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": "
Identifier | A00000000000005 |
Date of birth | 12 January 2013 |
",
- "status": "generated"
- },
- "birthDate": "2013-01-12",
- "gender": "female",
- "identifier": [{
- "system": "https://developer.cigna.com",
- "type": {
- "coding": [{
- "code": "um",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/IdentifierTypeCS"
- }]
- },
- "value": "A00000000000005"
- }, {
- "system": "https://developer.cigna.com",
- "type": {
- "coding": [{
- "code": "mb",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/IdentifierTypeCS"
- }]
- },
- "value": "unknown"
- }],
- "maritalStatus": {
- "coding": [{
- "code": "UNK",
- "display": "unknown",
- "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"
- }],
- "text": "unknown"
- },
- "name": [{
- "family": "Monahan",
- "given": ["Felecita"],
- "use": "official"
- }],
- "telecom": [{
- "system": "phone",
- "use": "mobile",
- "value": "9404535496"
- }],
- "resourceType": "Patient"
- },
- "search": {
- "mode": "match"
- }
- },{
- "fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/Condition/ifp-A00000000000005-CS0000449534-K57.92",
- "resource": {
- "id": "ifp-A00000000000005-CS0000449534-K57.92",
- "meta": {
- "lastUpdated": "2022-06-20T15:45:22.431000+00:00",
- "profile": ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition"],
- "source": "IFP#BfVDmjcVAxAfr5Be",
- "versionId": "1"
- },
- "category": [{
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- }],
- "clinicalStatus": {
- "coding": [{
- "code": "active",
- "display": "active",
- "system": "http://terminology.hl7.org/CodeSystem/condition-clinical"
- }],
- "text": "active"
- },
- "code": {
- "coding": [{
- "code": "K57.92",
- "display": "DVTRCLI OF INTEST, PART UNSP, W/O PERF OR ABSCESS W/O BLEED"
- }],
- "text": "Null"
- },
- "identifier": [{
- "value": "A00000000000005-CS0000449534-K57.92"
- }],
- "recordedDate": "2019-10-22",
- "subject": {
- "reference": "Patient/ifp-A00000000000005"
- },
- "resourceType": "Condition"
- },
- "search": {
- "mode": "match"
- }
- }, {
- "fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/Encounter/ifp-1C9A46F07B3CADE33EFC75ABA3DC37CF",
- "resource": {
- "id": "ifp-1C9A46F07B3CADE33EFC75ABA3DC37CF",
- "meta": {
- "lastUpdated": "2022-06-20T15:45:29.685000+00:00",
- "profile": ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"],
- "source": "IFP#e7zkeLCSmQFgUX0Z",
- "versionId": "1"
- },
- "class": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "diagnosis": [{
- "condition": {
- "reference": "Condition/ifp-A00000000000005-OP0447575426-K57.80-Y-"
- },
- "use": {
- "coding": [{
- "display": "Admission diagnosis"
- }]
- }
- }],
- "identifier": [{
- "system": "http://dev.cigna.com/system/TRCR",
- "value": "TRCR-OP0447575426-1"
- }],
- "location": [{
- "location": {
- "reference": "Location/ifp-7312532"
- }
- }, {
- "location": {
- "reference": "Location/ifp-0566265"
- }
- }],
- "participant": [{
- "individual": {
- "reference": "Practitioner/ifp-50ef4542ecb5ae5eddc0dac76a10aaed"
- }
- }, {
- "individual": {
- "reference": "Practitioner/ifp-6a4d3d6fe165b6a0a79b6a976d043c2c"
- }
- }],
- "period": {
- "end": "2019-12-31",
- "start": "2019-11-07"
- },
- "reasonCode": [{
- "coding": [{
- "code": "K57.80",
- "display": "Dvtrcli of intest, part unsp, w perf and abscess w/o bleed"
- }]
- }],
- "reasonReference": [{
- "reference": "Condition/ifp-A00000000000005-OP0447575426-K57.80-Y-"
- }],
- "serviceProvider": {
- "reference": "Organization/ifp-0566265"
- },
- "serviceType": {
- "coding": [{
- "code": "302",
- "display": "Medical Outpatient"
- }]
- },
- "status": "unknown",
- "subject": {
- "reference": "Patient/ifp-A00000000000005"
- },
- "type": [{
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- }],
- "resourceType": "Encounter"
- },
- "search": {
- "mode": "match"
- }
- }, {
- "fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/ExplanationOfBenefit/ifp-577B939844288EC2702EA92A8A2BEAA0",
- "resource": {
- "id": "ifp-577B939844288EC2702EA92A8A2BEAA0",
- "meta": {
- "lastUpdated": "2022-06-20T15:45:34.176000+00:00",
- "profile": ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"],
- "source": "IFP#8SdkvkRZ51amC5sY",
- "versionId": "1"
- },
- "accident": {
- "type": {
- "coding": [{
- "display": "XXXXX"
- }]
- }
- },
- "billablePeriod": {
- "end": "2019-11-22",
- "start": "2019-11-08"
- },
- "careTeam": [{
- "provider": {
- "reference": "Organization/ifp-0566265"
- },
- "role": {
- "coding": [{
- "code": "performing",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole"
- }]
- },
- "_sequence": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- }
- }],
- "_created": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "diagnosis": [{
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "K5720",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 1,
- "type": [{
- "coding": [{
- "code": "principal",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "N186",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 2,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "K5720",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 1,
- "type": [{
- "coding": [{
- "code": "admitting",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Z905",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 11,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Z87442",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 12,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Z98890",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 14,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "D649",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 7,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Q612",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 5,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "E876",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 9,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Z7982",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 10,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Z8249",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 13,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "E871",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 3,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "I120",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 4,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "Z940",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "sequence": 6,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }, {
- "diagnosisCodeableConcept": {
- "coding": [{
- "code": "E785",
- "system": "http://hl7.org/fhir/sid/icd-10-cm",
- "version": "10"
- }]
- },
- "onAdmission": {
- "coding": [{
- "code": "y",
- "system": "http://www.nubc.org/PresentOnAdmission"
- }]
- },
- "sequence": 8,
- "type": [{
- "coding": [{
- "code": "other",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"
- }]
- }]
- }],
- "identifier": [{
- "type": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "value": "1925381131-8-FCTS"
- }],
- "insurance": [{
- "coverage": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "_focal": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- }
- }],
- "insurer": {
- "display": "Cigna"
- },
- "outcome": "complete",
- "patient": {
- "reference": "Patient/ifp-A00000000000005"
- },
- "payee": {
- "party": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "type": {
- "coding": [{
- "code": "other",
- "display": "Provider",
- "system": "http://terminology.hl7.org/CodeSystem/payeetype"
- }]
- }
- },
- "payment": {
- "date": "2020-01-02"
- },
- "provider": {
- "reference": "Organization/ifp-0566265"
- },
- "_status": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "total": [{
- "amount": {
- "extension": [{
- "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
- "valueCode": "unknown"
- }]
- },
- "category": {
- "coding": [{
- "code": "innetwork",
- "display": "In Network",
- "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"
- }]
- }
- }],
- "type": {
- "coding": [{
- "code": "institutional",
- "display": "Institutional Claim",
- "system": "http://terminology.hl7.org/CodeSystem/claim-type"
- }]
- },
- "use": "claim",
- "resourceType": "ExplanationOfBenefit"
- },
- "search": {
- "mode": "match"
- }
- }, {
- "fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/ExplanationOfBenefit/ifp-B4028B5B95E3E540CD1DFA1968D5C08D",
- "resource": {
- "id": "ifp-B4028B5B95E3E540CD1DFA1968D5C08D",
- "meta": {
- "lastUpdated": "2022-06-20T15:45:34.699000+00:00",
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Alesha810_Marks830_1e0a8bd3-3b82-4f17-b1d6-19043aa0db6b.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Alesha810_Marks830_1e0a8bd3-3b82-4f17-b1d6-19043aa0db6b.json
deleted file mode 100644
index 64e2c9c7..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Alesha810_Marks830_1e0a8bd3-3b82-4f17-b1d6-19043aa0db6b.json
+++ /dev/null
@@ -1,16695 +0,0 @@
-{
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"
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- "extension": [
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Blair400_Grady603_51978986-f824-43da-b69a-d2d17f49df70.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Blair400_Grady603_51978986-f824-43da-b69a-d2d17f49df70.json
deleted file mode 100644
index 3e4c7bdb..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Blair400_Grady603_51978986-f824-43da-b69a-d2d17f49df70.json
+++ /dev/null
@@ -1,12872 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:d7714835-c7e2-408f-9652-c8c2bdd9d2bf",
- "resource": {
- "resourceType": "Patient",
- "id": "d7714835-c7e2-408f-9652-c8c2bdd9d2bf",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 6854428927621892691 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Roxane435 Lesch175"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "M"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Rome",
- "state": "Lazio",
- "country": "IT"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 0.38741462478185473
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 46.612585375218146
- }
- ],
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "51978986-f824-43da-b69a-d2d17f49df70"
- },
- {
- "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",
- "value": "51978986-f824-43da-b69a-d2d17f49df70"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
- ],
- "text": "Social Security Number"
- },
- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-53-7253"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "DL",
- "display": "Driver's License"
- }
- ],
- "text": "Driver's License"
- },
- "system": "urn:oid:2.16.840.1.113883.4.3.25",
- "value": "S99971395"
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- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "PPN",
- "display": "Passport Number"
- }
- ],
- "text": "Passport Number"
- },
- "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
- "value": "X5903319X"
- }
- ],
- "name": [
- {
- "use": "official",
- "family": "Grady603",
- "given": [
- "Blair400"
- ],
- "prefix": [
- "Mr."
- ]
- }
- ],
- "telecom": [
- {
- "system": "phone",
- "value": "555-222-7035",
- "use": "home"
- }
- ],
- "gender": "male",
- "birthDate": "1971-08-04",
- "address": [
- {
- "extension": [
- {
- "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
- "extension": [
- {
- "url": "latitude",
- "valueDecimal": 42.20684095661692
- },
- {
- "url": "longitude",
- "valueDecimal": -72.62738153515339
- }
- ]
- }
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- "line": [
- "349 Murazik Fork"
- ],
- "city": "West Springfield",
- "state": "Massachusetts",
- "postalCode": "01089",
- "country": "US"
- }
- ],
- "maritalStatus": {
- "coding": [
- {
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- "code": "M",
- "display": "M"
- }
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- "text": "M"
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- "communication": [
- {
- "language": {
- "coding": [
- {
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- "code": "it",
- "display": "Italian"
- }
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- "text": "Italian"
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- "request": {
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- "url": "Patient"
- }
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- {
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- "resource": {
- "resourceType": "Organization",
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- "identifier": [
- {
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- "value": "a0123c36-2436-3609-a5eb-3c3857ed711d"
- }
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- "active": true,
- "type": [
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- "code": "prov",
- "display": "Healthcare Provider"
- }
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- "text": "Healthcare Provider"
- }
- ],
- "name": "PCP8367",
- "telecom": [
- {
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- "value": "413-887-7827"
- }
- ],
- "address": [
- {
- "line": [
- "12 CORSER ST"
- ],
- "city": "HOLYOKE",
- "state": "MA",
- "postalCode": "01040-2275",
- "country": "US"
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- "url": "Organization"
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- "identifier": [
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- "value": "5840"
- }
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- "active": true,
- "name": [
- {
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- "given": [
- "MarÃa Soledad68"
- ],
- "prefix": [
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- ]
- }
- ],
- "telecom": [
- {
- "system": "email",
- "value": "MarÃa Soledad68.Marrero674@example.com",
- "use": "work"
- }
- ],
- "address": [
- {
- "line": [
- "12 CORSER ST"
- ],
- "city": "HOLYOKE",
- "state": "MA",
- "postalCode": "01040-2275",
- "country": "US"
- }
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- "gender": "female"
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- "request": {
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- "url": "Practitioner"
- }
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- {
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- "resource": {
- "resourceType": "Encounter",
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- "display": "Mr. Blair400 Grady603"
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- "display": "Dr. MarÃa Soledad68 Marrero674"
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- "period": {
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- "end": "2011-08-10T08:34:16-04:00"
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- "system": "http://terminology.hl7.org/CodeSystem/claim-type",
- "code": "institutional"
- }
- ]
- },
- "use": "claim",
- "patient": {
- "reference": "urn:uuid:d7714835-c7e2-408f-9652-c8c2bdd9d2bf"
- },
- "billablePeriod": {
- "start": "2019-08-28T08:34:16-04:00",
- "end": "2020-08-28T08:34:16-04:00"
- },
- "created": "2019-08-28T08:34:16-04:00",
- "insurer": {
- "display": "Humana"
- },
- "provider": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-0000000016d0"
- },
- "referral": {
- "reference": "#referral"
- },
- "claim": {
- "reference": "urn:uuid:3d6defeb-9443-478d-b6c8-67bd41c659f4"
- },
- "outcome": "complete",
- "careTeam": [
- {
- "sequence": 1,
- "provider": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-0000000016d0"
- },
- "role": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
- "code": "primary",
- "display": "Primary Care Practitioner"
- }
- ]
- }
- }
- ],
- "insurance": [
- {
- "focal": true,
- "coverage": {
- "reference": "#coverage",
- "display": "Humana"
- }
- }
- ],
- "item": [
- {
- "sequence": 1,
- "category": {
- "coding": [
- {
- "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
- "code": "1",
- "display": "Medical care"
- }
- ]
- },
- "productOrService": {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "162673000",
- "display": "General examination of patient (procedure)"
- }
- ],
- "text": "General examination of patient (procedure)"
- },
- "servicedPeriod": {
- "start": "2019-08-28T08:19:16-04:00",
- "end": "2019-08-28T08:34:16-04:00"
- },
- "locationCodeableConcept": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/ex-serviceplace",
- "code": "19",
- "display": "Off Campus-Outpatient Hospital"
- }
- ]
- },
- "encounter": [
- {
- "reference": "urn:uuid:3e587649-e9ad-44d7-b515-6257b69c4113"
- }
- ]
- },
- {
- "sequence": 2,
- "informationSequence": [
- 1
- ],
- "category": {
- "coding": [
- {
- "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
- "code": "1",
- "display": "Medical care"
- }
- ]
- },
- "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": "2019-08-28T08:19:16-04:00",
- "end": "2019-08-28T08:34:16-04:00"
- },
- "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/base/testdata/fixtures/401-R4/bundle/synthea_Carl856_Powlowski563_49e4037a-b643-4acf-bbfe-e29ca79b97a1.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Carl856_Powlowski563_49e4037a-b643-4acf-bbfe-e29ca79b97a1.json
deleted file mode 100644
index 0c6ba92c..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Carl856_Powlowski563_49e4037a-b643-4acf-bbfe-e29ca79b97a1.json
+++ /dev/null
@@ -1,9929 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd",
- "resource": {
- "resourceType": "Patient",
- "id": "10c09023-42cd-4ed8-9055-09bf6120c7dd",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 1176089665387826969 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Mabelle762 Schamberger479"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "M"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Worcester",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 2.204054020908369
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 35.795945979091634
- }
- ],
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "49e4037a-b643-4acf-bbfe-e29ca79b97a1"
- },
- {
- "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",
- "value": "49e4037a-b643-4acf-bbfe-e29ca79b97a1"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
- ],
- "text": "Social Security Number"
- },
- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-99-3293"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "DL",
- "display": "Driver's License"
- }
- ],
- "text": "Driver's License"
- },
- "system": "urn:oid:2.16.840.1.113883.4.3.25",
- "value": "S99910425"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "PPN",
- "display": "Passport Number"
- }
- ],
- "text": "Passport Number"
- },
- "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
- "value": "X909994X"
- }
- ],
- "name": [
- {
- "use": "official",
- "family": "Powlowski563",
- "given": [
- "Carl856"
- ],
- "prefix": [
- "Mr."
- ]
- }
- ],
- "telecom": [
- {
- "system": "phone",
- "value": "555-365-3426",
- "use": "home"
- }
- ],
- "gender": "male",
- "birthDate": "1980-02-16",
- "address": [
- {
- "extension": [
- {
- "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
- "extension": [
- {
- "url": "latitude",
- "valueDecimal": 41.81313720090747
- },
- {
- "url": "longitude",
- "valueDecimal": -71.01426895740737
- }
- ]
- }
- ],
- "line": [
- "367 Farrell Lock Suite 49"
- ],
- "city": "Fall River",
- "state": "Massachusetts",
- "postalCode": "02720",
- "country": "US"
- }
- ],
- "maritalStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
- "code": "M",
- "display": "M"
- }
- ],
- "text": "M"
- },
- "multipleBirthBoolean": false,
- "communication": [
- {
- "language": {
- "coding": [
- {
- "system": "urn:ietf:bcp:47",
- "code": "en-US",
- "display": "English"
- }
- ],
- "text": "English"
- }
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "Patient"
- }
- },
- {
- "fullUrl": "urn:uuid:7a0b9372-1373-333a-9846-0e6c0030ba45",
- "resource": {
- "resourceType": "Organization",
- "id": "7a0b9372-1373-333a-9846-0e6c0030ba45",
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "7a0b9372-1373-333a-9846-0e6c0030ba45"
- }
- ],
- "active": true,
- "type": [
- {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/organization-type",
- "code": "prov",
- "display": "Healthcare Provider"
- }
- ],
- "text": "Healthcare Provider"
- }
- ],
- "name": "PCP17971",
- "telecom": [
- {
- "system": "phone",
- "value": "508-947-0747"
- }
- ],
- "address": [
- {
- "line": [
- "66 MAIN ST"
- ],
- "city": "LAKEVILLE",
- "state": "MA",
- "postalCode": "02347-1608",
- "country": "US"
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "Organization"
- }
- },
- {
- "fullUrl": "urn:uuid:0000016d-3a85-4cca-0000-00000000302a",
- "resource": {
- "resourceType": "Practitioner",
- "id": "0000016d-3a85-4cca-0000-00000000302a",
- "identifier": [
- {
- "system": "http://hl7.org/fhir/sid/us-npi",
- "value": "12330"
- }
- ],
- "active": true,
- "name": [
- {
- "family": "Barton704",
- "given": [
- "Oliver401"
- ],
- "prefix": [
- "Dr."
