 @@ func (ae *AppEngine) Setup(logger *logrus.Entry) *gin.Engine { }) api.POST("/auth/signup", handler.AuthSignup) - api.POST("/auth/signin", handler.AuthSignin) - - secure := api.Group("/secure").Use(middleware.RequireAuth()) - { - secure.GET("/summary", handler.GetSummary) - - secure.POST("/source/manual", handler.CreateManualSource) - secure.GET("/source", handler.ListSource) - secure.GET("/source/:sourceId", handler.GetSource) - secure.POST("/source/:sourceId/sync", handler.SourceSync) - secure.GET("/source/:sourceId/summary", handler.GetSourceSummary) - secure.GET("/resource/fhir", handler.ListResourceFhir) // - secure.GET("/resource/fhir/:sourceId/:resourceId", handler.GetResourceFhir) - } - api.GET("/metadata/source", handler.GetMetadataSource) - - if ae.Config.GetString("log.level") == "DEBUG" { - //in debug mode, this endpoint lets us request data directly from the source api - ae.Logger.Warningf("***INSECURE*** ***INSECURE*** DEBUG mode enables developer functionality, including unauthenticated raw api requests") - - //http://localhost:9090/api/raw/test@test.com/436d7277-ad56-41ce-9823-44e353d1b3f6/Patient/smart-1288992 - api.GET("/raw/:username/:sourceId/*path", handler.RawRequestSource) - } } } diff --git a/docker-compose.yml b/docker-compose.yml new file mode 100644 index 00000000..cc2fb3b2 --- /dev/null +++ b/docker-compose.yml @@ -0,0 +1,14 @@ +version: "3.9" +services: + couchdb: + build: + context: ./docker/couchdb + dockerfile: Dockerfile +# environment: +# - COUCHDB_USER=admin +# - COUCHDB_PASSWORD=password + ports: + - "5984:5984" + volumes: + - ./.couchdb/data:/opt/couchdb/data + - ./.couchdb/config:/opt/couchdb/etc/local.d diff --git a/docker/couchdb/Dockerfile b/docker/couchdb/Dockerfile new file mode 100644 index 00000000..7fbc2096 --- /dev/null +++ b/docker/couchdb/Dockerfile @@ -0,0 +1,3 @@ +FROM couchdb:3.2 + +COPY local.ini /opt/couchdb/etc/ diff --git a/docker/couchdb/local.ini b/docker/couchdb/local.ini new file mode 100644 index 00000000..fada0515 --- /dev/null +++ b/docker/couchdb/local.ini @@ -0,0 +1,108 @@ +; CouchDB Configuration Settings + +; Custom settings should be made in this file. They will override settings +; in default.ini, but unlike changes made to default.ini, this file won't be +; overwritten on server upgrade. + +[cors] +origins = * +headers = accept, authorization, content-type, origin, referer +credentials = true +methods = GET, PUT, POST, HEAD, DELETE + +[couchdb] +;max_document_size = 4294967296 ; bytes +;os_process_timeout = 5000 +single_node=true + +[couch_peruser] +; If enabled, couch_peruser ensures that a private per-user database +; exists for each document in _users. These databases are writable only +; by the corresponding user. Databases are in the following form: +; userdb-{hex encoded username} +enable = true +; If set to true and a user is deleted, the respective database gets +; deleted as well. +;delete_dbs = true +; Set a default q value for peruser-created databases that is different from +; cluster / q +;q = 1 + +[chttpd] +;port = 5984 +;bind_address = 127.0.0.1 +; Options for the MochiWeb HTTP server. +;server_options = [{backlog, 128}, {acceptor_pool_size, 16}] +; For more socket options, consult Erlang's module 'inet' man page. +;socket_options = [{sndbuf, 262144}, {nodelay, true}] +bind_address = 0.0.0.0 +enable_cors = true +x_forwarded_host = X-Forwarded-Host + +[httpd] +; NOTE that this only configures the "backend" node-local port, not the +; "frontend" clustered port. You probably don't want to change anything in +; this section. +; Uncomment next line to trigger basic-auth popup on unauthorized