/
valuesets-EXM165_FHIR4-8.5.000-bundle.json
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valuesets-EXM165_FHIR4-8.5.000-bundle.json
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{
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"title": "Payer",
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{
"system": "http://www.phdsc.org/standards/pdfs/SourceofPaymentTypologyVersion6FINALSeptember2015.pdf",
"version": "8.0",
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{
"code": "11",
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{
"code": "111",
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{
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{
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{
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{
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{
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},
{
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},
{
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"display": "Medicare Medical Savings Account (MSA)"
},
{
"code": "129",
"display": "Medicare Non-managed Care Other"
},
{
"code": "13",
"display": "Medicare Hospice"
},
{
"code": "14",
"display": "Dual Eligibility Medicare/Medicaid Organization"
},
{
"code": "19",
"display": "Medicare Other"
},
{
"code": "191",
"display": "Medicare Pharmacy Benefit Manager"
},
{
"code": "2",
"display": "MEDICAID"
},
{
"code": "21",
"display": "Medicaid (Managed Care)"
},
{
"code": "211",
"display": "Medicaid HMO"
},
{
"code": "212",
"display": "Medicaid PPO"
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{
"code": "213",
"display": "Medicaid PCCM (Primary Care Case Management)"
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{
"code": "219",
"display": "Medicaid Managed Care Other"
},
{
"code": "22",
"display": "Medicaid (Non-managed Care Plan)"
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{
"code": "23",
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{
"code": "25",
"display": "Medicaid - Out of State"
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{
"code": "26",
"display": "Medicaid -- Long Term Care"
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{
"code": "29",
"display": "Medicaid Other"
},
{
"code": "291",
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},
{
"code": "299",
"display": "Medicaid - Dental"
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{
"code": "3",
"display": "OTHER GOVERNMENT (Federal/State/Local) (excluding Department of Corrections)"
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{
"code": "31",
"display": "Department of Defense"
},
{
"code": "311",
"display": "TRICARE (CHAMPUS)"
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{
"code": "3111",
"display": "TRICARE Prime--HMO"
},
{
"code": "3112",
"display": "TRICARE Extra--PPO"
},
{
"code": "3113",
"display": "TRICARE Standard - Fee For Service"
},
{
"code": "3114",
"display": "TRICARE For Life--Medicare Supplement"
},
{
"code": "3115",
"display": "TRICARE Reserve Select"
},
{
"code": "3116",
"display": "Uniformed Services Family Health Plan (USFHP) -- HMO"
},
{
"code": "3119",
"display": "Department of Defense - (other)"
},
{
"code": "312",
"display": "Military Treatment Facility"
},
{
"code": "3121",
"display": "Enrolled Prime--HMO"
},
{
"code": "3122",
"display": "Non-enrolled Space Available"
},
{
"code": "3123",
"display": "TRICARE For Life (TFL)"
},
{
"code": "313",
"display": "Dental --Stand Alone"
},
{
"code": "32",
"display": "Department of Veterans Affairs"
},
{
"code": "321",
"display": "Veteran care--Care provided to Veterans"
},
{
"code": "3211",
"display": "Direct Care--Care provided in VA facilities"
},
{
"code": "3212",
"display": "Indirect Care--Care provided outside VA facilities"
},
{
"code": "32121",
"display": "Fee Basis"
},
{
"code": "32122",
"display": "Foreign Fee/Foreign Medical Program (FMP)"
},
{
"code": "32123",
"display": "Contract Nursing Home/Community Nursing Home"
},
{
"code": "32124",
"display": "State Veterans Home"
},
{
"code": "32125",
"display": "Sharing Agreements"
},
{
"code": "32126",
"display": "Other Federal Agency"
},