- ]
- }
- ],
- "telecom": [
- {
- "system": "email",
- "value": "Oliver401.Barton704@example.com",
- "use": "work"
- }
- ],
- "address": [
- {
- "line": [
- "66 MAIN ST"
- ],
- "city": "LAKEVILLE",
- "state": "MA",
- "postalCode": "02347-1608",
- "country": "US"
- }
- ],
- "gender": "male"
- },
- "request": {
- "method": "POST",
- "url": "Practitioner"
- }
- },
- {
- "fullUrl": "urn:uuid:a1c9d9e5-a867-4d05-b003-609931321c90",
- "resource": {
- "resourceType": "Encounter",
- "id": "a1c9d9e5-a867-4d05-b003-609931321c90",
- "status": "finished",
- "class": {
- "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
- "code": "AMB"
- },
- "type": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "162673000",
- "display": "General examination of patient (procedure)"
- }
- ],
- "text": "General examination of patient (procedure)"
- }
- ],
- "subject": {
- "reference": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd",
- "display": "Mr. Carl856 Powlowski563"
- },
- "participant": [
- {
- "individual": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-00000000302a",
- "display": "Dr. Oliver401 Barton704"
- }
- }
- ],
- "period": {
- "start": "2002-04-20T16:57:25-04:00",
- "end": "2002-04-20T17:12:25-04:00"
- },
- "serviceProvider": {
- "reference": "urn:uuid:7a0b9372-1373-333a-9846-0e6c0030ba45",
- "display": "PCP17971"
- }
- },
- "request": {
- "method": "POST",
- "url": "Encounter"
- }
- },
- {
- "fullUrl": "urn:uuid:f0ace865-8a12-453c-b9dc-4f1a73cd2fd0",
- "resource": {
- "resourceType": "Condition",
- "id": "f0ace865-8a12-453c-b9dc-4f1a73cd2fd0",
- "clinicalStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
- "code": "active"
- }
- ]
- },
- "verificationStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
- "code": "confirmed"
- }
- ]
- },
- "code": {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "15777000",
- "display": "Prediabetes"
- }
- ],
- "text": "Prediabetes"
- },
- "subject": {
- "reference": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd"
- },
- "encounter": {
- "reference": "urn:uuid:a1c9d9e5-a867-4d05-b003-609931321c90"
- },
- "onsetDateTime": "2002-04-20T16:57:25-04:00",
- "recordedDate": "2002-04-20T16:57:25-04:00"
- },
- "request": {
- "method": "POST",
- "url": "Condition"
- }
- },
- {
- "fullUrl": "urn:uuid:36ced40e-e299-46a5-8f3f-b64584ab7840",
- "resource": {
- "resourceType": "CareTeam",
- "id": "36ced40e-e299-46a5-8f3f-b64584ab7840",
- "status": "active",
- "subject": {
- "reference": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd"
- },
- "encounter": {
- "reference": "urn:uuid:a1c9d9e5-a867-4d05-b003-609931321c90"
- },
- "period": {
- "start": "2002-04-20T16:57:25-04:00"
- },
- "participant": [
- {
- "role": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "116153009",
- "display": "Patient"
- }
- ],
- "text": "Patient"
- }
- ],
- "member": {
- "reference": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd",
- "display": "Mr. Carl856 Powlowski563"
- }
- },
- {
- "role": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "303118004",
- "display": "Person in the healthcare environment (person)"
- }
- ],
- "text": "Person in the healthcare environment (person)"
- }
- ],
- "member": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-00000000302a",
- "display": "Dr. Oliver401 Barton704"
- }
- },
- {
- "role": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "303118004",
- "display": "Healthcare related organization (qualifier value)"
- }
- ],
- "text": "Healthcare related organization (qualifier value)"
- }
- ],
- "member": {
- "reference": "urn:uuid:7a0b9372-1373-333a-9846-0e6c0030ba45",
- "display": "PCP17971"
- }
- }
- ],
- "reasonCode": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "15777000",
- "display": "Prediabetes"
- }
- ],
- "text": "Prediabetes"
- }
- ],
- "managingOrganization": [
- {
- "reference": "urn:uuid:7a0b9372-1373-333a-9846-0e6c0030ba45",
- "display": "PCP17971"
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "CareTeam"
- }
- },
- {
- "fullUrl": "urn:uuid:c7ce64c4-2ab4-4420-a52f-36c106a74910",
- "resource": {
- "resourceType": "Goal",
- "id": "c7ce64c4-2ab4-4420-a52f-36c106a74910",
- "lifecycleStatus": "accepted",
- "achievementStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
- "code": "in-progress"
- }
- ]
- },
- "description": {
- "text": "Hemoglobin A1c total in Blood < 7.0"
- },
- "subject": {
- "reference": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd"
- }
- },
- "request": {
- "method": "POST",
- "url": "Goal"
- }
- },
- {
- "fullUrl": "urn:uuid:affa2e19-4db7-4869-969d-09f152effa15",
- "resource": {
- "resourceType": "Goal",
- "id": "affa2e19-4db7-4869-969d-09f152effa15",
- "lifecycleStatus": "accepted",
- "achievementStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
- "code": "in-progress"
- }
- ]
- },
- "description": {
- "text": "Glucose [Mass/volume] in Blood < 108"
- },
- "subject": {
- "reference": "urn:uuid:10c09023-42cd-4ed8-9055-09bf6120c7dd"
- }
- },
- "request": {
- "method": "POST",
- "url": "Goal"
- }
- },
- {
- "fullUrl": "urn:uuid:46ea4161-1eae-437b-85c7-ee2d6c9f1fee",
- "resource": {
- "resourceType": "Goal",
- "id": "46ea4161-1eae-437b-85c7-ee2d6c9f1fee",
- "lifecycleStatus": "accepted",
- "achievementStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/goal-achievement",
- "code": "in-progress"
- }
- ]
- },
- "description": {
- "text": "Maintain blood pressure below 140/90 mmHg"
- },
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- "display": "Submitted Amount"
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- "text": "Submitted Amount"
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- "currency": "USD"
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Christia477_Hermann103_3815b8af-23b0-45b7-ba24-235307622f15.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Christia477_Hermann103_3815b8af-23b0-45b7-ba24-235307622f15.json
deleted file mode 100644
index 89f2830b..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Christia477_Hermann103_3815b8af-23b0-45b7-ba24-235307622f15.json
+++ /dev/null
@@ -1,33242 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:73f076b2-64d5-4135-a4e5-1af0d338af59",
- "resource": {
- "resourceType": "Patient",
- "id": "73f076b2-64d5-4135-a4e5-1af0d338af59",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 5245364836250954000 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Patsy569 Frami345"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "F"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Shrewsbury",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 3.455251540539983
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 46.54474845946002
- }
- ],
- "identifier": [
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- "system": "https://github.com/synthetichealth/synthea",
- "value": "3815b8af-23b0-45b7-ba24-235307622f15"
- },
- {
- "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",
- "value": "3815b8af-23b0-45b7-ba24-235307622f15"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
- ],
- "text": "Social Security Number"
- },
- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-54-2474"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "DL",
- "display": "Driver's License"
- }
- ],
- "text": "Driver's License"
- },
- "system": "urn:oid:2.16.840.1.113883.4.3.25",
- "value": "S99979106"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "PPN",
- "display": "Passport Number"
- }
- ],
- "text": "Passport Number"
- },
- "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
- "value": "X39388045X"
- }
- ],
- "name": [
- {
- "use": "official",
- "family": "Hermann103",
- "given": [
- "Christia477"
- ],
- "prefix": [
- "Ms."
- ]
- }
- ],
- "telecom": [
- {
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- "value": "555-672-5641",
- "use": "home"
- }
- ],
- "gender": "female",
- "birthDate": "1968-07-27",
- "address": [
- {
- "extension": [
- {
- "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
- "extension": [
- {
- "url": "latitude",
- "valueDecimal": 42.515263260635024
- },
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Donnette259_Sporer811_3400bda2-9f20-4e71-a0f8-c09cd2ac3f0f.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Donnette259_Sporer811_3400bda2-9f20-4e71-a0f8-c09cd2ac3f0f.json
deleted file mode 100644
index c201cf33..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Donnette259_Sporer811_3400bda2-9f20-4e71-a0f8-c09cd2ac3f0f.json
+++ /dev/null
@@ -1,54596 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:74d801e7-3ab7-4fae-ba82-a33a89340f32",
- "resource": {
- "resourceType": "Patient",
- "id": "74d801e7-3ab7-4fae-ba82-a33a89340f32",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 3041628524624170284 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Dodie685 Watsica258"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "F"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Worcester",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 13.397121672042847
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 14.602878327957153
- }
- ],
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "3400bda2-9f20-4e71-a0f8-c09cd2ac3f0f"
- },
- {
- "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",
- "value": "3400bda2-9f20-4e71-a0f8-c09cd2ac3f0f"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
- ],
- "text": "Social Security Number"
- },
- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-49-9469"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "DL",
- "display": "Driver's License"
- }
- ],
- "text": "Driver's License"
- },
- "system": "urn:oid:2.16.840.1.113883.4.3.25",
- "value": "S99982043"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "PPN",
- "display": "Passport Number"
- }
- ],
- "text": "Passport Number"
- },
- "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
- "value": "X9314869X"
- }
- ],
- "name": [
- {
- "use": "official",
- "family": "Sporer811",
- "given": [
- "Donnette259"
- ],
- "prefix": [
- "Mrs."
- ]
- },
- {
- "use": "maiden",
- "family": "Bartoletti50",
- "given": [
- "Donnette259"
- ],
- "prefix": [
- "Mrs."
- ]
- }
- ],
- "telecom": [
- {
- "system": "phone",
- "value": "555-961-6317",
- "use": "home"
- }
- ],
- "gender": "female",
- "birthDate": "1990-03-08",
- "address": [
- {
- "extension": [
- {
- "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
- "extension": [
- {
- "url": "latitude",
- "valueDecimal": 42.50180039342782
- },
- {
- "url": "longitude",
- "valueDecimal": -71.43235993849201
- }
- ]
- }
- ],
- "line": [
- "219 Rohan Bypass"
- ],
- "city": "Acton",
- "state": "Massachusetts",
- "country": "US"
- }
- ],
- "maritalStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
- "code": "M",
- "display": "M"
- }
- ],
- "text": "M"
- },
- "multipleBirthBoolean": false,
- "communication": [
- {
- "language": {
- "coding": [
- {
- "system": "urn:ietf:bcp:47",
- "code": "en-US",
- "display": "English"
- }
- ],
- "text": "English"
- }
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "Patient"
- }
- },
- {
- "fullUrl": "urn:uuid:ac8356a5-78f8-3a63-8a1e-59e832fd54e7",
- "resource": {
- "resourceType": "Organization",
- "id": "ac8356a5-78f8-3a63-8a1e-59e832fd54e7",
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "ac8356a5-78f8-3a63-8a1e-59e832fd54e7"
- }
- ],
- "active": true,
- "type": [
- {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/organization-type",
- "code": "prov",
- "display": "Healthcare Provider"
- }
- ],
- "text": "Healthcare Provider"
- }
- ],
- "name": "NASHOBA VALLEY MEDICAL CENTER",
- "telecom": [
- {
- "system": "phone",
- "value": "9787849000"
- }
- ],
- "address": [
- {
- "line": [
- "200 GROTON ROAD"
- ],
- "city": "AYER",
- "state": "MA",
- "postalCode": "01432",
- "country": "US"
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "Organization"
- }
- },
- {
- "fullUrl": "urn:uuid:0000016d-3a85-4cca-0000-000000000190",
- "resource": {
- "resourceType": "Practitioner",
- "id": "0000016d-3a85-4cca-0000-000000000190",
- "identifier": [
- {
- "system": "http://hl7.org/fhir/sid/us-npi",
- "value": "400"
- }
- ],
- "active": true,
- "name": [
- {
- "family": "Hoeger474",
- "given": [
- "Stephaine613"
- ],
- "prefix": [
- "Dr."
- ]
- }
- ],
- "telecom": [
- {
- "system": "email",
- "value": "Stephaine613.Hoeger474@example.com",
- "use": "work"
- }
- ],
- "address": [
- {
- "line": [
- "200 GROTON ROAD"
- ],
- "city": "AYER",
- "state": "MA",
- "postalCode": "01432",
- "country": "US"
- }
- ],
- "gender": "female"
- },
- "request": {
- "method": "POST",
- "url": "Practitioner"
- }
- },
- {
- "fullUrl": "urn:uuid:381e1530-159d-4299-895a-e31a0130eef2",
- "resource": {
- "resourceType": "Encounter",
- "id": "381e1530-159d-4299-895a-e31a0130eef2",
- "status": "finished",
- "class": {
- "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
- "code": "AMB"
- },
- "type": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "185347001",
- "display": "Encounter for problem"
- }
- ],
- "text": "Encounter for problem"
- }
- ],
- "subject": {
- "reference": "urn:uuid:74d801e7-3ab7-4fae-ba82-a33a89340f32",
- "display": "Mrs. Donnette259 Sporer811"
- },
- "participant": [
- {
- "individual": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000000190",
- "display": "Dr. Stephaine613 Hoeger474"
- }
- }
- ],
- "period": {
- "start": "1991-02-01T17:09:51-05:00",
- "end": "1991-02-01T17:24:51-05:00"
- },
- "serviceProvider": {
- "reference": "urn:uuid:ac8356a5-78f8-3a63-8a1e-59e832fd54e7",
- "display": "NASHOBA VALLEY MEDICAL CENTER"
- }
- },
- "request": {
- "method": "POST",
- "url": "Encounter"
- }
- },
- {
- "fullUrl": "urn:uuid:0352ed88-4eb3-4b0a-92d1-009d0f3545cd",
- "resource": {
- "resourceType": "CareTeam",
- "id": "0352ed88-4eb3-4b0a-92d1-009d0f3545cd",
- "status": "active",
- "subject": {
- "reference": "urn:uuid:74d801e7-3ab7-4fae-ba82-a33a89340f32"
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- "encounter": {
- "reference": "urn:uuid:381e1530-159d-4299-895a-e31a0130eef2"
- },
- "period": {
- "start": "1991-02-01T17:09:51-05:00"
- },
- "participant": [
- {
- "role": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "116153009",
- "display": "Patient"
- }
- ],
- "text": "Patient"
- }
- ],
- "member": {
- "reference": "urn:uuid:74d801e7-3ab7-4fae-ba82-a33a89340f32",
- "display": "Mrs. Donnette259 Sporer811"
- }
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- {
- "role": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "303118004",
- "display": "Person in the healthcare environment (person)"
- }
- ],
- "text": "Person in the healthcare environment (person)"
- }
- ],
- "member": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000000190",
- "display": "Dr. Stephaine613 Hoeger474"
- }
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- "role": [
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- {
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- "code": "303118004",
- "display": "Healthcare related organization (qualifier value)"
- }
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- "text": "Healthcare related organization (qualifier value)"
- }
- ],
- "member": {
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- "display": "NASHOBA VALLEY MEDICAL CENTER"
- }
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- "managingOrganization": [
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- "display": "NASHOBA VALLEY MEDICAL CENTER"
- }
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- "request": {
- "method": "POST",
- "url": "CareTeam"
- }
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- {
- "fullUrl": "urn:uuid:fa470173-f052-498b-8326-f20d272e3bf8",
- "resource": {
- "resourceType": "CarePlan",
- "id": "fa470173-f052-498b-8326-f20d272e3bf8",
- "text": {
- "status": "generated",
- "div": "Care Plan for Self care.
Activities:
- Self care
- Self care
- Self care
"
- },
- "status": "active",
- "intent": "order",
- "category": [
- {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "326051000000105",
- "display": "Self care"
- }
- ],
- "text": "Self care"
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- "subject": {
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- "encounter": {
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- "period": {
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- "careTeam": [
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- "display": "Food allergy diet"
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- "display": "Allergy education"
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- ]
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- "request": {
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- {
- "fullUrl": "urn:uuid:a06db911-be3c-4e53-b032-0bf3eedc3179",
- "resource": {
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- "use": "claim",
- "patient": {
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- "display": "Donnette259 Sporer811"
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- "code": "normal"
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- "display": "Encounter for problem"
- }
- ],
- "text": "Encounter for problem"
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- "total": {
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- "currency": "USD"
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- "request": {
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- }
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- "resource": {
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- "type": {
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- "identifier": [
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- "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
- "value": "a06db911-be3c-4e53-b032-0bf3eedc3179"
- },
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- "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
- "value": "99999999999"
- }
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- },
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- "code": "primary",
- "display": "Primary Care Practitioner"
- }
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- "insurance": [
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- "display": "Medical care"
- }
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- ],
- "text": "Encounter for problem"
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- },
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- {
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- "display": "Submitted Amount"
- }
- ],
- "text": "Submitted Amount"
- },
- "amount": {
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- "currency": "USD"
- }
- }
- ],
- "payment": {
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- "currency": "USD"
- }
- }
- },
- "request": {
- "method": "POST",
- "url": "ExplanationOfBenefit"
- }
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- {
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- },
- "type": [
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Gregory545_Reynolds644_ae5b3987-68f9-4008-af13-e63d18b98c5f.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Gregory545_Reynolds644_ae5b3987-68f9-4008-af13-e63d18b98c5f.json
deleted file mode 100644
index 0ebd5086..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Gregory545_Reynolds644_ae5b3987-68f9-4008-af13-e63d18b98c5f.json
+++ /dev/null
@@ -1,12078 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:1c81d708-bf61-44a3-82f3-1500ad965538",
- "resource": {
- "resourceType": "Patient",
- "id": "1c81d708-bf61-44a3-82f3-1500ad965538",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 4482083831205177148 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Majorie11 Marquardt819"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "M"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Methuen",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 0.0
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 30.0
- }
- ],
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "ae5b3987-68f9-4008-af13-e63d18b98c5f"
- },
- {
- "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",
- "value": "ae5b3987-68f9-4008-af13-e63d18b98c5f"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
- ],
- "text": "Social Security Number"
- },
- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-92-6210"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "DL",
- "display": "Driver's License"
- }
- ],
- "text": "Driver's License"
- },
- "system": "urn:oid:2.16.840.1.113883.4.3.25",
- "value": "S99911584"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "PPN",
- "display": "Passport Number"
- }
- ],
- "text": "Passport Number"
- },
- "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
- "value": "X34486008X"
- }
- ],
- "name": [
- {
- "use": "official",
- "family": "Reynolds644",
- "given": [
- "Gregory545"
- ],
- "prefix": [
- "Mr."
