{ "resourceType" : "Bundle", "id" : "sa-example-submission-bundle", "meta" : { "profile" : ["https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-submission-bundle"] }, "type" : "collection", "timestamp" : "2026-10-14T10:35:05+13:00", "entry" : [{ "fullUrl" : "https://api.example.health.nz/fhir/Claim/sa-example-claim", "resource" : { "resourceType" : "Claim", "id" : "sa-example-claim", "meta" : { "profile" : ["https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-claim"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim sa-example-claim

Profile: SA Claim

status: Active

type: Pharmacy

use: Preauthorization

patient: Aroha Parata (official) (no stated gender), DoB: 1968-03-14 ( https://standards.digital.health.nz/ns/nhi-id#NHI#ZZZ0016\u00a0(use:\u00a0official))

created: 2026-10-14 10:35:00+1300

provider: Jane Smith (official) (https://standards.digital.health.nz/ns/hpi-person-id#HPIProvider#99ZZZZ\u00a0(use:\u00a0official))

priority: Normal

SupportingInfos

-SequenceCategoryValue[x]
*1Questionnaire responseResponse to Questionnaire '->Example Special Authority form SA9999 - Initial application' about '->Aroha Parata (official) (no stated gender), DoB: 1968-03-14 ( https://standards.digital.health.nz/ns/nhi-id#NHI#ZZZ0016\u00a0(use:\u00a0official))'

Insurances

-SequenceFocalCoverage
*1truePharmaceutical Schedule
" }, "status" : "active", "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/claim-type", "code" : "pharmacy" }] }, "use" : "preauthorization", "patient" : { "reference" : "Patient/sa-example-patient" }, "created" : "2026-10-14T10:35:00+13:00", "provider" : { "reference" : "Practitioner/sa-example-applicant" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal" }] }, "supportingInfo" : [{ "sequence" : 1, "category" : { "coding" : [{ "system" : "https://fhir-ig.digital.health.nz/special-authority/CodeSystem/sa-supporting-info-category", "code" : "questionnaire-response" }] }, "valueReference" : { "reference" : "QuestionnaireResponse/sa-example-qr" } }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "display" : "Pharmaceutical Schedule" } }] } }, { "fullUrl" : "https://api.example.health.nz/fhir/QuestionnaireResponse/sa-example-qr", "resource" : { "resourceType" : "QuestionnaireResponse", "id" : "sa-example-qr", "meta" : { "profile" : ["https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-questionnaire-response"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: QuestionnaireResponse sa-example-qr

Profile: SA QuestionnaireResponse

\r\n\r\n\r\n\r\n\r\n
LinkIDTextDefinitionAnswer\"doco\"
\"\"\"\" sa-example-qrQuestionnaire:Example Special Authority form SA9999 - Initial application
\"\"\"\"\"\" sa-example-qr / initial
\"\"\"\"\"\"\"\" sa-example-qr / initial / 00001Patient has a confirmed diagnosis of the relevant conditiontrue
\"\"\"\"\"\"\"\" sa-example-qr / initial / 00002Patient has had an inadequate response to at least 3 months of first-line treatmenttrue
\"\"\"\"\"\"\"\" sa-example-qr / initial / 00003First-line treatment trialledExample first-line medicine, 6 months