{
"code": "32127",
"display": "Dental Care"
},
{
"code": "32128",
"display": "Vision Care"
},
{
"code": "322",
"display": "Non-veteran care"
},
{
"code": "3221",
"display": "Civilian Health and Medical Program for the VA (CHAMPVA)"
},
{
"code": "3222",
"display": "Spina Bifida Health Care Program (SB)"
},
{
"code": "3223",
"display": "Children of Women Vietnam Veterans (CWVV)"
},
{
"code": "3229",
"display": "Other non-veteran care"
},
{
"code": "33",
"display": "Indian Health Service or Tribe"
},
{
"code": "331",
"display": "Indian Health Service -- Regular"
},
{
"code": "332",
"display": "Indian Health Service -- Contract"
},
{
"code": "333",
"display": "Indian Health Service - Managed Care"
},
{
"code": "334",
"display": "Indian Tribe - Sponsored Coverage"
},
{
"code": "34",
"display": "HRSA Program"
},
{
"code": "341",
"display": "Title V (MCH Block Grant)"
},
{
"code": "342",
"display": "Migrant Health Program"
},
{
"code": "343",
"display": "Ryan White Act"
},
{
"code": "349",
"display": "Other"
},
{
"code": "35",
"display": "Black Lung"
},
{
"code": "36",
"display": "State Government"
},
{
"code": "361",
"display": "State SCHIP program (codes for individual states)"
},
{
"code": "362",
"display": "Specific state programs (list/ local code)"
},
{
"code": "369",
"display": "State, not otherwise specified (other state)"
},
{
"code": "37",
"display": "Local Government"
},
{
"code": "371",
"display": "Local - Managed care"
},
{
"code": "3711",
"display": "HMO"
},
{
"code": "3712",
"display": "PPO"
},
{
"code": "3713",
"display": "POS"
},
{
"code": "372",
"display": "FFS/Indemnity"
},
{
"code": "379",
"display": "Local, not otherwise specified (other local, county)"
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{
"code": "38",
"display": "Other Government (Federal, State, Local not specified)"
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{
"code": "381",
"display": "Federal, State, Local not specified managed care"
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{
"code": "3811",
"display": "Federal, State, Local not specified - HMO"
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{
"code": "3812",
"display": "Federal, State, Local not specified - PPO"
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{
"code": "3813",
"display": "Federal, State, Local not specified - POS"
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{
"code": "3819",
"display": "Federal, State, Local not specified - not specified managed care"
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{
"code": "382",
"display": "Federal, State, Local not specified - FFS"
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{
"code": "389",
"display": "Federal, State, Local not specified - Other"
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{
"code": "39",
"display": "Other Federal"
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{
"code": "391",
"display": "Federal Employee Health Plan - Use when known"
},
{
"code": "4",
"display": "DEPARTMENTS OF CORRECTIONS"
},
{
"code": "41",
"display": "Corrections Federal"
},
{
"code": "42",
"display": "Corrections State"
},
{
"code": "43",
"display": "Corrections Local"
},
{
"code": "44",
"display": "Corrections Unknown Level"
},
{
"code": "5",
"display": "PRIVATE HEALTH INSURANCE"
},
{
"code": "51",
"display": "Managed Care (Private)"
},
{
"code": "511",
"display": "Commercial Managed Care - HMO"
},
{
"code": "512",
"display": "Commercial Managed Care - PPO"
},
{
"code": "513",
"display": "Commercial Managed Care - POS"
},
{
"code": "514",
"display": "Exclusive Provider Organization"
},
{
"code": "515",
"display": "Gatekeeper PPO (GPPO)"
},
{
"code": "516",
"display": "Commercial Managed Care - Pharmacy Benefit Manager"
},
{
"code": "517",
"display": "Commercial Managed Care - Dental"
},
{
"code": "519",
"display": "Managed Care, Other (non HMO)"
},
{
"code": "52",
"display": "Private Health Insurance - Indemnity"
},
{
"code": "521",
"display": "Commercial Indemnity"
},
{
"code": "522",
"display": "Self-insured (ERISA) Administrative Services Only (ASO) plan"
},
{
"code": "523",
"display": "Medicare supplemental policy (as second payer)"