- ]
- }
- ],
- "telecom": [
- {
- "system": "phone",
- "value": "555-335-5042",
- "use": "home"
- }
- ],
- "gender": "male",
- "birthDate": "1988-08-16",
- "address": [
- {
- "extension": [
- {
- "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
- "extension": [
- {
- "url": "latitude",
- "valueDecimal": 42.18175858378396
- },
- {
- "url": "longitude",
- "valueDecimal": -72.44024567312613
- }
- ]
- }
- ],
- "line": [
- "891 Von Bridge Unit 62"
- ],
- "city": "Springfield",
- "state": "Massachusetts",
- "postalCode": "01013",
- "country": "US"
- }
- ],
- "maritalStatus": {
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- {
- "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
- "code": "M",
- "display": "M"
- }
- ],
- "text": "M"
- },
- "multipleBirthBoolean": false,
- "communication": [
- {
- "language": {
- "coding": [
- {
- "system": "urn:ietf:bcp:47",
- "code": "en-US",
- "display": "English"
- }
- ],
- "text": "English"
- }
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- "request": {
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- "url": "Patient"
- }
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- {
- "fullUrl": "urn:uuid:9c87cfde-bd50-3911-85fe-1fea5bfcf49e",
- "resource": {
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- "id": "9c87cfde-bd50-3911-85fe-1fea5bfcf49e",
- "identifier": [
- {
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- "value": "9c87cfde-bd50-3911-85fe-1fea5bfcf49e"
- }
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- "active": true,
- "type": [
- {
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- {
- "system": "http://terminology.hl7.org/CodeSystem/organization-type",
- "code": "prov",
- "display": "Healthcare Provider"
- }
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- "text": "Healthcare Provider"
- }
- ],
- "name": "PCP23049",
- "telecom": [
- {
- "system": "phone",
- "value": "413-583-3308"
- }
- ],
- "address": [
- {
- "line": [
- "733 CHAPIN ST"
- ],
- "city": "LUDLOW",
- "state": "MA",
- "postalCode": "01056-1900",
- "country": "US"
- }
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- "url": "Organization"
- }
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- "value": "15220"
- }
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- "active": true,
- "name": [
- {
- "family": "Rogahn59",
- "given": [
- "Oswaldo857"
- ],
- "prefix": [
- "Dr."
- ]
- }
- ],
- "telecom": [
- {
- "system": "email",
- "value": "Oswaldo857.Rogahn59@example.com",
- "use": "work"
- }
- ],
- "address": [
- {
- "line": [
- "733 CHAPIN ST"
- ],
- "city": "LUDLOW",
- "state": "MA",
- "postalCode": "01056-1900",
- "country": "US"
- }
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- "gender": "male"
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- "url": "Practitioner"
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- "resourceType": "Encounter",
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- "code": "162673000",
- "display": "General examination of patient (procedure)"
- }
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- "text": "General examination of patient (procedure)"
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- ],
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- "reference": "urn:uuid:1c81d708-bf61-44a3-82f3-1500ad965538",
- "display": "Mr. Gregory545 Reynolds644"
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- "participant": [
- {
- "individual": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000003b74",
- "display": "Dr. Oswaldo857 Rogahn59"
- }
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- "period": {
- "start": "2010-10-19T12:08:24-04:00",
- "end": "2010-10-19T12:23:24-04:00"
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- "coding": [
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- "text": "Body Height"
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- "text": "Pain severity - 0-10 verbal numeric rating [Score] - Reported"
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- {
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- "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
- "display": "Line Beneficiary Coinsurance Amount"
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- "display": "Line Provider Payment Amount"
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- "currency": "USD"
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- {
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- {
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- {
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- "display": "Line Beneficiary Part B Deductible Amount"
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- {
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- "display": "Line Processing Indicator Code"
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- "total": [
- {
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- {
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- "code": "submitted",
- "display": "Submitted Amount"
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- ],
- "text": "Submitted Amount"
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- "payment": {
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- {
- "fullUrl": "urn:uuid:f49b680a-202f-45b7-812b-e7bb60619a7c",
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- {
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- "display": "Dr. Lourdes258 Reyna401"
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- "end": "2018-06-05T12:23:24-04:00"
- },
- "serviceProvider": {
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- "display": "CONCENTRA URGENT CARE - SPRINGFIELD"
- }
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- "request": {
- "method": "POST",
- "url": "Encounter"
- }
- },
- {
- "fullUrl": "urn:uuid:778c31da-599c-4b99-ad1e-cd1af242f6d4",
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- "resourceType": "Immunization",
- "id": "778c31da-599c-4b99-ad1e-cd1af242f6d4",
- "status": "completed",
- "vaccineCode": {
- "coding": [
- {
- "system": "http://hl7.org/fhir/sid/cvx",
- "code": "140",
- "display": "Influenza, seasonal, injectable, preservative free"
- }
- ],
- "text": "Influenza, seasonal, injectable, preservative free"
- },
- "patient": {
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- },
- "encounter": {
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- },
- "occurrenceDateTime": "2018-06-05T12:08:24-04:00",
- "primarySource": true
- },
- "request": {
- "method": "POST",
- "url": "Immunization"
- }
- },
- {
- "fullUrl": "urn:uuid:91054cea-923c-43c8-89f8-bedd680fa261",
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- "id": "91054cea-923c-43c8-89f8-bedd680fa261",
- "status": "active",
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- {
- "system": "http://terminology.hl7.org/CodeSystem/claim-type",
- "code": "institutional"
- }
- ]
- },
- "use": "claim",
- "patient": {
- "reference": "urn:uuid:1c81d708-bf61-44a3-82f3-1500ad965538",
- "display": "Gregory545 Reynolds644"
- },
- "billablePeriod": {
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- "end": "2018-06-05T12:23:24-04:00"
- },
- "created": "2018-06-05T12:23:24-04:00",
- "provider": {
- "reference": "urn:uuid:7ffe74ac-786d-3c6d-bcb9-323352f6149c",
- "display": "CONCENTRA URGENT CARE - SPRINGFIELD"
- },
- "priority": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/processpriority",
- "code": "normal"
- }
- ]
- },
- "supportingInfo": [
- {
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- "category": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
- "code": "info"
- }
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- "valueReference": {
- "reference": "urn:uuid:778c31da-599c-4b99-ad1e-cd1af242f6d4"
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- {
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- "requester": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000016d28"
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- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000016d28"
- }
- ]
- },
- {
- "resourceType": "Coverage",
- "id": "coverage",
- "status": "active",
- "type": {
- "text": "Humana"
- },
- "beneficiary": {
- "reference": "urn:uuid:1c81d708-bf61-44a3-82f3-1500ad965538"
- },
- "payor": [
- {
- "display": "Humana"
- }
- ]
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- ],
- "identifier": [
- {
- "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
- "value": "91054cea-923c-43c8-89f8-bedd680fa261"
- },
- {
- "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
- "value": "99999999999"
- }
- ],
- "status": "active",
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claim-type",
- "code": "institutional"
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- "use": "claim",
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- "billablePeriod": {
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- "end": "2019-06-05T12:23:24-04:00"
- },
- "created": "2018-06-05T12:23:24-04:00",
- "insurer": {
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- },
- "provider": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000016d28"
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- "referral": {
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- "reference": "urn:uuid:91054cea-923c-43c8-89f8-bedd680fa261"
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- "outcome": "complete",
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- },
- "role": {
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- "code": "primary",
- "display": "Primary Care Practitioner"
- }
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- }
- ],
- "insurance": [
- {
- "focal": true,
- "coverage": {
- "reference": "#coverage",
- "display": "Humana"
- }
- }
- ],
- "item": [
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- "text": "Urgent care clinic (procedure)"
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- "code": "1",
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- "code": "https://bluebutton.cms.gov/resources/variables/line_coinsrnc_amt",
- "display": "Line Beneficiary Coinsurance Amount"
- }
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- "amount": {
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- "code": "https://bluebutton.cms.gov/resources/variables/line_prvdr_pmt_amt",
- "display": "Line Provider Payment Amount"
- }
- ]
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- "amount": {
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- "currency": "USD"
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- "code": "https://bluebutton.cms.gov/resources/variables/line_sbmtd_chrg_amt",
- "display": "Line Submitted Charge Amount"
- }
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- "amount": {
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- "currency": "USD"
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- {
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- "code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
- "display": "Line Allowed Charge Amount"
- }
- ]
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- "amount": {
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- "currency": "USD"
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- "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"
- }
- ]
- }
- }
- ]
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- ],
- "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/base/testdata/fixtures/401-R4/bundle/synthea_Jules135_Gutmann970_6bcb9066-cf6c-443e-91b3-c9022c8c4f6a.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Jules135_Gutmann970_6bcb9066-cf6c-443e-91b3-c9022c8c4f6a.json
deleted file mode 100644
index 144a11a7..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Jules135_Gutmann970_6bcb9066-cf6c-443e-91b3-c9022c8c4f6a.json
+++ /dev/null
@@ -1,55963 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:7a42a3e6-4dfc-4d76-bec2-4854d1e7caa2",
- "resource": {
- "resourceType": "Patient",
- "id": "7a42a3e6-4dfc-4d76-bec2-4854d1e7caa2",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 7251516320691860882 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Louella862 Kutch271"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "M"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "North Adams",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 11.687058394580909
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 72.3129416054191
- }
- ],
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "6bcb9066-cf6c-443e-91b3-c9022c8c4f6a"
- },
- {
- "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",
- "value": "6bcb9066-cf6c-443e-91b3-c9022c8c4f6a"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
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- "text": "Medicare"
- },
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- "display": "Line Allowed Charge Amount"
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- "display": "Line Beneficiary Part B Deductible Amount"
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- "amount": {
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- "text": "Submitted Amount"
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- "currency": "USD"
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Roselia779_Lind531_99285aac-e5e3-4f5b-857d-f67271c97304.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Roselia779_Lind531_99285aac-e5e3-4f5b-857d-f67271c97304.json
deleted file mode 100644
index 6d286b92..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Roselia779_Lind531_99285aac-e5e3-4f5b-857d-f67271c97304.json
+++ /dev/null
@@ -1,10881 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
- "fullUrl": "urn:uuid:508d6dbb-7fbf-4aef-b077-eb3acc937832",
- "resource": {
- "resourceType": "Patient",
- "id": "508d6dbb-7fbf-4aef-b077-eb3acc937832",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 2978214333338970539 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2054-5",
- "display": "Black or African American"
- }
- },
- {
- "url": "text",
- "valueString": "Black or African American"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Lenita591 Klein929"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "F"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "New Bedford",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 0.0
- },
- {
- "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
- "valueDecimal": 1.0
- }
- ],
- "identifier": [
- {
- "system": "https://github.com/synthetichealth/synthea",
- "value": "99285aac-e5e3-4f5b-857d-f67271c97304"
- },
- {
- "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",
- "value": "99285aac-e5e3-4f5b-857d-f67271c97304"
- },
- {
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
- ],
- "text": "Social Security Number"
- },
- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-62-8033"
- }
- ],
- "name": [
- {
- "use": "official",
- "family": "Lind531",
- "given": [
- "Roselia779"
- ]
- }
- ],
- "telecom": [
- {
- "system": "phone",
- "value": "555-412-9390",
- "use": "home"
- }
- ],
- "gender": "female",
- "birthDate": "2017-12-02",
- "address": [
- {
- "extension": [
- {
- "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
- "extension": [
- {
- "url": "latitude",
- "valueDecimal": 42.320791335534174
- },
- {
- "url": "longitude",
- "valueDecimal": -71.74935945200963
- }
- ]
- }
- ],
- "line": [
- "455 Shanahan Route Suite 70"
- ],
- "city": "Worcester",
- "state": "Massachusetts",
- "postalCode": "01545",
- "country": "US"
- }
- ],
- "maritalStatus": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
- "code": "S",
- "display": "Never Married"
- }
- ],
- "text": "Never Married"
- },
- "multipleBirthBoolean": false,
- "communication": [
- {
- "language": {
- "coding": [
- {
- "system": "urn:ietf:bcp:47",
- "code": "en-US",
- "display": "English"
- }
- ],
- "text": "English"
- }
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "Patient"
- }
- },
- {
- "fullUrl": "urn:uuid:395a9f52-1f2d-35cd-8cfe-35e2771f8921",
- "resource": {
- "resourceType": "Organization",
- "id": "395a9f52-1f2d-35cd-8cfe-35e2771f8921",
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Tania553_Harris789_545c2380-b77f-4919-ab5d-0f615f877250.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Tania553_Harris789_545c2380-b77f-4919-ab5d-0f615f877250.json
deleted file mode 100644
index 4a115c9c..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Tania553_Harris789_545c2380-b77f-4919-ab5d-0f615f877250.json
+++ /dev/null
@@ -1,16198 +0,0 @@
-{
- "resourceType": "Bundle",
- "type": "transaction",
- "entry": [
- {
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- "resource": {
- "resourceType": "Patient",
- "id": "57959813-8cd2-4e3c-8970-e4364b74980a",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: -6016242411370302863 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2106-3",
- "display": "White"
- }
- },
- {
- "url": "text",
- "valueString": "White"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Patrick786 Robel940"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "F"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Lowell",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
- "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
- "valueDecimal": 0.012998260499375002
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- {
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- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "MR",
- "display": "Medical Record Number"
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- "text": "Medical Record Number"
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- "system": "http://hospital.smarthealthit.org",
- "value": "545c2380-b77f-4919-ab5d-0f615f877250"
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- {
- "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
- "code": "SS",
- "display": "Social Security Number"
- }
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- "text": "Social Security Number"
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- "system": "http://hl7.org/fhir/sid/us-ssn",
- "value": "999-80-3174"
- },
- {
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- "value": "X49558432X"
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- "code": "140",
- "display": "Influenza, seasonal, injectable, preservative free"
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- "display": "Line Beneficiary Coinsurance Amount"
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- "amount": {
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- "display": "Line Beneficiary Part B Deductible Amount"
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- "amount": {
- "value": 0,
- "currency": "USD"
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- {
- "category": {
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- "display": "Line Processing Indicator Code"
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- "total": [
- {
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- "coding": [
- {
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- "code": "submitted",
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- "text": "Submitted Amount"
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diff --git a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Willian804_Moen819_439b24b4-6f25-4093-b101-47a39bd061ca.json b/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Willian804_Moen819_439b24b4-6f25-4093-b101-47a39bd061ca.json
deleted file mode 100644
index e6a8f259..00000000
--- a/backend/pkg/hub/internal/fhir/base/testdata/fixtures/401-R4/bundle/synthea_Willian804_Moen819_439b24b4-6f25-4093-b101-47a39bd061ca.json
+++ /dev/null
@@ -1,14908 +0,0 @@
-{
- "resourceType": "Bundle",
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- "entry": [
- {
- "fullUrl": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304",
- "resource": {
- "resourceType": "Patient",
- "id": "17b5cd0a-c2b6-4d3e-bbe4-7a8255832304",
- "text": {
- "status": "generated",
- "div": "Generated by
Synthea.Version identifier: v2.4.0-404-ge7ce2295\n . Person seed: 186383988687977231 Population seed: 0
"
- },
- "extension": [
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
- "extension": [
- {
- "url": "ombCategory",
- "valueCoding": {
- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2054-5",
- "display": "Black or African American"
- }
- },
- {
- "url": "text",
- "valueString": "Black or African American"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity",
- "extension": [
- {
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- "system": "urn:oid:2.16.840.1.113883.6.238",
- "code": "2186-5",
- "display": "Not Hispanic or Latino"
- }
- },
- {
- "url": "text",
- "valueString": "Not Hispanic or Latino"
- }
- ]
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
- "valueString": "Delois358 Hintz995"
- },
- {
- "url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
- "valueCode": "M"
- },
- {
- "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
- "valueAddress": {
- "city": "Lawrence",
- "state": "Massachusetts",
- "country": "US"
- }
- },
- {
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- "valueDecimal": 0.09827400029822156
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- {
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- "text": "Medical Record Number"
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- "system": "http://hospital.smarthealthit.org",
- "value": "439b24b4-6f25-4093-b101-47a39bd061ca"
- },
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- "code": "SS",
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- "text": "Social Security Number"
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- "value": "999-57-3355"
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- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "encounter": {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- },
- "effectiveDateTime": "2018-12-23T14:48:37-05:00",
- "issued": "2018-12-23T14:48:37.413-05:00",
- "valueQuantity": {
- "value": 90.45305211778118,
- "unit": "kg",
- "system": "http://unitsofmeasure.org",
- "code": "kg"
- }
- },
- "request": {
- "method": "POST",
- "url": "Observation"
- }
- },
- {
- "fullUrl": "urn:uuid:056189d7-fa8c-4178-9823-24e5c92903b7",
- "resource": {
- "resourceType": "Observation",
- "id": "056189d7-fa8c-4178-9823-24e5c92903b7",