requests. +;WWW-Authenticate = Basic realm="administrator" + +; Uncomment next line to set the configuration modification whitelist. Only +; whitelisted values may be changed via the /_config URLs. To allow the admin +; to change this value over HTTP, remember to include {httpd,config_whitelist} +; itself. Excluding it from the list would require editing this file to update +; the whitelist. +;config_whitelist = [{httpd,config_whitelist}, {log,level}, {etc,etc}] +enable_cors = true + +[chttpd_auth] +; If you set this to true, you should also uncomment the WWW-Authenticate line +; above. If you don't configure a WWW-Authenticate header, CouchDB will send +; Basic realm="server" in order to prevent you getting logged out. +; require_valid_user = false +allow_persistent_cookies = true +;cookie_domain = localhost:5984 + +[ssl] +;enable = true +;cert_file = /full/path/to/server_cert.pem +;key_file = /full/path/to/server_key.pem +;password = somepassword +; set to true to validate peer certificates +;verify_ssl_certificates = false +; Set to true to fail if the client does not send a certificate. Only used if verify_ssl_certificates is true. +;fail_if_no_peer_cert = false +; Path to file containing PEM encoded CA certificates (trusted +; certificates used for verifying a peer certificate). May be omitted if +; you do not want to verify the peer. +;cacert_file = /full/path/to/cacertf +; The verification fun (optional) if not specified, the default +; verification fun will be used. +;verify_fun = {Module, VerifyFun} +; maximum peer certificate depth +;ssl_certificate_max_depth = 1 +; +; Reject renegotiations that do not live up to RFC 5746. +;secure_renegotiate = true +; The cipher suites that should be supported. +; Can be specified in erlang format "{ecdhe_ecdsa,aes_128_cbc,sha256}" +; or in OpenSSL format "ECDHE-ECDSA-AES128-SHA256". +;ciphers = ["ECDHE-ECDSA-AES128-SHA256", "ECDHE-ECDSA-AES128-SHA"] +; The SSL/TLS versions to support +;tls_versions = [tlsv1, 'tlsv1.1', 'tlsv1.2'] + +; To enable Virtual Hosts in CouchDB, add a vhost = path directive. All requests to +; the Virual Host will be redirected to the path. In the example below all requests +; to http://example.com/ are redirected to /database. +; If you run CouchDB on a specific port, include the port number in the vhost: +; example.com:5984 = /database +[vhosts] +;example.com = /database/ + +; To create an admin account uncomment the '[admins]' section below and add a +; line in the format 'username = password'. When you next start CouchDB, it +; will change the password to a hash (so that your passwords don't linger +; around in plain-text files). You can add more admin accounts with more +; 'username = password' lines. Don't forget to restart CouchDB after +; changing this. +[admins] +admin = mysecretpassword diff --git a/go.mod b/go.mod index 6db8042c..fbe0618d 100644 --- a/go.mod +++ b/go.mod @@ -4,40 +4,25 @@ go 1.18 require ( github.com/analogj/go-util v0.0.0-20210417161720-39b497cca03b - github.com/fastenhealth/gofhir-models v0.0.4 github.com/gin-gonic/gin v1.8.1 - github.com/glebarez/sqlite v1.4.6 - github.com/golang-jwt/jwt v3.2.2+incompatible + github.com/go-kivik/couchdb/v3 v3.3.0 + github.com/go-kivik/kivik/v3 v3.2.3 github.com/golang/mock v1.4.4 - github.com/google/uuid v1.3.0 - github.com/samber/lo v1.27.1 - github.com/seborama/govcr v4.5.0+incompatible github.com/sirupsen/logrus v1.9.0 github.com/spf13/viper v1.12.0 - github.com/stretchr/testify v1.7.1 github.com/urfave/cli/v2 v2.11.2 - golang.org/x/crypto v0.0.0-20220411220226-7b82a4e95df4 - golang.org/x/oauth2 v0.0.0-20220411215720-9780585627b5 - gorm.io/datatypes v1.0.7 - gorm.io/gorm v1.23.8 ) require ( github.com/cpuguy83/go-md2man/v2 v2.0.2 // indirect - github.com/davecgh/go-spew v1.1.1 // indirect github.com/fatih/color v1.13.0 // indirect github.com/fsnotify/fsnotify v1.5.4 // indirect github.com/gin-contrib/sse v0.1.0 // indirect - github.com/glebarez/go-sqlite v1.17.3 // indirect github.com/go-playground/locales v0.14.0 // indirect github.com/go-playground/universal-translator v0.18.0 // indirect github.com/go-playground/validator/v10 v10.10.0 // indirect - github.com/go-sql-driver/mysql v1.6.0 // indirect github.com/goccy/go-json v0.9.7 // indirect - github.com/golang/protobuf v1.5.2 // indirect github.com/hashicorp/hcl v1.0.0 // indirect - github.com/jinzhu/inflection v1.0.0 // indirect - github.com/jinzhu/now v1.1.5 // indirect github.com/json-iterator/go v1.1.12 // indirect github.com/kvz/logstreamer v0.0.0-20150507115422-a635b98146f0 // indirect github.com/leodido/go-urn v1.2.1 // indirect @@ -50,8 +35,6 @@ require ( github.com/modern-go/reflect2 v1.0.2 // indirect github.com/pelletier/go-toml v1.9.5 // indirect github.com/pelletier/go-toml/v2 v2.0.1 // indirect - github.com/pmezard/go-difflib v1.0.0 // indirect - github.com/remyoudompheng/bigfft v0.0.0-20200410134404-eec4a21b6bb0 // indirect github.com/russross/blackfriday/v2 v2.1.0 // indirect github.com/spf13/afero v1.8.2 // indirect github.com/spf13/cast v1.5.0 // indirect @@ -60,19 +43,14 @@ require ( github.com/subosito/gotenv v1.3.0 // indirect github.com/ugorji/go/codec v1.2.7 // indirect github.com/xrash/smetrics v0.0.0-20201216005158-039620a65673 // indirect - golang.org/x/exp v0.0.0-20220303212507-bbda1eaf7a17 // indirect - golang.org/x/net v0.0.0-20220520000938-2e3eb7b945c2 // indirect - golang.org/x/sys v0.0.0-20220715151400-c0bba94af5f8 // indirect + golang.org/x/crypto v0.0.0-20220411220226-7b82a4e95df4 // indirect + golang.org/x/net v0.0.0-20221004154528-8021a29435af // indirect + golang.org/x/sys v0.0.0-20220728004956-3c1f35247d10 // indirect golang.org/x/term v0.0.0-20210927222741-03fcf44c2211 // indirect golang.org/x/text v0.3.7 // indirect - google.golang.org/appengine v1.6.7 // indirect + golang.org/x/xerrors v0.0.0-20220907171357-04be3eba64a2 // indirect google.golang.org/protobuf v1.28.0 // indirect gopkg.in/ini.v1 v1.66.4 // indirect gopkg.in/yaml.v2 v2.4.0 // indirect gopkg.in/yaml.v3 v3.0.1 // indirect - gorm.io/driver/mysql v1.3.2 // indirect - modernc.org/libc v1.16.8 // indirect - modernc.org/mathutil v1.4.1 // indirect - modernc.org/memory v1.1.1 // indirect - modernc.org/sqlite v1.17.3 // indirect ) diff --git a/go.sum b/go.sum index b865734a..fd829d86 100644 --- a/go.sum +++ b/go.sum @@ -1,3 +1,4 @@ +bou.ke/monkey v1.0.1/go.mod h1:FgHuK96Rv2Nlf+0u1OOVDpCMdsWyOFmeeketDHE7LIg= cloud.google.com/go v0.26.0/go.mod h1:aQUYkXzVsufM+DwF1aE+0xfcU+56JwCaLick0ClmMTw= cloud.google.com/go v0.34.0/go.mod h1:aQUYkXzVsufM+DwF1aE+0xfcU+56JwCaLick0ClmMTw= cloud.google.com/go v0.38.0/go.mod h1:990N+gfupTy94rShfmMCWGDn0LpTmnzTp2qbd1dvSRU= @@ -36,11 +37,9 @@ cloud.google.com/go/storage v1.8.0/go.mod h1:Wv1Oy7z6Yz3DshWRJFhqM/UCfaWIRTdp0RX cloud.google.com/go/storage v1.10.0/go.mod h1:FLPqc6j+Ki4BU591ie1oL6qBQGu2Bl/tZ9ullr3+Kg0= cloud.google.com/go/storage v1.14.0/go.mod h1:GrKmX003DSIwi9o29oFT7YDnHYwZoctc3fOKtUw0Xmo= dmitri.shuralyov.com/gpu/mtl v0.0.0-20190408044501-666a987793e9/go.mod h1:H6x//7gZCb22OMCxBHrMx7a5I7Hp++hsVxbQ4BYO7hU= -github.com/Azure/azure-sdk-for-go/sdk/azcore v0.19.0/go.mod h1:h6H6c8enJmmocHUbLiiGY6sx7f9i+X3m1CHdd5c6Rdw= -github.com/Azure/azure-sdk-for-go/sdk/azidentity v0.11.0/go.mod h1:HcM1YX14R7CJcghJGOYCgdezslRSVzqwLf/q+4Y2r/0= -github.com/Azure/azure-sdk-for-go/sdk/internal