\"doco\" Documentation for this format
" }, "extension" : [{ "url" : "https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/request-for-waiver", "valueBoolean" : false }, { "url" : "https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/referring-practitioner", "valueReference" : { "reference" : "Practitioner/sa-example-referrer" } }], "identifier" : { "system" : "https://pms.example.co.nz/sa-reference", "value" : "PMS-REF-000981" }, "questionnaire" : "https://fhir-ig.digital.health.nz/special-authority/Questionnaire/SA9999|a3f2b8c91d4e7062", "status" : "completed", "subject" : { "reference" : "Patient/sa-example-patient" }, "authored" : "2026-10-14T10:32:00+13:00", "author" : { "reference" : "Practitioner/sa-example-applicant" }, "item" : [{ "linkId" : "initial", "item" : [{ "linkId" : "00001", "text" : "Patient has a confirmed diagnosis of the relevant condition", "answer" : [{ "valueBoolean" : true }] }, { "linkId" : "00002", "text" : "Patient has had an inadequate response to at least 3 months of first-line treatment", "answer" : [{ "valueBoolean" : true }] }, { "linkId" : "00003", "text" : "First-line treatment trialled", "answer" : [{ "valueString" : "Example first-line medicine, 6 months" }] }] }] } }, { "fullUrl" : "https://api.example.health.nz/fhir/Patient/sa-example-patient", "resource" : { "resourceType" : "Patient", "id" : "sa-example-patient", "meta" : { "profile" : ["https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-patient"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: Patient sa-example-patient

Profile: SA Patient

Aroha Parata (official) (no stated gender), DoB: 1968-03-14 ( https://standards.digital.health.nz/ns/nhi-id#NHI#ZZZ0016\u00a0(use:\u00a0official))

Contact Detail12 Kowhai Street Waikanae 5036 NZ (home) (NZ Suburb: Waikanae Beach)
" }, "identifier" : [{ "use" : "official", "system" : "https://standards.digital.health.nz/ns/nhi-id", "value" : "ZZZ0016" }], "name" : [{ "use" : "official", "family" : "Parata", "given" : ["Aroha"], "prefix" : ["Ms"] }], "birthDate" : "1968-03-14", "address" : [{ "extension" : [{ "url" : "http://hl7.org.nz/fhir/StructureDefinition/suburb", "valueString" : "Waikanae Beach" }], "use" : "home", "line" : ["12 Kowhai Street"], "city" : "Waikanae", "postalCode" : "5036", "country" : "NZ" }] } }, { "fullUrl" : "https://api.example.health.nz/fhir/Practitioner/sa-example-applicant", "resource" : { "resourceType" : "Practitioner", "id" : "sa-example-applicant", "meta" : { "profile" : ["https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-practitioner"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner sa-example-applicant

Profile: SA Practitioner

Jane Smith (official) (https://standards.digital.health.nz/ns/hpi-person-id#HPIProvider#99ZZZZ\u00a0(use:\u00a0official))

Other Id:NZMC/12345\u00a0(use:\u00a0secondary)
Contact Detail1 Main Highway Otaki 5512 NZ (work)
" }, "identifier" : [{ "use" : "official", "system" : "https://standards.digital.health.nz/ns/hpi-person-id", "value" : "99ZZZZ" }, { "use" : "secondary", "system" : "https://standards.digital.health.nz/ns/medical-council-id", "value" : "12345" }], "name" : [{ "use" : "official", "family" : "Smith", "given" : ["Jane"], "prefix" : ["Dr"] }], "address" : [{ "use" : "work", "line" : ["1 Main Highway"], "city" : "Otaki", "postalCode" : "5512", "country" : "NZ" }] } }, { "fullUrl" : "https://api.example.health.nz/fhir/Practitioner/sa-example-referrer", "resource" : { "resourceType" : "Practitioner", "id" : "sa-example-referrer", "meta" : { "profile" : ["https://fhir-ig.digital.health.nz/special-authority/StructureDefinition/sa-practitioner"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Practitioner sa-example-referrer

Profile: SA Practitioner

Rawiri Ngata (official) (https://standards.digital.health.nz/ns/medical-council-id#NZMC#54321\u00a0(use:\u00a0secondary))

" }, "identifier" : [{ "use" : "secondary", "system" : "https://standards.digital.health.nz/ns/medical-council-id", "value" : "54321" }], "name" : [{ "use" : "official", "family" : "Ngata", "given" : ["Rawiri"], "prefix" : ["Dr"] }] } }] }