- "status": "final",
- "category": [
- {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/observation-category",
- "code": "vital-signs",
- "display": "vital-signs"
- }
- ]
- }
- ],
- "code": {
- "coding": [
- {
- "system": "http://loinc.org",
- "code": "39156-5",
- "display": "Body Mass Index"
- }
- ],
- "text": "Body Mass Index"
- },
- "subject": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "encounter": {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- },
- "effectiveDateTime": "2018-12-23T14:48:37-05:00",
- "issued": "2018-12-23T14:48:37.413-05:00",
- "valueQuantity": {
- "value": 24.820524244138085,
- "unit": "kg/m2",
- "system": "http://unitsofmeasure.org",
- "code": "kg/m2"
- }
- },
- "request": {
- "method": "POST",
- "url": "Observation"
- }
- },
- {
- "fullUrl": "urn:uuid:44652330-e785-4931-ad14-374881a9f040",
- "resource": {
- "resourceType": "Observation",
- "id": "44652330-e785-4931-ad14-374881a9f040",
- "status": "final",
- "category": [
- {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/observation-category",
- "code": "vital-signs",
- "display": "vital-signs"
- }
- ]
- }
- ],
- "code": {
- "coding": [
- {
- "system": "http://loinc.org",
- "code": "55284-4",
- "display": "Blood Pressure"
- }
- ],
- "text": "Blood Pressure"
- },
- "subject": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "encounter": {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- },
- "effectiveDateTime": "2018-12-23T14:48:37-05:00",
- "issued": "2018-12-23T14:48:37.413-05:00",
- "component": [
- {
- "code": {
- "coding": [
- {
- "system": "http://loinc.org",
- "code": "8462-4",
- "display": "Diastolic Blood Pressure"
- }
- ],
- "text": "Diastolic Blood Pressure"
- },
- "valueQuantity": {
- "value": 82.78376773863606,
- "unit": "mm[Hg]",
- "system": "http://unitsofmeasure.org",
- "code": "mm[Hg]"
- }
- },
- {
- "code": {
- "coding": [
- {
- "system": "http://loinc.org",
- "code": "8480-6",
- "display": "Systolic Blood Pressure"
- }
- ],
- "text": "Systolic Blood Pressure"
- },
- "valueQuantity": {
- "value": 120.56024138138916,
- "unit": "mm[Hg]",
- "system": "http://unitsofmeasure.org",
- "code": "mm[Hg]"
- }
- }
- ]
- },
- "request": {
- "method": "POST",
- "url": "Observation"
- }
- },
- {
- "fullUrl": "urn:uuid:64830809-f9d9-4d8b-a391-2b9917f34f87",
- "resource": {
- "resourceType": "Observation",
- "id": "64830809-f9d9-4d8b-a391-2b9917f34f87",
- "status": "final",
- "category": [
- {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/observation-category",
- "code": "survey",
- "display": "survey"
- }
- ]
- }
- ],
- "code": {
- "coding": [
- {
- "system": "http://loinc.org",
- "code": "72166-2",
- "display": "Tobacco smoking status NHIS"
- }
- ],
- "text": "Tobacco smoking status NHIS"
- },
- "subject": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "encounter": {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- },
- "effectiveDateTime": "2018-12-23T14:48:37-05:00",
- "issued": "2018-12-23T14:48:37.413-05:00",
- "valueCodeableConcept": {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "266919005",
- "display": "Never smoker"
- }
- ],
- "text": "Never smoker"
- }
- },
- "request": {
- "method": "POST",
- "url": "Observation"
- }
- },
- {
- "fullUrl": "urn:uuid:7c543db5-e35a-444d-a87d-21b7e37895f6",
- "resource": {
- "resourceType": "Immunization",
- "id": "7c543db5-e35a-444d-a87d-21b7e37895f6",
- "status": "completed",
- "vaccineCode": {
- "coding": [
- {
- "system": "http://hl7.org/fhir/sid/cvx",
- "code": "140",
- "display": "Influenza, seasonal, injectable, preservative free"
- }
- ],
- "text": "Influenza, seasonal, injectable, preservative free"
- },
- "patient": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "encounter": {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- },
- "occurrenceDateTime": "2018-12-23T14:48:37-05:00",
- "primarySource": true
- },
- "request": {
- "method": "POST",
- "url": "Immunization"
- }
- },
- {
- "fullUrl": "urn:uuid:1468a9a0-a6b8-40ce-bb86-0f48643ef7d7",
- "resource": {
- "resourceType": "Claim",
- "id": "1468a9a0-a6b8-40ce-bb86-0f48643ef7d7",
- "status": "active",
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claim-type",
- "code": "institutional"
- }
- ]
- },
- "use": "claim",
- "patient": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304",
- "display": "Willian804 Moen819"
- },
- "billablePeriod": {
- "start": "2018-12-23T14:48:37-05:00",
- "end": "2018-12-23T15:03:37-05:00"
- },
- "created": "2018-12-23T15:03:37-05:00",
- "provider": {
- "reference": "urn:uuid:851964ad-fff8-3ab6-aba0-4f85090f0041",
- "display": "PCP260628"
- },
- "priority": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/processpriority",
- "code": "normal"
- }
- ]
- },
- "supportingInfo": [
- {
- "sequence": 1,
- "category": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
- "code": "info"
- }
- ]
- },
- "valueReference": {
- "reference": "urn:uuid:7c543db5-e35a-444d-a87d-21b7e37895f6"
- }
- }
- ],
- "insurance": [
- {
- "sequence": 1,
- "focal": true,
- "coverage": {
- "display": "Anthem"
- }
- }
- ],
- "item": [
- {
- "sequence": 1,
- "productOrService": {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "162673000",
- "display": "General examination of patient (procedure)"
- }
- ],
- "text": "General examination of patient (procedure)"
- },
- "encounter": [
- {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- }
- ]
- },
- {
- "sequence": 2,
- "informationSequence": [
- 1
- ],
- "productOrService": {
- "coding": [
- {
- "system": "http://hl7.org/fhir/sid/cvx",
- "code": "140",
- "display": "Influenza, seasonal, injectable, preservative free"
- }
- ],
- "text": "Influenza, seasonal, injectable, preservative free"
- },
- "net": {
- "value": 140.52,
- "currency": "USD"
- }
- }
- ],
- "total": {
- "value": 129.16,
- "currency": "USD"
- }
- },
- "request": {
- "method": "POST",
- "url": "Claim"
- }
- },
- {
- "fullUrl": "urn:uuid:17e5f4ff-fcf5-4506-9e22-e8dec3d91ed7",
- "resource": {
- "resourceType": "ExplanationOfBenefit",
- "id": "17e5f4ff-fcf5-4506-9e22-e8dec3d91ed7",
- "contained": [
- {
- "resourceType": "ServiceRequest",
- "id": "referral",
- "status": "completed",
- "intent": "order",
- "subject": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "requester": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000011a12"
- },
- "performer": [
- {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000011a12"
- }
- ]
- },
- {
- "resourceType": "Coverage",
- "id": "coverage",
- "status": "active",
- "type": {
- "text": "Anthem"
- },
- "beneficiary": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "payor": [
- {
- "display": "Anthem"
- }
- ]
- }
- ],
- "identifier": [
- {
- "system": "https://bluebutton.cms.gov/resources/variables/clm_id",
- "value": "1468a9a0-a6b8-40ce-bb86-0f48643ef7d7"
- },
- {
- "system": "https://bluebutton.cms.gov/resources/identifier/claim-group",
- "value": "99999999999"
- }
- ],
- "status": "active",
- "type": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claim-type",
- "code": "institutional"
- }
- ]
- },
- "use": "claim",
- "patient": {
- "reference": "urn:uuid:17b5cd0a-c2b6-4d3e-bbe4-7a8255832304"
- },
- "billablePeriod": {
- "start": "2018-12-23T15:03:37-05:00",
- "end": "2019-12-23T15:03:37-05:00"
- },
- "created": "2018-12-23T15:03:37-05:00",
- "insurer": {
- "display": "Anthem"
- },
- "provider": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000011a12"
- },
- "referral": {
- "reference": "#referral"
- },
- "claim": {
- "reference": "urn:uuid:1468a9a0-a6b8-40ce-bb86-0f48643ef7d7"
- },
- "outcome": "complete",
- "careTeam": [
- {
- "sequence": 1,
- "provider": {
- "reference": "urn:uuid:0000016d-3a85-4cca-0000-000000011a12"
- },
- "role": {
- "coding": [
- {
- "system": "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
- "code": "primary",
- "display": "Primary Care Practitioner"
- }
- ]
- }
- }
- ],
- "insurance": [
- {
- "focal": true,
- "coverage": {
- "reference": "#coverage",
- "display": "Anthem"
- }
- }
- ],
- "item": [
- {
- "sequence": 1,
- "category": {
- "coding": [
- {
- "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
- "code": "1",
- "display": "Medical care"
- }
- ]
- },
- "productOrService": {
- "coding": [
- {
- "system": "http://snomed.info/sct",
- "code": "162673000",
- "display": "General examination of patient (procedure)"
- }
- ],
- "text": "General examination of patient (procedure)"
- },
- "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"
- }
- ]
- },
- "encounter": [
- {
- "reference": "urn:uuid:f4426cd0-bc15-49dc-bff8-4de1e11b5a85"
- }
- ]
- },
- {
- "sequence": 2,
- "informationSequence": [
- 1
- ],
- "category": {
- "coding": [
- {
- "system": "https://bluebutton.cms.gov/resources/variables/line_cms_type_srvc_cd",
- "code": "1",
- "display": "Medical care"
- }
- ]
- },
- "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 xmlns=\"http://www.w3.org/1999/xhtml\"><div class=\"hapiHeaderText\">Felecita <b>MONAHAN </b></div><table class=\"hapiPropertyTable\"><tbody><tr><td>Identifier</td><td>A00000000000005</td></tr><tr><td>Date of birth</td><td><span>12 January 2013</span></td></tr></tbody></table></div>", "status": "generated"}, "birthDate": "2013-01-12", "gender": "female", "identifier": [{"system": "https://developer.cigna.com", "type": {"coding": [{"code": "um", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/IdentifierTypeCS"}]}, "value": "A00000000000005"}, {"system": "https://developer.cigna.com", "type": {"coding": [{"code": "mb", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/IdentifierTypeCS"}]}, "value": "unknown"}], "maritalStatus": {"coding": [{"code": "UNK", "display": "unknown", "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"}], "text": "unknown"}, "name": [{"family": "Monahan", "given": ["Felecita"], "use": "official"}], "telecom": [{"system": "phone", "use": "mobile", "value": "9404535496"}], "resourceType": "Patient"}, "search": {"mode": "match"}}, {"fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/Condition/ifp-A00000000000005-CS0000449534-K57.92", "resource": {"id": "ifp-A00000000000005-CS0000449534-K57.92", "meta": {"lastUpdated": "2022-06-20T15:45:22.431000+00:00", "profile": ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition"], "source": "IFP#BfVDmjcVAxAfr5Be", "versionId": "1"}, "category": [{"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}], "clinicalStatus": {"coding": [{"code": "active", "display": "active", "system": "http://terminology.hl7.org/CodeSystem/condition-clinical"}], "text": "active"}, "code": {"coding": [{"code": "K57.92", "display": "DVTRCLI OF INTEST, PART UNSP, W/O PERF OR ABSCESS W/O BLEED"}], "text": "Null"}, "identifier": [{"value": "A00000000000005-CS0000449534-K57.92"}], "recordedDate": "2019-10-22", "subject": {"reference": "Patient/ifp-A00000000000005"}, "resourceType": "Condition"}, "search": {"mode": "match"}}, {"fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/Encounter/ifp-1C9A46F07B3CADE33EFC75ABA3DC37CF", "resource": {"id": "ifp-1C9A46F07B3CADE33EFC75ABA3DC37CF", "meta": {"lastUpdated": "2022-06-20T15:45:29.685000+00:00", "profile": ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"], "source": "IFP#e7zkeLCSmQFgUX0Z", "versionId": "1"}, "class": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "diagnosis": [{"condition": {"reference": "Condition/ifp-A00000000000005-OP0447575426-K57.80-Y-"}, "use": {"coding": [{"display": "Admission diagnosis"}]}}], "identifier": [{"system": "http://dev.cigna.com/system/TRCR", "value": "TRCR-OP0447575426-1"}], "location": [{"location": {"reference": "Location/ifp-7312532"}}, {"location": {"reference": "Location/ifp-0566265"}}], "participant": [{"individual": {"reference": "Practitioner/ifp-50ef4542ecb5ae5eddc0dac76a10aaed"}}, {"individual": {"reference": "Practitioner/ifp-6a4d3d6fe165b6a0a79b6a976d043c2c"}}], "period": {"end": "2019-12-31", "start": "2019-11-07"}, "reasonCode": [{"coding": [{"code": "K57.80", "display": "Dvtrcli of intest, part unsp, w perf and abscess w/o bleed"}]}], "reasonReference": [{"reference": "Condition/ifp-A00000000000005-OP0447575426-K57.80-Y-"}], "serviceProvider": {"reference": "Organization/ifp-0566265"}, "serviceType": {"coding": [{"code": "302", "display": "Medical Outpatient"}]}, "status": "unknown", "subject": {"reference": "Patient/ifp-A00000000000005"}, "type": [{"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}], "resourceType": "Encounter"}, "search": {"mode": "match"}}, {"fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/ExplanationOfBenefit/ifp-577B939844288EC2702EA92A8A2BEAA0", "resource": {"id": "ifp-577B939844288EC2702EA92A8A2BEAA0", "meta": {"lastUpdated": "2022-06-20T15:45:34.176000+00:00", "profile": ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"], "source": "IFP#8SdkvkRZ51amC5sY", "versionId": "1"}, "accident": {"type": {"coding": [{"display": "XXXXX"}]}}, "billablePeriod": {"end": "2019-11-22", "start": "2019-11-08"}, "careTeam": [{"provider": {"reference": "Organization/ifp-0566265"}, "role": {"coding": [{"code": "performing", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole"}]}, "_sequence": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}}], "_created": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "diagnosis": [{"diagnosisCodeableConcept": {"coding": [{"code": "K5720", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 1, "type": [{"coding": [{"code": "principal", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "N186", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 2, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "K5720", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 1, "type": [{"coding": [{"code": "admitting", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Z905", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 11, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Z87442", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 12, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Z98890", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 14, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "D649", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 7, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Q612", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 5, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "E876", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 9, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Z7982", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 10, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Z8249", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 13, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "E871", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 3, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "I120", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 4, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Z940", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 6, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "E785", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "onAdmission": {"coding": [{"code": "y", "system": "http://www.nubc.org/PresentOnAdmission"}]}, "sequence": 8, "type": [{"coding": [{"code": "other", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}], "identifier": [{"type": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "value": "1925381131-8-FCTS"}], "insurance": [{"coverage": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "_focal": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}}], "insurer": {"display": "Cigna"}, "outcome": "complete", "patient": {"reference": "Patient/ifp-A00000000000005"}, "payee": {"party": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "type": {"coding": [{"code": "other", "display": "Provider", "system": "http://terminology.hl7.org/CodeSystem/payeetype"}]}}, "payment": {"date": "2020-01-02"}, "provider": {"reference": "Organization/ifp-0566265"}, "_status": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "total": [{"amount": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "category": {"coding": [{"code": "innetwork", "display": "In Network", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"}]}}], "type": {"coding": [{"code": "institutional", "display": "Institutional Claim", "system": "http://terminology.hl7.org/CodeSystem/claim-type"}]}, "use": "claim", "resourceType": "ExplanationOfBenefit"}, "search": {"mode": "match"}}, {"fullUrl": "https://p-hi2.digitaledge.cigna.com/PatientAccess/v1-devportal/ExplanationOfBenefit/ifp-B4028B5B95E3E540CD1DFA1968D5C08D", "resource": {"id": "ifp-B4028B5B95E3E540CD1DFA1968D5C08D", "meta": {"lastUpdated": "2022-06-20T15:45:34.699000+00:00", "profile": ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"], "source": "IFP#BmUfv05t9wDcyAt0", "versionId": "1"}, "accident": {"type": {"coding": [{"display": "XXXXX"}]}}, "billablePeriod": {"end": "2019-11-22", "start": "2019-11-22"}, "careTeam": [{"provider": {"reference": "Organization/ifp-1465120"}, "qualification": {"coding": [{"code": "unknown", "display": "Pathology, Anatomic", "system": "http://nucc.org/provider-taxonomy"}]}, "role": {"coding": [{"code": "performing", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimCareTeamRole"}]}, "_sequence": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}}], "_created": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "diagnosis": [{"diagnosisCodeableConcept": {"coding": [{"code": "N186", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 2, "type": [{"coding": [{"code": "secondary", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "K5720", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 1, "type": [{"coding": [{"code": "principal", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "E871", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 3, "type": [{"coding": [{"code": "secondary", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}, {"diagnosisCodeableConcept": {"coding": [{"code": "Q612", "system": "http://hl7.org/fhir/sid/icd-10-cm", "version": "10"}]}, "sequence": 4, "type": [{"coding": [{"code": "secondary", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType"}]}]}], "identifier": [{"type": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "value": "1927246798-6-FCTS"}], "insurance": [{"coverage": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "_focal": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}}], "insurer": {"display": "Cigna"}, "item": [{"adjudication": [{"category": {"coding": [{"code": "innetwork", "display": "In Network", "system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus"}]}}], "net": {"value": 25}, "productOrService": {"coding": [{"code": "83735", "display": "ASSAY OF MAGNESIUM", "system": "http://www.ama-assn.org/go/cpt"}]}, "quantity": {"unit": "item_quantity_unit", "value": 1}, "_sequence": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "unknown"}]}, "servicedPeriod": {"end": "2019-11-22", "start": "2019-11-22"}}], "outcome": "complete", "patient": {"reference": 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- "Value": "Amazon"
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- "Critical": false,
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- }
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- "ExtraExtensions": null,
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- "IsCA": true,
- "MaxPathLen": -1,
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- "SubjectKeyId": "hBjMhTTsvAyUlC4IWZzHshBOCgg=",
- "AuthorityKeyId": "nF8A36oB1zArOIiiuG1KnPIRkYM=",
- "OCSPServer": [
- "http://ocsp.rootg2.amazontrust.com"
- ],
- "IssuingCertificateURL": [
- "http://crt.rootg2.amazontrust.com/rootg2.cer"
- ],
- "DNSNames": null,
- "EmailAddresses": null,
- "IPAddresses": null,
- "URIs": null,
- "PermittedDNSDomainsCritical": false,
- "PermittedDNSDomains": null,
- "ExcludedDNSDomains": null,
- "PermittedIPRanges": null,
- "ExcludedIPRanges": null,
- "PermittedEmailAddresses": null,
- "ExcludedEmailAddresses": null,
- "PermittedURIDomains": null,
- "ExcludedURIDomains": null,
- "CRLDistributionPoints": [
- "http://crl.rootg2.amazontrust.com/rootg2.crl"
- ],
- "PolicyIdentifiers": [
- [
- 2,
- 5,
- 29,
- 32,
- 0
- ]
- ]
- },
- {
- "Raw": "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",
- "RawTBSCertificate": "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",
- "RawSubjectPublicKeyInfo": "MIIBIjANBgkqhkiG9w0BAQEFAAOCAQ8AMIIBCgKCAQEA1Qw6xCr5TuL1vhmXX46IU7EfP8vPnyATbSk6yA99PPdrdjhj2TZgqJteXACAsi9Zf/aH+SVDhudpG1KakOFx49gtDU5v9shJ2bbzGlauK7Z0FOvP+ybjGrodli5qO1iUiUdW/yWgk3BTg9qEdBTDZ54EaDrfjkBaHUpOz0ORO+dW1gBwy1Lue32uOue8MflF9sJgzxNZAiuAzDRH37nekGVtAs8skaam596FGEl8Zk6jOm2pte40LroNA7gz30frsWuNJdmbzoHRRUYylnCH3gIOSUOFtmxzu2TqYUGsydRU34cvxyKyJsyfWVRon/y+Ki/EVRx1QGAXhQJVOYt/BQIDAQAB",
- "RawSubject": "MIGYMQswCQYDVQQGEwJVUzEQMA4GA1UECBMHQXJpem9uYTETMBEGA1UEBxMKU2NvdHRzZGFsZTElMCMGA1UEChMcU3RhcmZpZWxkIFRlY2hub2xvZ2llcywgSW5jLjE7MDkGA1UEAxMyU3RhcmZpZWxkIFNlcnZpY2VzIFJvb3QgQ2VydGlmaWNhdGUgQXV0aG9yaXR5IC0gRzI=",
- "RawIssuer": "MGgxCzAJBgNVBAYTAlVTMSUwIwYDVQQKExxTdGFyZmllbGQgVGVjaG5vbG9naWVzLCBJbmMuMTIwMAYDVQQLEylTdGFyZmllbGQgQ2xhc3MgMiBDZXJ0aWZpY2F0aW9uIEF1dGhvcml0eQ==",
- "Signature": "Ix3jilfKfekXeUzxHlX9zFNuPkcP38ZV8rIENu2AH1PEXTQoa77HVfxn6ss/f5CyM80bWBCCAvj4L/UTYNQFzvGBCMHdp3WXTxi5bd73k5EIun5ALO3B6rt2njMGdx0NCH9T3Rtkq4In8WnVTV6u9KHDdadYRC3yPHCYrLpptpV3fw8xXiz8oIc6R2nweV/0FFSklV4ReBJgJ86fwnf/I1N3Xbr/6lnn28+vkpbvJJo1EHqckcYOfZn2Pxnf9XJU4RWpB1l7g79SLkaMsgBkdhxI09h56G5WzK4sA5DXGTiZ5MoJGVv/B5awqH80Sd9WqfewX+0z7YxHtzADXfQDjA==",
- "SignatureAlgorithm": 4,
- "PublicKeyAlgorithm": 1,
- "PublicKey": {
- "N": "26894789576491863019171445242018370132029525033879210664513024255165308689836081694724912552986436241602345929261854187816625921774943728567119070351838976265193901442169339571326613928339955106648223197498035701437846440970934704192382084561469274550003268570741310868032789070264835003681318445644941362885752628282968349509706358865971392279088395067847314610178969555804359319567178098112935181143559364150874524817692694181296058297355335204675211145990489303168553611700020424738364579606192390834705213026692659672388567853246354560726855054573503174641583891075106464210711468427779853334564691648681991700229",
- "E": 65537
- },
- "Version": 3,
- "SerialNumber": 12037640545166866303,
- "Issuer": {
- "Country": [
- "US"
- ],
- "Organization": [
- "Starfield Technologies, Inc."