v0.7.0/go.mod h1:yqy467j36fJxcRV2TzfVZ1pCb5vxm4BtZPUdYWe/Xo8= github.com/BurntSushi/toml v0.3.1/go.mod h1:xHWCNGjB5oqiDr8zfno3MHue2Ht5sIBksp03qcyfWMU= github.com/BurntSushi/xgb v0.0.0-20160522181843-27f122750802/go.mod h1:IVnqGOEym/WlBOVXweHU+Q+/VP0lqqI8lqeDx9IjBqo= +github.com/Masterminds/semver/v3 v3.1.1 h1:hLg3sBzpNErnxhQtUy/mmLR2I9foDujNK030IGemrRc= github.com/Masterminds/semver/v3 v3.1.1/go.mod h1:VPu/7SZ7ePZ3QOrcuXROw5FAcLl4a0cBrbBpGY/8hQs= github.com/analogj/go-util v0.0.0-20210417161720-39b497cca03b h1:Y/+MfmdKPPpVY7C6ggt/FpltFSitlpUtyJEdcQyFXQg= github.com/analogj/go-util v0.0.0-20210417161720-39b497cca03b/go.mod h1:bRSzJXgXnT5+Ihah7RSC7Cvp16UmoLn3wq6ROciS1Ow= @@ -52,31 +51,23 @@ github.com/client9/misspell v0.3.4/go.mod h1:qj6jICC3Q7zFZvVWo7KLAzC3yx5G7kyvSDk github.com/cncf/udpa/go v0.0.0-20191209042840-269d4d468f6f/go.mod h1:M8M6+tZqaGXZJjfX53e64911xZQV5JYwmTeXPW+k8Sc= github.com/cncf/udpa/go v0.0.0-20200629203442-efcf912fb354/go.mod h1:WmhPx2Nbnhtbo57+VJT5O0JRkEi1Wbu0z5j0R8u5Hbk= github.com/cncf/udpa/go v0.0.0-20201120205902-5459f2c99403/go.mod h1:WmhPx2Nbnhtbo57+VJT5O0JRkEi1Wbu0z5j0R8u5Hbk= -github.com/cockroachdb/apd v1.1.0/go.mod h1:8Sl8LxpKi29FqWXR16WEFZRNSz3SoPzUzeMeY4+DwBQ= -github.com/coreos/go-systemd v0.0.0-20190321100706-95778dfbb74e/go.mod h1:F5haX7vjVVG0kc13fIWeqUViNPyEJxv/OmvnBo0Yme4= -github.com/coreos/go-systemd v0.0.0-20190719114852-fd7a80b32e1f/go.mod h1:F5haX7vjVVG0kc13fIWeqUViNPyEJxv/OmvnBo0Yme4= github.com/cpuguy83/go-md2man/v2 v2.0.2 h1:p1EgwI/C7NhT0JmVkwCD2ZBK8j4aeHQX2pMHHBfMQ6w= github.com/cpuguy83/go-md2man/v2 v2.0.2/go.mod h1:tgQtvFlXSQOSOSIRvRPT7W67SCa46tRHOmNcaadrF8o= -github.com/creack/pty v1.1.7/go.mod h1:lj5s0c3V2DBrqTV7llrYr5NG6My20zk30Fl46Y7DoTY= github.com/creack/pty v1.1.9/go.mod h1:oKZEueFk5CKHvIhNR5MUki03XCEU+Q6VDXinZuGJ33E= github.com/davecgh/go-spew v1.1.0/go.mod h1:J7Y8YcW2NihsgmVo/mv3lAwl/skON4iLHjSsI+c5H38= github.com/davecgh/go-spew v1.1.1 h1:vj9j/u1bqnvCEfJOwUhtlOARqs3+rkHYY13jYWTU97c= github.com/davecgh/go-spew v1.1.1/go.mod h1:J7Y8YcW2NihsgmVo/mv3lAwl/skON4iLHjSsI+c5H38= -github.com/denisenkom/go-mssqldb v0.12.0 h1:VtrkII767ttSPNRfFekePK3sctr+joXgO58stqQbtUA= -github.com/denisenkom/go-mssqldb v0.12.0/go.mod h1:iiK0YP1ZeepvmBQk/QpLEhhTNJgfzrpArPY/aFvc9yU= -github.com/dnaeon/go-vcr v1.2.0/go.mod h1:R4UdLID7HZT3taECzJs4YgbbH6PIGXB6W/sc5OLb6RQ= -github.com/dustin/go-humanize v1.0.0/go.mod h1:HtrtbFcZ19U5GC7JDqmcUSB87Iq5E25KnS6fMYU6eOk= github.com/envoyproxy/go-control-plane v0.9.0/go.mod h1:YTl/9mNaCwkRvm6d1a2C3ymFceY/DCBVvsKhRF0iEA4= github.com/envoyproxy/go-control-plane v0.9.1-0.20191026205805-5f8ba28d4473/go.mod h1:YTl/9mNaCwkRvm6d1a2C3ymFceY/DCBVvsKhRF0iEA4= github.com/envoyproxy/go-control-plane v0.9.4/go.mod h1:6rpuAdCZL397s3pYoYcLgu1mIlRU8Am5FuJP05cCM98= github.com/envoyproxy/go-control-plane v0.9.7/go.mod h1:cwu0lG7PUMfa9snN8LXBig5ynNVH9qI8YYLbd1fK2po= github.com/envoyproxy/go-control-plane v0.9.9-0.20201210154907-fd9021fe5dad/go.mod h1:cXg6YxExXjJnVBQHBLXeUAgxn2UodCpnH306RInaBQk= github.com/envoyproxy/protoc-gen-validate v0.1.0/go.mod h1:iSmxcyjqTsJpI2R4NaDN7+kN2VEUnK/pcBlmesArF7c= -github.com/fastenhealth/gofhir-models v0.0.4 h1:Q//StwNXGfK+WAS2DckGBHAP1R4cHMRZEF/sLGgmR04= -github.com/fastenhealth/gofhir-models v0.0.4/go.mod h1:xB8ikGxu3bUq2b1JYV+CZpHqBaLXpOizFR0eFBCunis= github.com/fatih/color v1.7.0/go.mod h1:Zm6kSWBoL9eyXnKyktHP6abPY2pDugNf5KwzbycvMj4= github.com/fatih/color v1.13.0 h1:8LOYc1KYPPmyKMuN8QV2DNRWNbLo6LZ0iLs8+mlH53w= github.com/fatih/color v1.13.0/go.mod h1:kLAiJbzzSOZDVNGyDpeOxJ47H46qBXwg5ILebYFFOfk= +github.com/flimzy/diff v0.1.5/go.mod h1:lFJtC7SPsK0EroDmGTSrdtWKAxOk3rO+q+e04LL05Hs= +github.com/flimzy/testy