- ],
- "OrganizationalUnit": [
- "Starfield Class 2 Certification Authority"
- ],
- "Locality": null,
- "Province": null,
- "StreetAddress": null,
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- "SerialNumber": "",
- "CommonName": "",
- "Names": [
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- ],
- "Value": "US"
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- {
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- "Value": "Starfield Technologies, Inc."
- },
- {
- "Type": [
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- 4,
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- ],
- "Value": "Starfield Class 2 Certification Authority"
- }
- ],
- "ExtraNames": null
- },
- "Subject": {
- "Country": [
- "US"
- ],
- "Organization": [
- "Starfield Technologies, Inc."
- ],
- "OrganizationalUnit": null,
- "Locality": [
- "Scottsdale"
- ],
- "Province": [
- "Arizona"
- ],
- "StreetAddress": null,
- "PostalCode": null,
- "SerialNumber": "",
- "CommonName": "Starfield Services Root Certificate Authority - G2",
- "Names": [
- {
- "Type": [
- 2,
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- 4,
- 6
- ],
- "Value": "US"
- },
- {
- "Type": [
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- 5,
- 4,
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- ],
- "Value": "Arizona"
- },
- {
- "Type": [
- 2,
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- 4,
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- ],
- "Value": "Scottsdale"
- },
- {
- "Type": [
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- 10
- ],
- "Value": "Starfield Technologies, Inc."
- },
- {
- "Type": [
- 2,
- 5,
- 4,
- 3
- ],
- "Value": "Starfield Services Root Certificate Authority - G2"
- }
- ],
- "ExtraNames": null
- },
- "NotBefore": "2009-09-02T00:00:00Z",
- "NotAfter": "2034-06-28T17:39:16Z",
- "KeyUsage": 97,
- "Extensions": [
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- ],
- "Critical": true,
- "Value": "MAMBAf8="
- },
- {
- "Id": [
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- ],
- "Critical": true,
- "Value": "AwIBhg=="
- },
- {
- "Id": [
- 2,
- 5,
- 29,
- 14
- ],
- "Critical": false,
- "Value": "BBScXwDfqgHXMCs4iKK4bUqc8hGRgw=="
- },
- {
- "Id": [
- 2,
- 5,
- 29,
- 35
- ],
- "Critical": false,
- "Value": "MBaAFL9ft9HO3R+G9FtVrNzXEMIOqYjn"
- },
- {
- "Id": [
- 1,
- 3,
- 6,
- 1,
- 5,
- 5,
- 7,
- 1,
- 1
- ],
- "Critical": false,
- "Value": "MEEwHAYIKwYBBQUHMAGGEGh0dHA6Ly9vLnNzMi51cy8wIQYIKwYBBQUHMAKGFWh0dHA6Ly94LnNzMi51cy94LmNlcg=="
- },
- {
- "Id": [
- 2,
- 5,
- 29,
- 31
- ],
- "Critical": false,
- "Value": "MB0wG6AZoBeGFWh0dHA6Ly9zLnNzMi51cy9yLmNybA=="
- },
- {
- "Id": [
- 2,
- 5,
- 29,
- 32
- ],
- "Critical": false,
- "Value": "MAgwBgYEVR0gAA=="
- }
- ],
- "ExtraExtensions": null,
- "UnhandledCriticalExtensions": null,
- "ExtKeyUsage": null,
- "UnknownExtKeyUsage": null,
- "BasicConstraintsValid": true,
- "IsCA": true,
- "MaxPathLen": -1,
- "MaxPathLenZero": false,
- "SubjectKeyId": "nF8A36oB1zArOIiiuG1KnPIRkYM=",
- "AuthorityKeyId": "v1+30c7dH4b0W1Ws3NcQwg6piOc=",
- "OCSPServer": [
- "http://o.ss2.us/"
- ],
- "IssuingCertificateURL": [
- "http://x.ss2.us/x.cer"
- ],
- "DNSNames": null,
- "EmailAddresses": null,
- "IPAddresses": null,
- "URIs": null,
- "PermittedDNSDomainsCritical": false,
- "PermittedDNSDomains": null,
- "ExcludedDNSDomains": null,
- "PermittedIPRanges": null,
- "ExcludedIPRanges": null,
- "PermittedEmailAddresses": null,
- "ExcludedEmailAddresses": null,
- "PermittedURIDomains": null,
- "ExcludedURIDomains": null,
- "CRLDistributionPoints": [
- "http://s.ss2.us/r.crl"
- ],
- "PolicyIdentifiers": [
- [
- 2,
- 5,
- 29,
- 32,
- 0
- ]
- ]
- }
- ],
- "VerifiedChains": null,
- "SignedCertificateTimestamps": null,
- "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": "",
- "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-Headers": [
- "X-FHIR-Starter,authorization,Prefer,Origin,Accept,X-Requested-With,Content-Type,Access-Control-Request-Method,Access-Control-Request-Headers"
- ],
- "Access-Control-Allow-Methods": [
- "POST, PUT, GET, OPTIONS, DELETE"
- ],
- "Access-Control-Allow-Origin": [
- "*"
- ],
- "Access-Control-Expose-Headers": [
- "Location, Content-Location"
- ],
- "Access-Control-Max-Age": [
- "3600"
- ],
- "Cache-Control": [
- "no-cache, no-store, max-age=0, must-revalidate"
- ],
- "Content-Length": [
- "79622"
- ],
- "Content-Location": [
- "https://api.logicahealth.org/fastenhealth/data/Bundle/2b87e9ea-0af9-429f-abf2-0a72b2e33ad1"
- ],
- "Content-Type": [
- "application/fhir+json;charset=UTF-8"
- ],
- "Date": [
- "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"
  } ],
  "entry": [ {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Patient/smart-1288992",
    "resource": {
      "resourceType": "Patient",
      "id": "smart-1288992",
      "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\">Daniel Adams</div>"
      },
      "identifier": [ {
        "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",
        "value": "smart-1288992"
      } ],
      "active": true,
      "name": [ {
        "use": "official",
        "family": "Adams",
        "given": [ "Daniel", "X" ]
      } ],
      "telecom": [ {
        "system": "email",
        "value": "daniel.adams@example.com"
      } ],
      "gender": "male",
      "birthDate": "1925-12-23",
      "address": [ {
        "use": "home",
        "line": [ "1 Hill Ave" ],
        "city": "Tulsa",
        "state": "OK",
        "postalCode": "74117",
        "country": "USA"
      } ],
      "generalPractitioner": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-179-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-179-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\">1999-12-21: temperature = 37.0 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-179-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": "1999-12-21",
      "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-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"
      },
      "effectiveDateTime": "2001-01-25",
      "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-180-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-180-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\">1999-12-21: weight = 96.34302 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-180-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": "1999-12-21",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 96.34302,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-163-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-163-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\">1997-05-07: heart_rate = 43.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-163-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": "1997-05-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 43.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "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"
      } ],
      "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": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 35.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-278-weight",
    "resource": {
      "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"
      } ],
      "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": "2009-04-08",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 89.31234,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-252-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-252-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\">2005-02-23: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-252-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": "2005-02-23",
      "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"
      } ],
      "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": "2009-04-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.88889,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-161-oxygensaturation",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-161-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\">1997-05-01: oxygen_saturation = 100.0 %{HemoglobinSaturation}</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-161-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": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
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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": {
        "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: temperature = 37.05556 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-172-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": "1999-12-20",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 37.05556,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-153-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-153-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\">1997-04-30: bmi = 35.8 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-153-bmi"
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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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      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 35.8,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "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": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-188-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": "2001-01-19",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 34.6,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-220-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-220-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\">2001-11-02: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-220-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": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "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": [ {
        "use": "official",
        "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"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "2710-2",
          "display": "oxygen_saturation"
        } ],
        "text": "oxygen_saturation"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-07",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
        "system": "http://unitsofmeasure.org",
        "code": "%{HemoglobinSaturation}"
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    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-286-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-286-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\">2009-04-14: bmi = 34.7 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-286-bmi"
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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"
      },
      "effectiveDateTime": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 34.7,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-152-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-152-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\">1997-04-30: weight = 97.52236 kg</div>"
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      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-152-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": "1997-04-30",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 97.52236,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-251-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-251-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\">2005-02-23: bmi = 33.8 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-251-bmi"
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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"
      },
      "effectiveDateTime": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 33.8,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-150-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-150-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\">1997-04-30: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-150-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": "1997-04-30",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 20.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "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"
      },
      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2001-11-01: temperature = 37.05556 Cel</div>"
      },
      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-214-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": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 37.05556,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-277-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-277-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\">2009-04-08: temperature = 36.94444 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-277-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": "2009-04-08",
      "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-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"
      } ],
      "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"
      } ],
      "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",
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        "code": "Cel"
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    "resource": {
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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\">2009-04-08: respiratory_rate = 20.0 {breaths}/min</div>"
      },
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        "value": "smart-276-respiratoryrate"
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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"
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        "text": "Vital Signs"
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      "code": {
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          "code": "9279-1",
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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",
        "end": "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",
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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": "2710-2",
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        "text": "oxygen_saturation"
      },
      "subject": {
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      "effectiveDateTime": "2001-01-19",
      "performer": [ {
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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-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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        "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"
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      "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>"
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      "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"
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    },
    "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": [ {
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        "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": [ {
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        "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": [ {
          "system": "http://loinc.org",
          "code": "8310-5",
          "display": "temperature"
        } ],
        "text": "temperature"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2001-01-24",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 37.05556,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-151-temperature",
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        "unit": "%{HemoglobinSaturation}",
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        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-839",
    "resource": {
      "resourceType": "Encounter",
      "id": "smart-839",
      "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: 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": "2001-11-05",
        "end": "2001-11-05"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-838",
    "resource": {
      "resourceType": "Encounter",
      "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: 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": "2001-11-02",
        "end": "2001-11-02"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-837",
    "resource": {
      "resourceType": "Encounter",
      "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: 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": "2001-11-01",
        "end": "2001-11-01"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-836",
    "resource": {
      "resourceType": "Encounter",
      "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: 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": "2001-10-31",
        "end": "2001-10-31"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-226-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-226-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\">2001-11-05: heart_rate = 82.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-226-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": "2001-11-05",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 82.0,
        "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-200-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-200-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\">2001-01-25: temperature = 37.05556 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-200-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": "2001-01-25",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 37.05556,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-216-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-216-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\">2001-11-01: bmi = 36.3 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-216-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": "2001-11-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.3,
        "unit": "kg/m2",
        "system": "http://unitsofmeasure.org",
        "code": "kg/m2"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-221-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-221-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\">2001-11-02: temperature = 37.05556 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-221-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": "2001-11-02",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 37.05556,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "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>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-284-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": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 36.88889,
        "unit": "Cel",
        "system": "http://unitsofmeasure.org",
        "code": "Cel"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "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"
      } ],
      "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": "2001-01-25",
      "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>"
      },
      "identifier": [ {
        "use": "official",
        "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"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "9279-1",
          "display": "respiratory_rate"
        } ],
        "text": "respiratory_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "1999-12-21",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 19.0,
        "unit": "{breaths}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{breaths}/min"
      }
    },
    "search": {
      "mode": "match"
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    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-157-respiratoryrate",
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-162-height",
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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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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      "valueQuantity": {
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        "code": "cm"
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-849",
    "resource": {
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        "source": "#N3ReKjR75As8Kjhk"
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    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Encounter/smart-847",
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    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-213-respiratoryrate",
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          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-210-oxygensaturation",
    "resource": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
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      "text": {
        "status": "generated",
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        "text": "Vital Signs"
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          "code": "2710-2",
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      "performer": [ {
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      "valueQuantity": {
        "value": 100.0,
        "unit": "%{HemoglobinSaturation}",
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        "code": "%{HemoglobinSaturation}"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-244-bmi",
    "resource": {
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        "lastUpdated": "2020-07-15T02:52:36.000+00:00",
        "source": "#N3ReKjR75As8Kjhk"
      },
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        "status": "generated",
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          "display": "Vital Signs"
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        "text": "Vital Signs"
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      "code": {
        "coding": [ {
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          "code": "39156-5",
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        "text": "bmi"
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    },
    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-240-heartrate",
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      "resourceType": "Observation",
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        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2005-02-10: heart_rate = 58.0 {beats}/min</div>"
      },
      "identifier": [ {
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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": "8867-4",
          "display": "heart_rate"
        } ],
        "text": "heart_rate"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-10",
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        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
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        "unit": "{beats}/min",
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-187-weight",
    "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\">2001-01-19: weight = 95.0276 kg</div>"
      },
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
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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": "3141-9",
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        } ],
        "text": "weight"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
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      "valueQuantity": {
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    },
    "search": {