v0.1.17-0.20190521133342-95b386c3ece6/go.mod h1:3szguN8NXqgq9bt9Gu8TQVj698PJWmyx/VY1frwwKrM= github.com/frankban/quicktest v1.14.3 h1:FJKSZTDHjyhriyC81FLQ0LY93eSai0ZyR/ZIkd3ZUKE= github.com/fsnotify/fsnotify v1.5.4 h1:jRbGcIw6P2Meqdwuo0H1p6JVLbL5DHKAKlYndzMwVZI= github.com/fsnotify/fsnotify v1.5.4/go.mod h1:OVB6XrOHzAwXMpEM7uPOzcehqUV2UqJxmVXmkdnm1bU= @@ -84,15 +75,17 @@ github.com/gin-contrib/sse v0.1.0 h1:Y/yl/+YNO8GZSjAhjMsSuLt29uWRFHdHYUb5lYOV9qE github.com/gin-contrib/sse v0.1.0/go.mod h1:RHrZQHXnP2xjPF+u1gW/2HnVO7nvIa9PG3Gm+fLHvGI= github.com/gin-gonic/gin v1.8.1 h1:4+fr/el88TOO3ewCmQr8cx/CtZ/umlIRIs5M4NTNjf8= github.com/gin-gonic/gin v1.8.1/go.mod h1:ji8BvRH1azfM+SYow9zQ6SZMvR8qOMZHmsCuWR9tTTk= -github.com/glebarez/go-sqlite v1.17.3 h1:Rji9ROVSTTfjuWD6j5B+8DtkNvPILoUC3xRhkQzGxvk= -github.com/glebarez/go-sqlite v1.17.3/go.mod h1:Hg+PQuhUy98XCxWEJEaWob8x7lhJzhNYF1nZbUiRGIY= -github.com/glebarez/sqlite v1.4.6 h1:D5uxD2f6UJ82cHnVtO2TZ9pqsLyto3fpDKHIk2OsR8A= -github.com/glebarez/sqlite v1.4.6/go.mod h1:WYEtEFjhADPaPJqL/PGlbQQGINBA3eUAfDNbKFJf/zA= github.com/go-gl/glfw v0.0.0-20190409004039-e6da0acd62b1/go.mod h1:vR7hzQXu2zJy9AVAgeJqvqgH9Q5CA+iKCZ2gyEVpxRU= github.com/go-gl/glfw/v3.3/glfw v0.0.0-20191125211704-12ad95a8df72/go.mod h1:tQ2UAYgL5IevRw8kRxooKSPJfGvJ9fJQFa0TUsXzTg8= github.com/go-gl/glfw/v3.3/glfw v0.0.0-20200222043503-6f7a984d4dc4/go.mod h1:tQ2UAYgL5IevRw8kRxooKSPJfGvJ9fJQFa0TUsXzTg8= -github.com/go-kit/log v0.1.0/go.mod h1:zbhenjAZHb184qTLMA9ZjW7ThYL0H2mk7Q6pNt4vbaY= -github.com/go-logfmt/logfmt v0.5.0/go.mod h1:wCYkCAKZfumFQihp8CzCvQ3paCTfi41vtzG1KdI/P7A= +github.com/go-kivik/couchdb/v3 v3.3.0 h1:xipDIw66Sqei550OzSXWlLmJ9y01fMbBLkX0F/snjnw= +github.com/go-kivik/couchdb/v3 v3.3.0/go.mod h1:idTUN/G5HGE+YP2EgW+dvZ5ODkdhvddcU7ZzFZfwN6Q= +github.com/go-kivik/kivik/v3 v3.0.1/go.mod h1:7tmQDvkta/pcijpUjLMsQ9HJUELiKD5zm6jQ3Gb9cxE= +github.com/go-kivik/kivik/v3 v3.2.0/go.mod h1:chqVuHKAU9j2C7qL0cAH2FCO26oL+0B4aIBeCRMnLa8= +github.com/go-kivik/kivik/v3 v3.2.3 h1:ZFGR3hMDa+AUmPUCQxq4da3+3C4awdFQwdOtjLS+MxM= +github.com/go-kivik/kivik/v3 v3.2.3/go.mod h1:chqVuHKAU9j2C7qL0cAH2FCO26oL+0B4aIBeCRMnLa8= +github.com/go-kivik/kiviktest/v3 v3.0.4 h1:mHX/9gpz5VdSOOOs7sN0/6iLK6jQcLiYbteEd33cKNo= +github.com/go-kivik/kiviktest/v3 v3.0.4/go.mod h1:sqsz3M2sJxTxAUdOj+2SU21y4phcpYc0FJIn+hbf1D0= github.com/go-playground/assert/v2 v2.0.1 h1:MsBgLAaY856+nPRTKrp3/OZK38U/wa0CcBYNjji3q3A= github.com/go-playground/assert/v2 v2.0.1/go.mod h1:VDjEfimB/XKnb+ZQfWdccd7VUvScMdVu0Titje2rxJ4= github.com/go-playground/locales v0.14.0 h1:u50s323jtVGugKlcYeyzC0etD1HifMjqmJqb8WugfUU= @@ -101,19 +94,8 @@ github.com/go-playground/universal-translator v0.18.0 h1:82dyy6p4OuJq4/CByFNOn/j github.com/go-playground/universal-translator v0.18.0/go.mod h1:UvRDBj+xPUEGrFYl+lu/H90nyDXpg0fqeB/AQUGNTVA= github.com/go-playground/validator/v10 v10.10.0 h1:I7mrTYv78z8k8VXa/qJlOlEXn/nBh+BF8dHX5nt/dr0= github.com/go-playground/validator/v10 v10.10.0/go.mod h1:74x4gJWsvQexRdW8Pn3dXSGrTK4nAUsbPlLADvpJkos= -github.com/go-sql-driver/mysql v1.6.0 h1:BCTh4TKNUYmOmMUcQ3IipzF5prigylS7XXjEkfCHuOE= -github.com/go-sql-driver/mysql v1.6.0/go.mod h1:DCzpHaOWr8IXmIStZouvnhqoel9Qv2LBy8hT2VhHyBg= -github.com/go-stack/stack v1.8.0/go.mod h1:v0f6uXyyMGvRgIKkXu+yp6POWl0qKG85gN/melR3HDY= github.com/goccy/go-json v0.9.7 h1:IcB+Aqpx/iMHu5Yooh7jEzJk1JZ7Pjtmys2ukPr7EeM= github.com/goccy/go-json v0.9.7/go.mod h1:6MelG93GURQebXPDq3khkgXZkazVtN9CRI+MGFi0w8I= -github.com/gofrs/uuid v4.0.0+incompatible/go.mod h1:b2aQJv3Z4Fp6yNu3cdSllBxTCLRxnplIgP/c0N/04lM= -github.com/golang-jwt/jwt v3.2.2+incompatible h1:IfV12K8xAKAnZqdXVzCZ+TOjboZ2keLg81eXfW3O+oY= -github.com/golang-jwt/jwt v3.2.2+incompatible/go.mod h1:8pz2t5EyA70fFQQSrl6XZXzqecmYZeUEB8OUGHkxJ+I= -github.com/golang-sql/civil v0.0.0-20190719163853-cb61b32ac6fe/go.mod h1:8vg3r2VgvsThLBIFL93Qb5yWzgyZWhEmBwUJWevAkK0= -github.com/golang-sql/civil v0.0.0-20220223132316-b832511892a9 h1:au07oEsX2xN0ktxqI+Sida1w446QrXBRJ0nee3SNZlA= -github.com/golang-sql/civil v0.0.0-20220223132316-b832511892a9/go.mod h1:8vg3r2VgvsThLBIFL93Qb5yWzgyZWhEmBwUJWevAkK0= -github.com/golang-sql/sqlexp v0.0.0-20170517235910-f1bb20e5a188 h1:+eHOFJl1BaXrQxKX+T06f78590z4qA2ZzBTqahsKSE4= -github.com/golang-sql/sqlexp v0.0.0-20170517235910-f1bb20e5a188/go.mod h1:vXjM/+wXQnTPR4KqTKDgJukSZ6amVRtWMPEjE6sQoK8= github.com/golang/glog v0.0.0-20160126235308-23def4e6c14b/go.mod h1:SBH7ygxi8pfUlaOkMMuAQtPIUF8ecWP5IEl/CR7VP2Q= github.com/golang/groupcache v0.0.0-20190702054246-869f871628b6/go.mod 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h1:J/WKrq2StrnmMY6+EHIKF9dgMWnmCNThgcyBT1FY9mM= golang.org/x/exp v0.0.0-20200224162631-6cc2880d07d6/go.mod h1:3jZMyOhIsHpP37uCMkUooju7aAi5cS1Q23tOzKc+0MU= -golang.org/x/exp v0.0.0-20220303212507-bbda1eaf7a17 h1:3MTrJm4PyNL9NBqvYDSj3DHl46qQakyfqfWo4jgfaEM= -golang.org/x/exp v0.0.0-20220303212507-bbda1eaf7a17/go.mod h1:lgLbSvA5ygNOMpwM/9anMpWVlVJ7Z+cHWq/eFuinpGE= golang.org/x/image v0.0.0-20190227222117-0694c2d4d067/go.mod h1:kZ7UVZpmo3dzQBMxlp+ypCbDeSB+sBbTgSJuh5dn5js= golang.org/x/image v0.0.0-20190802002840-cff245a6509b/go.mod h1:FeLwcggjj3mMvU+oOTbSwawSJRM1uh48EjtB4UJZlP0= golang.org/x/lint v0.0.0-20181026193005-c67002cb31c3/go.mod h1:UVdnD1Gm6xHRNCYTkRU2/jEulfH38KcIWyp/GAMgvoE= @@ -442,7 +327,6 @@ golang.org/x/net v0.0.0-20190603091049-60506f45cf65/go.mod h1:HSz+uSET+XFnRR8LxR golang.org/x/net v0.0.0-20190620200207-3b0461eec859/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= golang.org/x/net v0.0.0-20190628185345-da137c7871d7/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= golang.org/x/net v0.0.0-20190724013045-ca1201d0de80/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= -golang.org/x/net v0.0.0-20190813141303-74dc4d7220e7/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= golang.org/x/net v0.0.0-20191209160850-c0dbc17a3553/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= golang.org/x/net v0.0.0-20200114155413-6afb5195e5aa/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= golang.org/x/net v0.0.0-20200202094626-16171245cfb2/go.mod h1:z5CRVTTTmAJ677TzLLGU+0bjPO0LkuOLi4/5GtJWs/s= @@ -459,14 +343,12 @@ golang.org/x/net v0.0.0-20200707034311-ab3426394381/go.mod h1:/O7V0waA8r7cgGh81R golang.org/x/net v0.0.0-20200822124328-c89045814202/go.mod h1:/O7V0waA8r7cgGh81Ro3o1hOxt32SMVPicZroKQ2sZA= golang.org/x/net v0.0.0-20201021035429-f5854403a974/go.mod h1:sp8m0HH+o8qH0wwXwYZr8TS3Oi6o0r6Gce1SSxlDquU= golang.org/x/net v0.0.0-20201031054903-ff519b6c9102/go.mod 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h1:CfG3xpIq0wQ8r1q4Su4UZFWDARRcnwPjda9FqA0JpMk= +golang.org/x/net v0.0.0-20221004154528-8021a29435af h1:wv66FM3rLZGPdxpYL+ApnDe2HzHcTFta3z5nsc13wI4= +golang.org/x/net v0.0.0-20221004154528-8021a29435af/go.mod h1:YDH+HFinaLZZlnHAfSS6ZXJJ9M9t4Dl22yv3iI2vPwk= golang.org/x/oauth2 v0.0.0-20180821212333-d2e6202438be/go.mod h1:N/0e6XlmueqKjAGxoOufVs8QHGRruUQn6yWY3a++T0U= golang.org/x/oauth2 v0.0.0-20190226205417-e64efc72b421/go.mod h1:gOpvHmFTYa4IltrdGE7lF6nIHvwfUNPOp7c8zoXwtLw= golang.org/x/oauth2 v0.0.0-20190604053449-0f29369cfe45/go.mod h1:gOpvHmFTYa4IltrdGE7lF6nIHvwfUNPOp7c8zoXwtLw= @@ -476,8 +358,6 @@ golang.org/x/oauth2 v0.0.0-20200902213428-5d25da1a8d43/go.mod h1:KelEdhl1UZF7XfJ golang.org/x/oauth2 v0.0.0-20201109201403-9fd604954f58/go.mod