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    }
  }, {
    "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": [ {
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        "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",
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      "valueQuantity": {
        "value": 164.846,
        "unit": "cm",
        "system": "http://unitsofmeasure.org",
        "code": "cm"
      }
    },
    "search": {
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    }
  }, {
    "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": [ {
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        "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": {
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    }
  }, {
    "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": [ {
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        "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": [ {
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        "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"
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      "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>"
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        "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": [ {
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        "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"
      } ],
      "valueQuantity": {
        "value": 69.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "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": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-160-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": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "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": [ {
        "use": "official",
        "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"
      },
      "effectiveDateTime": "2005-02-09",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 66.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "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"
      } ],
      "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"
      } ],
      "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"
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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": "2005-02-24",
      "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-290-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-290-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\">2009-04-23: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-290-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": "2009-04-23",
      "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-235-temperature",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-235-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\">2005-02-09: temperature = 36.94444 Cel</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-235-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": "2005-02-09",
      "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-232-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-232-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\">2005-02-09: height = 166.624 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-232-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": "2005-02-09",
      "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-192-respiratoryrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-192-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\">2001-01-24: respiratory_rate = 20.0 {breaths}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-192-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": "2001-01-24",
      "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-250-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-250-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\">2005-02-23: weight = 93.89362 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-250-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": "2005-02-23",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 93.89362,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-209-bmi",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-209-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\">2001-10-31: bmi = 33.9 kg/m2</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-209-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": "2001-10-31",
      "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-243-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-243-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\">2005-02-10: weight = 93.48539 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-243-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": "2005-02-10",
      "performer": [ {
        "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"
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      "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>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-266-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": "2005-02-25",
      "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-841",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-841",
      "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: Blood pressure 97/58 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": "2005-02-10",
      "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": 97,
          "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": 58,
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org",
          "code": "mm[Hg]"
        }
      } ]
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-840",
    "resource": {
      "resourceType": "Observation",
      "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: 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": "2005-02-09",
      "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": 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-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"
      } ],
      "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": "1997-05-01",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 99.60888,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "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"
      } ],
      "component": [ {
        "code": {
          "coding": [ {
            "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"
      } ],
      "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]"
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-173-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-173-weight",
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        "source": "#N3ReKjR75As8Kjhk"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">1999-12-20: weight = 96.93269 kg</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": "3141-9",
          "display": "weight"
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        "text": "weight"
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        "code": "kg"
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    },
    "search": {
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  }, {
    "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",
          "display": "Blood pressure"
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2005-02-24",
      "performer": [ {
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      "component": [ {
        "code": {
          "coding": [ {
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            "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]"
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      } ]
    },
    "search": {
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    }
  }, {
    "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"
        } ],
        "text": "Vital Signs"
      } ],
      "code": {
        "coding": [ {
          "system": "http://loinc.org",
          "code": "55284-4",
          "display": "Blood pressure"
        } ],
        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2005-02-23",
      "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": 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>"
      },
      "identifier": [ {
        "use": "official",
        "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",
          "display": "Blood pressure"
        } ],
        "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": {
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    }
  }, {
    "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"
      } ],
      "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",
      "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: Blood pressure 125/75 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"
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/smart-Practitioner-71614502"
      } ],
      "component": [ {
        "code": {
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            "system": "http://loinc.org",
            "code": "8480-6",
            "display": "Systolic blood pressure"
          } ],
          "text": "Systolic blood pressure"
        },
        "valueQuantity": {
          "value": 125,
          "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": {
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    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-846",
    "resource": {
      "resourceType": "Observation",
      "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: 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"
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        "text": "Blood pressure"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2009-04-08",
      "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-285-weight",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-285-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\">2009-04-14: weight = 92.39677 kg</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-285-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": "2009-04-14",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "valueQuantity": {
        "value": 92.39677,
        "unit": "kg",
        "system": "http://unitsofmeasure.org",
        "code": "kg"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "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": {
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    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-837",
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      "code": {
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      "effectiveDateTime": "2001-10-31",
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      "valueQuantity": {
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      } ],
      "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-309-height",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-309-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\">2009-04-28: height = 163.068 cm</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-309-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": "2009-04-28",
      "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-310-heartrate",
    "resource": {
      "resourceType": "Observation",
      "id": "smart-310-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\">2009-04-28: heart_rate = 79.0 {beats}/min</div>"
      },
      "identifier": [ {
        "use": "official",
        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-310-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": "2009-04-28",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
      } ],
      "valueQuantity": {
        "value": 79.0,
        "unit": "{beats}/min",
        "system": "http://unitsofmeasure.org",
        "code": "{beats}/min"
      }
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Condition/smart-Condition-601",
    "resource": {
      "resourceType": "Condition",
      "id": "smart-Condition-601",
      "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\">Thiopurine methyltransferase deficiency</div>"
      },
      "clinicalStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
          "code": "active",
          "display": "Active"
        } ],
        "text": "Active"
      },
      "verificationStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/condition-ver-status",
          "code": "confirmed",
          "display": "Confirmed"
        } ],
        "text": "Confirmed"
      },
      "code": {
        "coding": [ {
          "system": "http://snomed.info/sct",
          "code": "238012003",
          "display": "Thiopurine methyltransferase deficiency"
        } ],
        "text": "Thiopurine methyltransferase deficiency"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "onsetDateTime": "2009-07-18"
    },
    "search": {
      "mode": "match"
    }
  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-108-lab",
    "resource": {
      "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"
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    },
    "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"
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      "text": {
        "status": "generated",
        "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">2009-12-01: weight = 91.53494 kg</div>"
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      "identifier": [ {
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        "system": "http://www.bmc.nl/zorgportal/identifiers/observations",
        "value": "smart-334-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"
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      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2009-12-01",
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      "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"
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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": "770-8",
          "display": "Neutrophils NFr Bld Auto"
        } ],
        "text": "Neutrophils NFr Bld Auto"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
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      "effectiveDateTime": "2008-07-10",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "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"
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      },
      "verificationStatus": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/allergyintolerance-verification",
          "code": "confirmed"
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      },
      "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"
      } ],
      "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"
          }
        }
      } ],
      "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"
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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": "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"
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      "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"
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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": "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"
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      "status": "unknown",
      "category": [ {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/observation-category",
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          "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"
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      "valueQuantity": {
        "value": 139.0,
        "unit": "mmol/L",
        "system": "http://unitsofmeasure.org",
        "code": "mmol/L"
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      "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"
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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-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"
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        "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": "2009-10-29",
      "performer": [ {
        "reference": "Practitioner/SMART-1234"
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      "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": {
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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\">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"
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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": "5796-8",
          "display": "Hyaline Casts #/area UrnS LPF"
        } ],
        "text": "Hyaline Casts #/area UrnS LPF"
      },
      "subject": {
        "reference": "Patient/smart-1288992"
      },
      "effectiveDateTime": "2008-07-10",
      "performer": [ {
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      "valueQuantity": {
        "value": 9.0,
        "unit": "/[LPF]",
        "system": "http://unitsofmeasure.org",
        "code": "/[LPF]"
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      "referenceRange": [ {
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          "value": 0.0,
          "unit": "/[LPF]",
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          "code": "/[LPF]"
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        "high": {
          "value": 2.0,
          "unit": "/[LPF]",
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          "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"
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        "text": "Hydrochlorothiazide 50 MG Oral Tablet"
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      "subject": {
        "reference": "Patient/smart-1288992"
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      "dosageInstruction": [ {
        "text": "1 daily",
        "timing": {
          "repeat": {
            "boundsPeriod": {
              "start": "2008-08-14"
            },
            "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/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"
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      "text": {
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-68-lab",
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    "search": {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-93-lab",
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  }, {
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  }, {
    "fullUrl": "https://api.logicahealth.org/fastenhealth/data/Observation/smart-76-lab",
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- "RawTBSCertificate": "MIIDXaADAgECAgkApw5KTDSCt38wDQYJKoZIhvcNAQELBQAwaDELMAkGA1UEBhMCVVMxJTAjBgNVBAoTHFN0YXJmaWVsZCBUZWNobm9sb2dpZXMsIEluYy4xMjAwBgNVBAsTKVN0YXJmaWVsZCBDbGFzcyAyIENlcnRpZmljYXRpb24gQXV0aG9yaXR5MB4XDTA5MDkwMjAwMDAwMFoXDTM0MDYyODE3MzkxNlowgZgxCzAJBgNVBAYTAlVTMRAwDgYDVQQIEwdBcml6b25hMRMwEQYDVQQHEwpTY290dHNkYWxlMSUwIwYDVQQKExxTdGFyZmllbGQgVGVjaG5vbG9naWVzLCBJbmMuMTswOQYDVQQDEzJTdGFyZmllbGQgU2VydmljZXMgUm9vdCBDZXJ0aWZpY2F0ZSBBdXRob3JpdHkgLSBHMjCCASIwDQYJKoZIhvcNAQEBBQADggEPADCCAQoCggEBANUMOsQq+U7i9b4Zl1+OiFOxHz/Lz58gE20pOsgPfTz3a3Y4Y9k2YKibXlwAgLIvWX/2h/klQ4bnaRtSmpDhcePYLQ1Ob/bISdm28xpWriu2dBTrz/sm4xq6HZYuajtYlIlHVv8loJNwU4PahHQUw2eeBGg6345AWh1KTs9DkTvnVtYAcMtS7nt9rjrnvDH5RfbCYM8TWQIrgMw0R9+53pBlbQLPLJGmpufehRhJfGZOozptqbXuNC66DQO4M99H67FrjSXZm86B0UVGMpZwh94CDklDhbZsc7tk6mFBrMnUVN+HL8cisibMn1lUaJ/8viovxFUcdUBgF4UCVTmLfwUCAwEAAaOB8DCB7TAPBgNVHRMBAf8EBTADAQH/MA4GA1UdDwEB/wQEAwIBhjAdBgNVHQ4EFgQUnF8A36oB1zArOIiiuG1KnPIRkYMwHwYDVR0jBBgwFoAUv1+30c7dH4b0W1Ws3NcQwg6piOcwTwYIKwYBBQUHAQEEQzBBMBwGCCsGAQUFBzABhhBodHRwOi8vby5zczIudXMvMCEGCCsGAQUFBzAChhVodHRwOi8veC5zczIudXMveC5jZXIwJgYDVR0fBB8wHTAboBmgF4YVaHR0cDovL3Muc3MyLnVzL3IuY3JsMBEGA1UdIAQKMAgwBgYEVR0gAA==",
- "RawSubjectPublicKeyInfo": "MIIBIjANBgkqhkiG9w0BAQEFAAOCAQ8AMIIBCgKCAQEA1Qw6xCr5TuL1vhmXX46IU7EfP8vPnyATbSk6yA99PPdrdjhj2TZgqJteXACAsi9Zf/aH+SVDhudpG1KakOFx49gtDU5v9shJ2bbzGlauK7Z0FOvP+ybjGrodli5qO1iUiUdW/yWgk3BTg9qEdBTDZ54EaDrfjkBaHUpOz0ORO+dW1gBwy1Lue32uOue8MflF9sJgzxNZAiuAzDRH37nekGVtAs8skaam596FGEl8Zk6jOm2pte40LroNA7gz30frsWuNJdmbzoHRRUYylnCH3gIOSUOFtmxzu2TqYUGsydRU34cvxyKyJsyfWVRon/y+Ki/EVRx1QGAXhQJVOYt/BQIDAQAB",
- "RawSubject": "MIGYMQswCQYDVQQGEwJVUzEQMA4GA1UECBMHQXJpem9uYTETMBEGA1UEBxMKU2NvdHRzZGFsZTElMCMGA1UEChMcU3RhcmZpZWxkIFRlY2hub2xvZ2llcywgSW5jLjE7MDkGA1UEAxMyU3RhcmZpZWxkIFNlcnZpY2VzIFJvb3QgQ2VydGlmaWNhdGUgQXV0aG9yaXR5IC0gRzI=",
- "RawIssuer": "MGgxCzAJBgNVBAYTAlVTMSUwIwYDVQQKExxTdGFyZmllbGQgVGVjaG5vbG9naWVzLCBJbmMuMTIwMAYDVQQLEylTdGFyZmllbGQgQ2xhc3MgMiBDZXJ0aWZpY2F0aW9uIEF1dGhvcml0eQ==",
- "Signature": "Ix3jilfKfekXeUzxHlX9zFNuPkcP38ZV8rIENu2AH1PEXTQoa77HVfxn6ss/f5CyM80bWBCCAvj4L/UTYNQFzvGBCMHdp3WXTxi5bd73k5EIun5ALO3B6rt2njMGdx0NCH9T3Rtkq4In8WnVTV6u9KHDdadYRC3yPHCYrLpptpV3fw8xXiz8oIc6R2nweV/0FFSklV4ReBJgJ86fwnf/I1N3Xbr/6lnn28+vkpbvJJo1EHqckcYOfZn2Pxnf9XJU4RWpB1l7g79SLkaMsgBkdhxI09h56G5WzK4sA5DXGTiZ5MoJGVv/B5awqH80Sd9WqfewX+0z7YxHtzADXfQDjA==",
- "SignatureAlgorithm": 4,
- "PublicKeyAlgorithm": 1,
- "PublicKey": {
- "N": "26894789576491863019171445242018370132029525033879210664513024255165308689836081694724912552986436241602345929261854187816625921774943728567119070351838976265193901442169339571326613928339955106648223197498035701437846440970934704192382084561469274550003268570741310868032789070264835003681318445644941362885752628282968349509706358865971392279088395067847314610178969555804359319567178098112935181143559364150874524817692694181296058297355335204675211145990489303168553611700020424738364579606192390834705213026692659672388567853246354560726855054573503174641583891075106464210711468427779853334564691648681991700229",
- "E": 65537
- },
- "Version": 3,
- "SerialNumber": 12037640545166866303,
- "Issuer": {
- "Country": [
- "US"
- ],
- "Organization": [
- "Starfield Technologies, Inc."
- ],
- "OrganizationalUnit": [
- "Starfield Class 2 Certification Authority"
- ],
- "Locality": null,
- "Province": null,
- "StreetAddress": null,
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- "CommonName": "",
- "Names": [
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- 4,
- 6
- ],
- "Value": "US"
- },
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- 5,
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- "Value": "Starfield Technologies, Inc."
- },
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- 4,
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- "Value": "Starfield Class 2 Certification Authority"
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- ],
- "ExtraNames": null
- },
- "Subject": {
- "Country": [
- "US"
- ],
- "Organization": [
- "Starfield Technologies, Inc."
- ],
- "OrganizationalUnit": null,
- "Locality": [
- "Scottsdale"
- ],
- "Province": [
- "Arizona"
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- "StreetAddress": null,
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- "SerialNumber": "",
- "CommonName": "Starfield Services Root Certificate Authority - G2",
- "Names": [
- {
- "Type": [
- 2,
- 5,
- 4,
- 6
- ],
- "Value": "US"
- },
- {
- "Type": [
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- 4,
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- "Value": "Arizona"
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- "Type": [
- 2,
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- "Value": "Scottsdale"
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- "Value": "Starfield Technologies, Inc."