h1:KelEdhl1UZF7XfJ4dDtk6s++YSgaE7mD/BuKKDLBl4A= golang.org/x/oauth2 v0.0.0-20201208152858-08078c50e5b5/go.mod h1:KelEdhl1UZF7XfJ4dDtk6s++YSgaE7mD/BuKKDLBl4A= golang.org/x/oauth2 v0.0.0-20210218202405-ba52d332ba99/go.mod h1:KelEdhl1UZF7XfJ4dDtk6s++YSgaE7mD/BuKKDLBl4A= -golang.org/x/oauth2 v0.0.0-20220411215720-9780585627b5 h1:OSnWWcOd/CtWQC2cYSBgbTSJv3ciqd8r54ySIW2y3RE= -golang.org/x/oauth2 v0.0.0-20220411215720-9780585627b5/go.mod h1:DAh4E804XQdzx2j+YRIaUnCqCV2RuMz24cGBJ5QYIrc= golang.org/x/sync v0.0.0-20180314180146-1d60e4601c6f/go.mod h1:RxMgew5VJxzue5/jJTE5uejpjVlOe/izrB70Jof72aM= golang.org/x/sync v0.0.0-20181108010431-42b317875d0f/go.mod h1:RxMgew5VJxzue5/jJTE5uejpjVlOe/izrB70Jof72aM= golang.org/x/sync v0.0.0-20181221193216-37e7f081c4d4/go.mod h1:RxMgew5VJxzue5/jJTE5uejpjVlOe/izrB70Jof72aM= @@ -489,22 +369,17 @@ golang.org/x/sync v0.0.0-20200625203802-6e8e738ad208/go.mod h1:RxMgew5VJxzue5/jJ golang.org/x/sync v0.0.0-20201020160332-67f06af15bc9/go.mod h1:RxMgew5VJxzue5/jJTE5uejpjVlOe/izrB70Jof72aM= golang.org/x/sync v0.0.0-20201207232520-09787c993a3a/go.mod h1:RxMgew5VJxzue5/jJTE5uejpjVlOe/izrB70Jof72aM= golang.org/x/sys v0.0.0-20180830151530-49385e6e1522/go.mod 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h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= golang.org/x/sys v0.0.0-20200113162924-86b910548bc1/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= @@ -528,19 +403,15 @@ golang.org/x/sys v0.0.0-20201201145000-ef89a241ccb3/go.mod h1:h1NjWce9XRLGQEsW7w golang.org/x/sys v0.0.0-20210104204734-6f8348627aad/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= golang.org/x/sys v0.0.0-20210119212857-b64e53b001e4/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= golang.org/x/sys v0.0.0-20210225134936-a50acf3fe073/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= -golang.org/x/sys v0.0.0-20210423082822-04245dca01da/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= golang.org/x/sys v0.0.0-20210423185535-09eb48e85fd7/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs= golang.org/x/sys v0.0.0-20210615035016-665e8c7367d1/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg= golang.org/x/sys v0.0.0-20210630005230-0f9fa26af87c/go.mod 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h1:Nr5EML6q2oocZ2LXRh80K7BxOlk5/8JxuGnuhpl+muw= +golang.org/x/sys v0.0.0-20220728004956-3c1f35247d10 h1:WIoqL4EROvwiPdUtaip4VcDdpZ4kha7wBWZrbVKCIZg= +golang.org/x/sys v0.0.0-20220728004956-3c1f35247d10/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg= golang.org/x/term v0.0.0-20201126162022-7de9c90e9dd1/go.mod h1:bj7SfCRtBDWHUb9snDiAeCFNEtKQo2Wmx5Cou7ajbmo= golang.org/x/term v0.0.0-20210927222741-03fcf44c2211 h1:JGgROgKl9N8DuW20oFS5gxc+lE67/N3FcwmBPMe7ArY= golang.org/x/term v0.0.0-20210927222741-03fcf44c2211/go.mod h1:jbD1KX2456YbFQfuXm/mYQcufACuNUgVhRMnK/tPxf8= @@ -563,18 +434,14 @@ golang.org/x/tools v0.0.0-20190311212946-11955173bddd/go.mod h1:LCzVGOaR6xXOjkQ3 golang.org/x/tools v0.0.0-20190312151545-0bb0c0a6e846/go.mod h1:LCzVGOaR6xXOjkQ3onu1FJEFr0SW1gC7cKk1uF8kGRs= golang.org/x/tools v0.0.0-20190312170243-e65039ee4138/go.mod h1:LCzVGOaR6xXOjkQ3onu1FJEFr0SW1gC7cKk1uF8kGRs= golang.org/x/tools v0.0.0-20190425150028-36563e24a262/go.mod 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h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= golang.org/x/tools v0.0.0-20191012152004-8de300cfc20a/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= -golang.org/x/tools v0.0.0-20191029041327-9cc4af7d6b2c/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= -golang.org/x/tools v0.0.0-20191029190741-b9c20aec41a5/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= golang.org/x/tools