- },
- {
- "Type": [
- 2,
- 5,
- 4,
- 3
- ],
- "Value": "Starfield Services Root Certificate Authority - G2"
- }
- ],
- "ExtraNames": null
- },
- "NotBefore": "2009-09-02T00:00:00Z",
- "NotAfter": "2034-06-28T17:39:16Z",
- "KeyUsage": 97,
- "Extensions": [
- {
- "Id": [
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- 19
- ],
- "Critical": true,
- "Value": "MAMBAf8="
- },
- {
- "Id": [
- 2,
- 5,
- 29,
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- ],
- "Critical": true,
- "Value": "AwIBhg=="
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- 29,
- 14
- ],
- "Critical": false,
- "Value": "BBScXwDfqgHXMCs4iKK4bUqc8hGRgw=="
- },
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- 2,
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- 29,
- 35
- ],
- "Critical": false,
- "Value": "MBaAFL9ft9HO3R+G9FtVrNzXEMIOqYjn"
- },
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- "Id": [
- 1,
- 3,
- 6,
- 1,
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- 5,
- 7,
- 1,
- 1
- ],
- "Critical": false,
- "Value": "MEEwHAYIKwYBBQUHMAGGEGh0dHA6Ly9vLnNzMi51cy8wIQYIKwYBBQUHMAKGFWh0dHA6Ly94LnNzMi51cy94LmNlcg=="
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- "Id": [
- 2,
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- 29,
- 31
- ],
- "Critical": false,
- "Value": "MB0wG6AZoBeGFWh0dHA6Ly9zLnNzMi51cy9yLmNybA=="
- },
- {
- "Id": [
- 2,
- 5,
- 29,
- 32
- ],
- "Critical": false,
- "Value": "MAgwBgYEVR0gAA=="
- }
- ],
- "ExtraExtensions": null,
- "UnhandledCriticalExtensions": null,
- "ExtKeyUsage": null,
- "UnknownExtKeyUsage": null,
- "BasicConstraintsValid": true,
- "IsCA": true,
- "MaxPathLen": -1,
- "MaxPathLenZero": false,
- "SubjectKeyId": "nF8A36oB1zArOIiiuG1KnPIRkYM=",
- "AuthorityKeyId": "v1+30c7dH4b0W1Ws3NcQwg6piOc=",
- "OCSPServer": [
- "http://o.ss2.us/"
- ],
- "IssuingCertificateURL": [
- "http://x.ss2.us/x.cer"
- ],
- "DNSNames": null,
- "EmailAddresses": null,
- "IPAddresses": null,
- "URIs": null,
- "PermittedDNSDomainsCritical": false,
- "PermittedDNSDomains": null,
- "ExcludedDNSDomains": null,
- "PermittedIPRanges": null,
- "ExcludedIPRanges": null,
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- "ExcludedEmailAddresses": null,
- "PermittedURIDomains": null,
- "ExcludedURIDomains": null,
- "CRLDistributionPoints": [
- "http://s.ss2.us/r.crl"
- ],
- "PolicyIdentifiers": [
- [
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- 5,
- 29,
- 32,
- 0
- ]
- ]
- }
- ],
- "VerifiedChains": null,
- "SignedCertificateTimestamps": null,
- "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=
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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 h1:cIg4eruTrX1D+g88fzRXU5OdNfaM+9IcxsU14FzY7Hc=
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@@ -141,8 +123,6 @@ github.com/golang/protobuf v1.4.1/go.mod h1:U8fpvMrcmy5pZrNK1lt4xCsGvpyWQ/VVv6QD
github.com/golang/protobuf v1.4.2/go.mod h1:oDoupMAO8OvCJWAcko0GGGIgR6R6ocIYbsSw735rRwI=
github.com/golang/protobuf v1.4.3/go.mod h1:oDoupMAO8OvCJWAcko0GGGIgR6R6ocIYbsSw735rRwI=
github.com/golang/protobuf v1.5.0/go.mod h1:FsONVRAS9T7sI+LIUmWTfcYkHO4aIWwzhcaSAoJOfIk=
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github.com/google/btree v0.0.0-20180813153112-4030bb1f1f0c/go.mod h1:lNA+9X1NB3Zf8V7Ke586lFgjr2dZNuvo3lPJSGZ5JPQ=
github.com/google/btree v1.0.0/go.mod h1:lNA+9X1NB3Zf8V7Ke586lFgjr2dZNuvo3lPJSGZ5JPQ=
github.com/google/go-cmp v0.2.0/go.mod h1:oXzfMopK8JAjlY9xF4vHSVASa0yLyX7SntLO5aqRK0M=
@@ -153,7 +133,6 @@ github.com/google/go-cmp v0.4.1/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/
github.com/google/go-cmp v0.5.0/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/gNBxE=
github.com/google/go-cmp v0.5.1/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/gNBxE=
github.com/google/go-cmp v0.5.2/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/gNBxE=
-github.com/google/go-cmp v0.5.3/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/gNBxE=
github.com/google/go-cmp v0.5.4/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/gNBxE=
github.com/google/go-cmp v0.5.5/go.mod h1:v8dTdLbMG2kIc/vJvl+f65V22dbkXbowE6jgT/gNBxE=
github.com/google/go-cmp v0.5.8 h1:e6P7q2lk1O+qJJb4BtCQXlK8vWEO8V1ZeuEdJNOqZyg=
@@ -173,85 +152,29 @@ github.com/google/pprof v0.0.0-20201203190320-1bf35d6f28c2/go.mod h1:kpwsk12EmLe
github.com/google/pprof v0.0.0-20201218002935-b9804c9f04c2/go.mod h1:kpwsk12EmLew5upagYY7GY0pfYCcupk39gWOCRROcvE=
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github.com/google/uuid v1.1.2/go.mod h1:TIyPZe4MgqvfeYDBFedMoGGpEw/LqOeaOT+nhxU+yHo=
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github.com/googleapis/gax-go/v2 v2.0.4/go.mod h1:0Wqv26UfaUD9n4G6kQubkQ+KchISgw+vpHVxEJEs9eg=
github.com/googleapis/gax-go/v2 v2.0.5/go.mod h1:DWXyrwAJ9X0FpwwEdw+IPEYBICEFu5mhpdKc/us6bOk=
github.com/googleapis/google-cloud-go-testing v0.0.0-20200911160855-bcd43fbb19e8/go.mod h1:dvDLG8qkwmyD9a/MJJN3XJcT3xFxOKAvTZGvuZmac9g=
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github.com/kr/pty v1.1.1/go.mod h1:pFQYn66WHrOpPYNljwOMqo10TkYh1fy3cYio2l3bCsQ=
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github.com/kr/text v0.1.0/go.mod h1:4Jbv+DJW3UT/LiOwJeYQe1efqtUx/iVham/4vfdArNI=
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@@ -259,27 +182,16 @@ github.com/kvz/logstreamer v0.0.0-20150507115422-a635b98146f0 h1:3tLzEnUizyN9YLW
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github.com/mattn/go-colorable v0.1.12 h1:jF+Du6AlPIjs2BiUiQlKOX0rt3SujHxPnksPKZbaA40=
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github.com/mitchellh/go-homedir v1.1.0 h1:lukF9ziXFxDFPkA1vsr5zpc1XuPDn/wFntq5mG+4E0Y=
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github.com/mitchellh/mapstructure v1.5.0 h1:jeMsZIYE/09sWLaz43PL7Gy6RuMjD2eJVyuac5Z2hdY=
@@ -289,39 +201,33 @@ github.com/modern-go/concurrent v0.0.0-20180306012644-bacd9c7ef1dd h1:TRLaZ9cD/w
github.com/modern-go/concurrent v0.0.0-20180306012644-bacd9c7ef1dd/go.mod h1:6dJC0mAP4ikYIbvyc7fijjWJddQyLn8Ig3JB5CqoB9Q=
github.com/modern-go/reflect2 v1.0.2 h1:xBagoLtFs94CBntxluKeaWgTMpvLxC4ur3nMaC9Gz0M=
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github.com/pelletier/go-toml v1.9.5 h1:4yBQzkHv+7BHq2PQUZF3Mx0IYxG7LsP222s7Agd3ve8=
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github.com/pelletier/go-toml/v2 v2.0.1/go.mod h1:r9LEWfGN8R5k0VXJ+0BkIe7MYkRdwZOjgMj2KwnJFUo=
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github.com/pkg/diff v0.0.0-20210226163009-20ebb0f2a09e/go.mod h1:pJLUxLENpZxwdsKMEsNbx1VGcRFpLqf3715MtcvvzbA=
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github.com/pkg/errors v0.9.1/go.mod h1:bwawxfHBFNV+L2hUp1rHADufV3IMtnDRdf1r5NINEl0=
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github.com/russross/blackfriday/v2 v2.1.0 h1:JIOH55/0cWyOuilr9/qlrm0BSXldqnqwMsf35Ld67mk=
github.com/russross/blackfriday/v2 v2.1.0/go.mod h1:+Rmxgy9KzJVeS9/2gXHxylqXiyQDYRxCVz55jmeOWTM=
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-github.com/shopspring/decimal v0.0.0-20180709203117-cd690d0c9e24/go.mod h1:M+9NzErvs504Cn4c5DxATwIqPbtswREoFCre64PpcG4=
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github.com/sirupsen/logrus v1.9.0 h1:trlNQbNUG3OdDrDil03MCb1H2o9nJ1x4/5LYw7byDE0=
github.com/sirupsen/logrus v1.9.0/go.mod h1:naHLuLoDiP4jHNo9R0sCBMtWGeIprob74mVsIT4qYEQ=
github.com/spf13/afero v1.8.2 h1:xehSyVa0YnHWsJ49JFljMpg1HX19V6NDZ1fkm1Xznbo=
@@ -335,8 +241,6 @@ github.com/spf13/pflag v1.0.5/go.mod h1:McXfInJRrz4CZXVZOBLb0bTZqETkiAhM9Iw0y3An
github.com/spf13/viper v1.12.0 h1:CZ7eSOd3kZoaYDLbXnmzgQI5RlciuXBMA+18HwHRfZQ=
github.com/spf13/viper v1.12.0/go.mod h1:b6COn30jlNxbm/V2IqWiNWkJ+vZNiMNksliPCiuKtSI=
github.com/stretchr/objx v0.1.0/go.mod h1:HFkY916IF+rwdDfMAkV7OtwuqBVzrE8GR6GFx+wExME=
-github.com/stretchr/objx v0.1.1/go.mod h1:HFkY916IF+rwdDfMAkV7OtwuqBVzrE8GR6GFx+wExME=
-github.com/stretchr/objx v0.2.0/go.mod h1:qt09Ya8vawLte6SNmTgCsAVtYtaKzEcn8ATUoHMkEqE=
github.com/stretchr/testify v1.2.2/go.mod h1:a8OnRcib4nhh0OaRAV+Yts87kKdq0PP7pXfy6kDkUVs=
github.com/stretchr/testify v1.3.0/go.mod h1:M5WIy9Dh21IEIfnGCwXGc5bZfKNJtfHm1UVUgZn+9EI=
github.com/stretchr/testify v1.4.0/go.mod h1:j7eGeouHqKxXV5pUuKE4zz7dFj8WfuZ+81PSLYec5m4=
@@ -347,7 +251,6 @@ github.com/stretchr/testify v1.7.1 h1:5TQK59W5E3v0r2duFAb7P95B6hEeOyEnHRa8MjYSMT
github.com/stretchr/testify v1.7.1/go.mod h1:6Fq8oRcR53rry900zMqJjRRixrwX3KX962/h/Wwjteg=
github.com/subosito/gotenv v1.3.0 h1:mjC+YW8QpAdXibNi+vNWgzmgBH4+5l5dCXv8cNysBLI=
github.com/subosito/gotenv v1.3.0/go.mod h1:YzJjq/33h7nrwdY+iHMhEOEEbW0ovIz0tB6t6PwAXzs=
-github.com/thoas/go-funk v0.9.1 h1:O549iLZqPpTUQ10ykd26sZhzD+rmR5pWhuElrhbC20M=
github.com/ugorji/go v1.2.7/go.mod h1:nF9osbDWLy6bDVv/Rtoh6QgnvNDpmCalQV5urGCCS6M=
github.com/ugorji/go/codec v1.2.7 h1:YPXUKf7fYbp/y8xloBqZOw2qaVggbfwMlI8WM3wZUJ0=
github.com/ugorji/go/codec v1.2.7/go.mod h1:WGN1fab3R1fzQlVQTkfxVtIBhWDRqOviHU95kRgeqEY=
@@ -359,40 +262,24 @@ github.com/yuin/goldmark v1.1.25/go.mod h1:3hX8gzYuyVAZsxl0MRgGTJEmQBFcNTphYh9de
github.com/yuin/goldmark v1.1.27/go.mod h1:3hX8gzYuyVAZsxl0MRgGTJEmQBFcNTphYh9decYSb74=
github.com/yuin/goldmark v1.1.32/go.mod h1:3hX8gzYuyVAZsxl0MRgGTJEmQBFcNTphYh9decYSb74=
github.com/yuin/goldmark v1.2.1/go.mod h1:3hX8gzYuyVAZsxl0MRgGTJEmQBFcNTphYh9decYSb74=
-github.com/zenazn/goji v0.9.0/go.mod h1:7S9M489iMyHBNxwZnk9/EHS098H4/F6TATF2mIxtB1Q=
+gitlab.com/flimzy/testy v0.0.3/go.mod h1:YObF4cq711ubd/3U0ydRQQVz7Cnq/ChgJpVwNr/AJac=
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+gitlab.com/flimzy/testy v0.9.1/go.mod h1:4Yy2aelUY6IgRmd3jHgGWewZLNMQZWQTlwyuMW642Mc=
go.opencensus.io v0.21.0/go.mod h1:mSImk1erAIZhrmZN+AvHh14ztQfjbGwt4TtuofqLduU=
go.opencensus.io v0.22.0/go.mod h1:+kGneAE2xo2IficOXnaByMWTGM9T73dGwxeWcUqIpI8=
go.opencensus.io v0.22.2/go.mod h1:yxeiOL68Rb0Xd1ddK5vPZ/oVn4vY4Ynel7k9FzqtOIw=
go.opencensus.io v0.22.3/go.mod h1:yxeiOL68Rb0Xd1ddK5vPZ/oVn4vY4Ynel7k9FzqtOIw=
go.opencensus.io v0.22.4/go.mod h1:yxeiOL68Rb0Xd1ddK5vPZ/oVn4vY4Ynel7k9FzqtOIw=
go.opencensus.io v0.22.5/go.mod h1:5pWMHQbX5EPX2/62yrJeAkowc+lfs/XD7Uxpq3pI6kk=
-go.uber.org/atomic v1.3.2/go.mod h1:gD2HeocX3+yG+ygLZcrzQJaqmWj9AIm7n08wl/qW/PE=
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golang.org/x/crypto v0.0.0-20190228161510-8dd112bcdc25/go.mod h1:djNgcEr1/C05ACkg1iLfiJU5Ep61QUkGW8qpdssI0+w=
golang.org/x/crypto v0.0.0-20190308221718-c2843e01d9a2/go.mod h1:djNgcEr1/C05ACkg1iLfiJU5Ep61QUkGW8qpdssI0+w=
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golang.org/x/crypto v0.0.0-20190510104115-cbcb75029529/go.mod h1:yigFU9vqHzYiE8UmvKecakEJjdnWj3jj499lnFckfCI=
golang.org/x/crypto v0.0.0-20190605123033-f99c8df09eb5/go.mod h1:yigFU9vqHzYiE8UmvKecakEJjdnWj3jj499lnFckfCI=
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golang.org/x/crypto v0.0.0-20191011191535-87dc89f01550/go.mod h1:yigFU9vqHzYiE8UmvKecakEJjdnWj3jj499lnFckfCI=
golang.org/x/crypto v0.0.0-20200622213623-75b288015ac9/go.mod h1:LzIPMQfyMNhhGPhUkYOs5KpL4U8rLKemX1yGLhDgUto=
-golang.org/x/crypto v0.0.0-20201016220609-9e8e0b390897/go.mod h1:LzIPMQfyMNhhGPhUkYOs5KpL4U8rLKemX1yGLhDgUto=
-golang.org/x/crypto v0.0.0-20201203163018-be400aefbc4c/go.mod h1:jdWPYTVW3xRLrWPugEBEK3UY2ZEsg3UU495nc5E+M+I=
golang.org/x/crypto v0.0.0-20210421170649-83a5a9bb288b/go.mod h1:T9bdIzuCu7OtxOm1hfPfRQxPLYneinmdGuTeoZ9dtd4=
-golang.org/x/crypto v0.0.0-20210616213533-5ff15b29337e/go.mod h1:GvvjBRRGRdwPK5ydBHafDWAxML/pGHZbMvKqRZ5+Abc=
golang.org/x/crypto v0.0.0-20210711020723-a769d52b0f97/go.mod h1:GvvjBRRGRdwPK5ydBHafDWAxML/pGHZbMvKqRZ5+Abc=
-golang.org/x/crypto v0.0.0-20210921155107-089bfa567519/go.mod h1:GvvjBRRGRdwPK5ydBHafDWAxML/pGHZbMvKqRZ5+Abc=
golang.org/x/crypto v0.0.0-20211108221036-ceb1ce70b4fa/go.mod h1:GvvjBRRGRdwPK5ydBHafDWAxML/pGHZbMvKqRZ5+Abc=
-golang.org/x/crypto v0.0.0-20220214200702-86341886e292/go.mod h1:IxCIyHEi3zRg3s0A5j5BB6A9Jmi73HwBIUl50j+osU4=
golang.org/x/crypto v0.0.0-20220411220226-7b82a4e95df4 h1:kUhD7nTDoI3fVd9G4ORWrbV5NY0liEs/Jg2pv5f+bBA=
golang.org/x/crypto v0.0.0-20220411220226-7b82a4e95df4/go.mod h1:IxCIyHEi3zRg3s0A5j5BB6A9Jmi73HwBIUl50j+osU4=
golang.org/x/exp v0.0.0-20190121172915-509febef88a4/go.mod h1:CJ0aWSM057203Lf6IL+f9T1iT9GByDxfZKAQTCR3kQA=
@@ -405,8 +292,6 @@ golang.org/x/exp v0.0.0-20191227195350-da58074b4299/go.mod h1:2RIsYlXP63K8oxa1u0
golang.org/x/exp v0.0.0-20200119233911-0405dc783f0a/go.mod h1:2RIsYlXP63K8oxa1u096TMicItID8zy7Y6sNkU49FU4=
golang.org/x/exp v0.0.0-20200207192155-f17229e696bd/go.mod 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 h1:sp8m0HH+o8qH0wwXwYZr8TS3Oi6o0r6Gce1SSxlDquU=
+golang.org/x/net v0.0.0-20201110031124-69a78807bb2b/go.mod h1:sp8m0HH+o8qH0wwXwYZr8TS3Oi6o0r6Gce1SSxlDquU=
golang.org/x/net v0.0.0-20201209123823-ac852fbbde11/go.mod h1:m0MpNAwzfU5UDzcl9v0D8zg8gWTRqZa9RBIspLL5mdg=
golang.org/x/net v0.0.0-20201224014010-6772e930b67b/go.mod h1:m0MpNAwzfU5UDzcl9v0D8zg8gWTRqZa9RBIspLL5mdg=
golang.org/x/net v0.0.0-20210226172049-e18ecbb05110/go.mod h1:m0MpNAwzfU5UDzcl9v0D8zg8gWTRqZa9RBIspLL5mdg=
-golang.org/x/net v0.0.0-20210610132358-84b48f89b13b/go.mod h1:9nx3DQGgdP8bBQD5qxJ1jj9UTztislL4KSBs9R2vV5Y=
-golang.org/x/net v0.0.0-20211112202133-69e39bad7dc2/go.mod h1:9nx3DQGgdP8bBQD5qxJ1jj9UTztislL4KSBs9R2vV5Y=
-golang.org/x/net v0.0.0-20220127200216-cd36cc0744dd/go.mod h1:CfG3xpIq0wQ8r1q4Su4UZFWDARRcnwPjda9FqA0JpMk=
-golang.org/x/net v0.0.0-20220520000938-2e3eb7b945c2 h1:NWy5+hlRbC7HK+PmcXVUmW1IMyFce7to56IUvhUFm7Y=
-golang.org/x/net v0.0.0-20220520000938-2e3eb7b945c2/go.mod 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 h1:STP8DvDyc/dI5b8T5hshtkjS+E42TnysNCUPdjciGhY=
-golang.org/x/sys v0.0.0-20180905080454-ebe1bf3edb33/go.mod h1:STP8DvDyc/dI5b8T5hshtkjS+E42TnysNCUPdjciGhY=
golang.org/x/sys v0.0.0-20190215142949-d0b11bdaac8a/go.mod h1:STP8DvDyc/dI5b8T5hshtkjS+E42TnysNCUPdjciGhY=
golang.org/x/sys v0.0.0-20190222072716-a9d3bda3a223/go.mod h1:STP8DvDyc/dI5b8T5hshtkjS+E42TnysNCUPdjciGhY=
golang.org/x/sys v0.0.0-20190228124157-a34e9553db1e/go.mod h1:STP8DvDyc/dI5b8T5hshtkjS+E42TnysNCUPdjciGhY=
golang.org/x/sys v0.0.0-20190312061237-fead79001313/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
-golang.org/x/sys v0.0.0-20190403152447-81d4e9dc473e/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20190412213103-97732733099d/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
-golang.org/x/sys v0.0.0-20190422165155-953cdadca894/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20190502145724-3ef323f4f1fd/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20190507160741-ecd444e8653b/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20190606165138-5da285871e9c/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20190624142023-c5567b49c5d0/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20190726091711-fc99dfbffb4e/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
-golang.org/x/sys v0.0.0-20190813064441-fde4db37ae7a/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20191001151750-bb3f8db39f24/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
-golang.org/x/sys v0.0.0-20191026070338-33540a1f6037/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20191204072324-ce4227a45e2e/go.mod h1:h1NjWce9XRLGQEsW7wpKNCjG9DtNlClVuFLEZdDNbEs=
golang.org/x/sys v0.0.0-20191228213918-04cbcbbfeed8/go.mod 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 h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
golang.org/x/sys v0.0.0-20210806184541-e5e7981a1069/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
golang.org/x/sys v0.0.0-20210927094055-39ccf1dd6fa6/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
-golang.org/x/sys v0.0.0-20211007075335-d3039528d8ac/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
-golang.org/x/sys v0.0.0-20211216021012-1d35b9e2eb4e/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
-golang.org/x/sys v0.0.0-20220405052023-b1e9470b6e64/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
golang.org/x/sys v0.0.0-20220412211240-33da011f77ad/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
-golang.org/x/sys v0.0.0-20220715151400-c0bba94af5f8 h1:0A+M6Uqn+Eje4kHMK80dtF3JCXC4ykBgQG4Fe06QRhQ=
golang.org/x/sys v0.0.0-20220715151400-c0bba94af5f8/go.mod h1:oPkhp1MJrh7nUepCBck5+mAzfO9JrbApNNgaTdGDITg=
-golang.org/x/term v0.0.0-20201117132131-f5c789dd3221/go.mod 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 h1:RgjU9mgBXZiqYHBnxXauZ1Gv1EHHAz9KjViQ78xBX0Q=
-golang.org/x/tools v0.0.0-20190425163242-31fd60d6bfdc/go.mod h1:RgjU9mgBXZiqYHBnxXauZ1Gv1EHHAz9KjViQ78xBX0Q=
golang.org/x/tools v0.0.0-20190506145303-2d16b83fe98c/go.mod h1:RgjU9mgBXZiqYHBnxXauZ1Gv1EHHAz9KjViQ78xBX0Q=
golang.org/x/tools v0.0.0-20190524140312-2c0ae7006135/go.mod h1:RgjU9mgBXZiqYHBnxXauZ1Gv1EHHAz9KjViQ78xBX0Q=
golang.org/x/tools v0.0.0-20190606124116-d0a3d012864b/go.mod h1:/rFqwRUd4F7ZHNgwSSTFct+R/Kf4OFW1sUzUTQQTgfc=
golang.org/x/tools v0.0.0-20190621195816-6e04913cbbac/go.mod h1:/rFqwRUd4F7ZHNgwSSTFct+R/Kf4OFW1sUzUTQQTgfc=
golang.org/x/tools v0.0.0-20190628153133-6cdbf07be9d0/go.mod h1:/rFqwRUd4F7ZHNgwSSTFct+R/Kf4OFW1sUzUTQQTgfc=
golang.org/x/tools v0.0.0-20190816200558-6889da9d5479/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo=
-golang.org/x/tools v0.0.0-20190823170909-c4a336ef6a2f/go.mod h1:b+2E5dAYhXwXZwtnZ6UAqBI28+e2cm9otk0dWdXHAEo=
golang.org/x/tools v0.0.0-20190911174233-4f2ddba30aff/go.mod 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 h1:emZCQorbCU4vsT4fOWvOPXz4eW1wZW4PmDk9uLelYpA=
-golang.org/x/tools v0.0.0-20201124115921-2c860bdd6e78/go.mod h1:emZCQorbCU4vsT4fOWvOPXz4eW1wZW4PmDk9uLelYpA=
golang.org/x/tools v0.0.0-20201201161351-ac6f37ff4c2a/go.mod h1:emZCQorbCU4vsT4fOWvOPXz4eW1wZW4PmDk9uLelYpA=
golang.org/x/tools v0.0.0-20201208233053-a543418bbed2/go.mod h1:emZCQorbCU4vsT4fOWvOPXz4eW1wZW4PmDk9uLelYpA=
golang.org/x/tools v0.0.0-20210105154028-b0ab187a4818/go.mod h1:emZCQorbCU4vsT4fOWvOPXz4eW1wZW4PmDk9uLelYpA=
golang.org/x/tools v0.0.0-20210108195828-e2f9c7f1fc8e/go.mod h1:emZCQorbCU4vsT4fOWvOPXz4eW1wZW4PmDk9uLelYpA=
golang.org/x/tools v0.1.0/go.mod h1:xkSsbof2nBLbhDlRMhhhyNLN/zl3eTqcnHD5viDpcZ0=
-golang.org/x/xerrors v0.0.0-20190410155217-1f06c39b4373/go.mod h1:I/5z698sn9Ka8TeJc9MKroUUfqBBauWjQqLJ2OPfmY0=
-golang.org/x/xerrors v0.0.0-20190513163551-3ee3066db522/go.mod h1:I/5z698sn9Ka8TeJc9MKroUUfqBBauWjQqLJ2OPfmY0=
golang.org/x/xerrors v0.0.0-20190717185122-a985d3407aa7/go.mod 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 h1:jlhhOSvTdKEhbULTjvd4ARK9grFBp09yW+WbY/TyQbw=
-google.golang.org/protobuf v1.26.0/go.mod h1:9q0QmTI4eRPtz6boOQmLYwt+qCgq0jsYwAQnmE0givc=
google.golang.org/protobuf v1.28.0 h1:w43yiav+6bVFTBQFZX0r7ipe9JQ1QsbMgHwbBziscLw=
google.golang.org/protobuf v1.28.0/go.mod h1:HV8QOd/L58Z+nl8r43ehVNZIU/HEI6OcFqwMG9pJV4I=
gopkg.in/check.v1 v0.0.0-20161208181325-20d25e280405/go.mod h1:Co6ibVJAznAaIkqp8huTwlJQCZ016jof/cbN4VW5Yz0=
@@ -713,31 +576,15 @@ gopkg.in/check.v1 v1.0.0-20180628173108-788fd7840127/go.mod h1:Co6ibVJAznAaIkqp8
gopkg.in/check.v1 v1.0.0-20201130134442-10cb98267c6c h1:Hei/4ADfdWqJk1ZMxUNpqntNwaWcugrBjAiHlqqRiVk=
gopkg.in/check.v1 v1.0.0-20201130134442-10cb98267c6c/go.mod h1:JHkPIbrfpd72SG/EVd6muEfDQjcINNoR0C8j2r3qZ4Q=
gopkg.in/errgo.v2 v2.1.0/go.mod h1:hNsd1EY+bozCKY1Ytp96fpM3vjJbqLJn88ws8XvfDNI=
-gopkg.in/inconshreveable/log15.v2 v2.0.0-20180818164646-67afb5ed74ec/go.mod h1:aPpfJ7XW+gOuirDoZ8gHhLh3kZ1B08FtV2bbmy7Jv3s=
gopkg.in/ini.v1 v1.66.4 h1:SsAcf+mM7mRZo2nJNGt8mZCjG8ZRaNGMURJw7BsIST4=
gopkg.in/ini.v1 v1.66.4/go.mod h1:pNLf8WUiyNEtQjuu5G5vTm06TEv9tsIgeAvK8hOrP4k=
gopkg.in/yaml.v2 v2.2.2/go.mod h1:hI93XBmqTisBFMUTm0b8Fm+jr3Dg1NNxqwp+5A1VGuI=
-gopkg.in/yaml.v2 v2.2.8/go.mod h1:hI93XBmqTisBFMUTm0b8Fm+jr3Dg1NNxqwp+5A1VGuI=
gopkg.in/yaml.v2 v2.4.0 h1:D8xgwECY7CYvx+Y2n4sBz93Jn9JRvxdiyyo8CTfuKaY=
gopkg.in/yaml.v2 v2.4.0/go.mod h1:RDklbk79AGWmwhnvt/jBztapEOGDOx6ZbXqjP6csGnQ=
gopkg.in/yaml.v3 v3.0.0-20200313102051-9f266ea9e77c/go.mod h1:K4uyk7z7BCEPqu6E+C64Yfv1cQ7kz7rIZviUmN+EgEM=
gopkg.in/yaml.v3 v3.0.0-20210107192922-496545a6307b/go.mod h1:K4uyk7z7BCEPqu6E+C64Yfv1cQ7kz7rIZviUmN+EgEM=
gopkg.in/yaml.v3 v3.0.1 h1:fxVm/GzAzEWqLHuvctI91KS9hhNmmWOoWu0XTYJS7CA=
gopkg.in/yaml.v3 v3.0.1/go.mod h1:K4uyk7z7BCEPqu6E+C64Yfv1cQ7kz7rIZviUmN+EgEM=
-gorm.io/datatypes v1.0.7 h1:8NhJN4+annFjwV1WufDhFiPjdUvV1lSGUdg1UCjQIWY=
-gorm.io/datatypes v1.0.7/go.mod h1:l9qkCuy0CdzDEop9HKUdcnC9gHC2sRlaFtHkTzsZRqg=
-gorm.io/driver/mysql v1.3.2 h1:QJryWiqQ91EvZ0jZL48NOpdlPdMjdip1hQ8bTgo4H7I=
-gorm.io/driver/mysql v1.3.2/go.mod h1:ChK6AHbHgDCFZyJp0F+BmVGb06PSIoh9uVYKAlRbb2U=
-gorm.io/driver/postgres v1.3.4 h1:evZ7plF+Bp+Lr1mO5NdPvd6M/N98XtwHixGB+y7fdEQ=
-gorm.io/driver/postgres v1.3.4/go.mod h1:y0vEuInFKJtijuSGu9e5bs5hzzSzPK+LancpKpvbRBw=
-gorm.io/driver/sqlite v1.3.1 h1:bwfE+zTEWklBYoEodIOIBwuWHpnx52Z9zJFW5F33WLk=
-gorm.io/driver/sqlite v1.3.1/go.mod h1:wJx0hJspfycZ6myN38x1O/AqLtNS6c5o9TndewFbELg=
-gorm.io/driver/sqlserver v1.3.1 h1:F5t6ScMzOgy1zukRTIZgLZwKahgt3q1woAILVolKpOI=
-gorm.io/driver/sqlserver v1.3.1/go.mod h1:w25Vrx2BG+CJNUu/xKbFhaKlGxT/nzRkhWCCoptX8tQ=
-gorm.io/gorm v1.23.1/go.mod h1:l2lP/RyAtc1ynaTjFksBde/O8v9oOGIApu2/xRitmZk=
-gorm.io/gorm v1.23.6/go.mod h1:l2lP/RyAtc1ynaTjFksBde/O8v9oOGIApu2/xRitmZk=
-gorm.io/gorm v1.23.8 h1:h8sGJ+biDgBA1AD1Ha9gFCx7h8npU7AsLdlkX0n2TpE=
-gorm.io/gorm v1.23.8/go.mod h1:l2lP/RyAtc1ynaTjFksBde/O8v9oOGIApu2/xRitmZk=
honnef.co/go/tools v0.0.0-20190102054323-c2f93a96b099/go.mod h1:rf3lG4BRIbNafJWhAfAdb/ePZxsR/4RtNHQocxwk9r4=
honnef.co/go/tools v0.0.0-20190106161140-3f1c8253044a/go.mod h1:rf3lG4BRIbNafJWhAfAdb/ePZxsR/4RtNHQocxwk9r4=
honnef.co/go/tools v0.0.0-20190418001031-e561f6794a2a/go.mod h1:rf3lG4BRIbNafJWhAfAdb/ePZxsR/4RtNHQocxwk9r4=
@@ -745,32 +592,6 @@ honnef.co/go/tools v0.0.0-20190523083050-ea95bdfd59fc/go.mod h1:rf3lG4BRIbNafJWh
honnef.co/go/tools v0.0.1-2019.2.3/go.mod h1:a3bituU0lyd329TUQxRnasdCoJDkEUEAqEt0JzvZhAg=
honnef.co/go/tools v0.0.1-2020.1.3/go.mod h1:X/FiERA/W4tHapMX5mGpAtMSVEeEUOyHaw9vFzvIQ3k=
honnef.co/go/tools v0.0.1-2020.1.4/go.mod h1:X/FiERA/W4tHapMX5mGpAtMSVEeEUOyHaw9vFzvIQ3k=
-lukechampine.com/uint128 v1.1.1/go.mod h1:c4eWIwlEGaxC/+H1VguhU4PHXNWDCDMUlWdIWl2j1gk=
-modernc.org/cc/v3 v3.36.0/go.mod h1:NFUHyPn4ekoC/JHeZFfZurN6ixxawE1BnVonP/oahEI=
-modernc.org/ccgo/v3 v3.0.0-20220428102840-41399a37e894/go.mod h1:eI31LL8EwEBKPpNpA4bU1/i+sKOwOrQy8D87zWUcRZc=
-modernc.org/ccgo/v3 v3.0.0-20220430103911-bc99d88307be/go.mod h1:bwdAnOoaIt8Ax9YdWGjxWsdkPcZyRPHqrOvJxaKAKGw=
-modernc.org/ccgo/v3 v3.16.4/go.mod h1:tGtX0gE9Jn7hdZFeU88slbTh1UtCYKusWOoCJuvkWsQ=
-modernc.org/ccgo/v3 v3.16.6/go.mod h1:tGtX0gE9Jn7hdZFeU88slbTh1UtCYKusWOoCJuvkWsQ=
-modernc.org/ccorpus v1.11.6/go.mod h1:2gEUTrWqdpH2pXsmTM1ZkjeSrUWDpjMu2T6m29L/ErQ=
-modernc.org/httpfs v1.0.6/go.mod h1:7dosgurJGp0sPaRanU53W4xZYKh14wfzX420oZADeHM=
-modernc.org/libc v0.0.0-20220428101251-2d5f3daf273b/go.mod h1:p7Mg4+koNjc8jkqwcoFBJx7tXkpj00G77X7A72jXPXA=
-modernc.org/libc v1.16.0/go.mod h1:N4LD6DBE9cf+Dzf9buBlzVJndKr/iJHG97vGLHYnb5A=
-modernc.org/libc v1.16.1/go.mod h1:JjJE0eu4yeK7tab2n4S1w8tlWd9MxXLRzheaRnAKymU=
-modernc.org/libc v1.16.7/go.mod h1:hYIV5VZczAmGZAnG15Vdngn5HSF5cSkbvfz2B7GRuVU=
-modernc.org/libc v1.16.8 h1:Ux98PaOMvolgoFX/YwusFOHBnanXdGRmWgI8ciI2z4o=
-modernc.org/libc v1.16.8/go.mod h1:hYIV5VZczAmGZAnG15Vdngn5HSF5cSkbvfz2B7GRuVU=
-modernc.org/mathutil v1.2.2/go.mod h1:mZW8CKdRPY1v87qxC/wUdX5O1qDzXMP5TH3wjfpga6E=
-modernc.org/mathutil v1.4.1 h1:ij3fYGe8zBF4Vu+g0oT7mB06r8sqGWKuJu1yXeR4by8=
-modernc.org/mathutil v1.4.1/go.mod h1:mZW8CKdRPY1v87qxC/wUdX5O1qDzXMP5TH3wjfpga6E=
-modernc.org/memory v1.1.1 h1:bDOL0DIDLQv7bWhP3gMvIrnoFw+Eo6F7a2QK9HPDiFU=
-modernc.org/memory v1.1.1/go.mod h1:/0wo5ibyrQiaoUoH7f9D8dnglAmILJ5/cxZlRECf+Nw=
-modernc.org/opt v0.1.1/go.mod h1:WdSiB5evDcignE70guQKxYUl14mgWtbClRi5wmkkTX0=
-modernc.org/sqlite v1.17.3 h1:iE+coC5g17LtByDYDWKpR6m2Z9022YrSh3bumwOnIrI=
-modernc.org/sqlite v1.17.3/go.mod h1:10hPVYar9C0kfXuTWGz8s0XtB8uAGymUy51ZzStYe3k=
-modernc.org/strutil v1.1.1/go.mod h1:DE+MQQ/hjKBZS2zNInV5hhcipt5rLPWkmpbGeW5mmdw=
-modernc.org/tcl v1.13.1/go.mod h1:XOLfOwzhkljL4itZkK6T72ckMgvj0BDsnKNdZVUOecw=
-modernc.org/token v1.0.0/go.mod h1:UGzOrNV1mAFSEB63lOFHIpNRUVMvYTc6yu1SMY/XTDM=
-modernc.org/z v1.5.1/go.mod h1:eWFB510QWW5Th9YGZT81s+LwvaAs3Q2yr4sP0rmLkv8=
rsc.io/binaryregexp v0.2.0/go.mod h1:qTv7/COck+e2FymRvadv62gMdZztPaShugOCi3I+8D8=
rsc.io/quote/v3 v3.1.0/go.mod h1:yEA65RcK8LyAZtP9Kv3t0HmxON59tX3rD+tICJqUlj0=
rsc.io/sampler v1.3.0/go.mod h1:T1hPZKmBbMNahiBKFy5HrXp6adAjACjK9JXDnKaTXpA=