v0.0.0-20191113191852-77e3bb0ad9e7/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= golang.org/x/tools v0.0.0-20191115202509-3a792d9c32b2/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= golang.org/x/tools v0.0.0-20191119224855-298f0cb1881e/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= @@ -582,7 +449,6 @@ golang.org/x/tools v0.0.0-20191125144606-a911d9008d1f/go.mod h1:b+2E5dAYhXwXZwtn golang.org/x/tools v0.0.0-20191130070609-6e064ea0cf2d/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo= golang.org/x/tools v0.0.0-20191216173652-a0e659d51361/go.mod h1:TB2adYChydJhpapKDTa4BR/hXlZSLoq2Wpct/0txZ28= golang.org/x/tools v0.0.0-20191227053925-7b8e75db28f4/go.mod h1:TB2adYChydJhpapKDTa4BR/hXlZSLoq2Wpct/0txZ28= -golang.org/x/tools v0.0.0-20200103221440-774c71fcf114/go.mod h1:TB2adYChydJhpapKDTa4BR/hXlZSLoq2Wpct/0txZ28= golang.org/x/tools v0.0.0-20200117161641-43d50277825c/go.mod h1:TB2adYChydJhpapKDTa4BR/hXlZSLoq2Wpct/0txZ28= golang.org/x/tools v0.0.0-20200122220014-bf1340f18c4a/go.mod h1:TB2adYChydJhpapKDTa4BR/hXlZSLoq2Wpct/0txZ28= golang.org/x/tools v0.0.0-20200130002326-2f3ba24bd6e7/go.mod h1:TB2adYChydJhpapKDTa4BR/hXlZSLoq2Wpct/0txZ28= @@ -603,18 +469,17 @@ golang.org/x/tools v0.0.0-20200804011535-6c149bb5ef0d/go.mod h1:njjCfa9FT2d7l9Bc golang.org/x/tools v0.0.0-20200825202427-b303f430e36d/go.mod h1:njjCfa9FT2d7l9Bc6FUM5FLjQPp3cFF28FI3qnDFljA= golang.org/x/tools v0.0.0-20200904185747-39188db58858/go.mod h1:Cj7w3i3Rnn0Xh82ur9kSqwfTHTeVxaDqrfMjpcNT6bE= golang.org/x/tools v0.0.0-20201110124207-079ba7bd75cd/go.mod 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h1:I/5z698sn9Ka8TeJc9MKroUUfqBBauWjQqLJ2OPfmY0= golang.org/x/xerrors v0.0.0-20191011141410-1b5146add898/go.mod h1:I/5z698sn9Ka8TeJc9MKroUUfqBBauWjQqLJ2OPfmY0= golang.org/x/xerrors v0.0.0-20191204190536-9bdfabe68543/go.mod h1:I/5z698sn9Ka8TeJc9MKroUUfqBBauWjQqLJ2OPfmY0= golang.org/x/xerrors v0.0.0-20200804184101-5ec99f83aff1/go.mod h1:I/5z698sn9Ka8TeJc9MKroUUfqBBauWjQqLJ2OPfmY0= +golang.org/x/xerrors v0.0.0-20220907171357-04be3eba64a2 h1:H2TDz8ibqkAF6YGhCdN3jS9O0/s90v0rJh3X/OLHEUk= +golang.org/x/xerrors v0.0.0-20220907171357-04be3eba64a2/go.mod h1:K8+ghG5WaK9qNqU5K3HdILfMLy1f3aNYFI/wnl100a8= google.golang.org/api v0.4.0/go.mod h1:8k5glujaEP+g9n7WNsDg8QP6cUVNI86fCNMcbazEtwE= google.golang.org/api v0.7.0/go.mod h1:WtwebWUNSVBH/HAw79HIFXZNqEvBhG+Ra+ax0hx3E3M= google.golang.org/api v0.8.0/go.mod h1:o4eAsZoiT+ibD93RtjEohWalFOjRDx6CVaqeizhEnKg= @@ -640,7 +505,6 @@ google.golang.org/appengine v1.5.0/go.mod h1:xpcJRLb0r/rnEns0DIKYYv+WjYCduHsrkT7 google.golang.org/appengine v1.6.1/go.mod h1:i06prIuMbXzDqacNJfV5OdTW448YApPu5ww/cMBSeb0= google.golang.org/appengine v1.6.5/go.mod h1:8WjMMxjGQR8xUklV/ARdw2HLXBOI7O7uCIDZVag1xfc= google.golang.org/appengine v1.6.6/go.mod h1:8WjMMxjGQR8xUklV/ARdw2HLXBOI7O7uCIDZVag1xfc= -google.golang.org/appengine v1.6.7 h1:FZR1q0exgwxzPzp/aF+VccGrSfxfPpkBqjIIEq3ru6c= google.golang.org/appengine v1.6.7/go.mod h1:8WjMMxjGQR8xUklV/ARdw2HLXBOI7O7uCIDZVag1xfc= google.golang.org/genproto v0.0.0-20180817151627-c66870c02cf8/go.mod h1:JiN7NxoALGmiZfu7CAH4rXhgtRTLTxftemlI0sWmxmc= google.golang.org/genproto v0.0.0-20190307195333-5fe7a883aa19/go.mod h1:VzzqZJRnGkLBvHegQrXjBqPurQTc5/KpmUdxsrq26oE= @@ -705,7 +569,6 @@ google.golang.org/protobuf v1.23.1-0.20200526195155-81db48ad09cc/go.mod h1:EGpAD google.golang.org/protobuf v1.24.0/go.mod h1:r/3tXBNzIEhYS9I1OUVjXDlt8tc493IdKGjtUeSXeh4= google.golang.org/protobuf v1.25.0/go.mod h1:9JNX74DMeImyA3h4bdi1ymwjUzf21/xIlbajtzgsN7c= google.golang.org/protobuf v1.26.0-rc.1/go.mod 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