},
{
"code": "524",
"display": "Indemnity Insurance - Dental"
},
{
"code": "529",
"display": "Private health insurance--other commercial Indemnity"
},
{
"code": "53",
"display": "Managed Care (private) or private health insurance (indemnity), not otherwise specified"
},
{
"code": "54",
"display": "Organized Delivery System"
},
{
"code": "55",
"display": "Small Employer Purchasing Group"
},
{
"code": "56",
"display": "Specialized Stand Alone Plan"
},
{
"code": "561",
"display": "Dental"
},
{
"code": "562",
"display": "Vision"
},
{
"code": "59",
"display": "Other Private Insurance"
},
{
"code": "6",
"display": "BLUE CROSS/BLUE SHIELD"
},
{
"code": "61",
"display": "BC Managed Care"
},
{
"code": "611",
"display": "BC Managed Care -- HMO"
},
{
"code": "612",
"display": "BC Managed Care -- PPO"
},
{
"code": "613",
"display": "BC Managed Care -- POS"
},
{
"code": "614",
"display": "BC Managed Care - Dental"
},
{
"code": "619",
"display": "BC Managed Care -- Other"
},
{
"code": "62",
"display": "BC Insurance Indemnity"
},
{
"code": "621",
"display": "BC Indemnity"
},
{
"code": "622",
"display": "BC Self-insured (ERISA) Administrative Services Only (ASO)Plan"
},
{
"code": "623",
"display": "BC Medicare Supplemental Plan"
},
{
"code": "629",
"display": "BC Indemnity - Dental"
},
{
"code": "7",
"display": "MANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private)"
},
{
"code": "71",
"display": "HMO"
},
{
"code": "72",
"display": "PPO"
},
{
"code": "73",
"display": "POS"
},
{
"code": "79",
"display": "Other Managed Care"
},
{
"code": "8",
"display": "NO PAYMENT from an Organization/Agency/Program/Private Payer Listed"
},
{
"code": "81",
"display": "Self-pay (Includes applicants for insurance and Medicaid applicants)"
},
{
"code": "82",
"display": "No Charge"
},
{
"code": "821",
"display": "Charity"
},
{
"code": "822",
"display": "Professional Courtesy"
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{
"code": "823",
"display": "Research/Clinical Trial"
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{
"code": "83",
"display": "Refusal to Pay/Bad Debt"
},
{
"code": "84",
"display": "Hill Burton Free Care"
},
{
"code": "85",
"display": "Research/Donor"
},
{
"code": "89",
"display": "No Payment, Other"
},
{
"code": "9",
"display": "MISCELLANEOUS/OTHER"
},
{
"code": "91",
"display": "Foreign National"
},
{
"code": "92",
"display": "Other (Non-government)"
},
{
"code": "93",
"display": "Disability Insurance"
},
{
"code": "94",
"display": "Long-term Care Insurance"
},
{
"code": "95",
"display": "Worker's Compensation"
},
{
"code": "951",
"display": "Worker's Comp HMO"
},
{
"code": "953",
"display": "Worker's Comp Fee-for-Service"
},
{
"code": "954",
"display": "Worker's Comp Other Managed Care"
},
{
"code": "959",
"display": "Worker's Comp, Other unspecified"
},
{
"code": "96",
"display": "Auto Insurance (includes no fault)"
},
{
"code": "97",
"display": "Legal Liability / Liability Insurance"
},
{
"code": "98",
"display": "Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)"
},
{
"code": "99",
"display": "No Typology Code available for payment source"
},
{
"code": "9999",
"display": "Unavailable / No Payer Specified / Blank"
}
]
}
]
}
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"version": "2019-03",
"concept": [
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"display": "History and physical examination with management of domiciliary or rest home patient (procedure)"
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"display": "Domiciliary or rest home patient evaluation and management (procedure)"
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"code": "99324",
"display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver."
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"code": "99325",
"display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver."
},
{
"code": "99326",
"display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver."
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"code": "99327",
"display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver."
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"code": "99328",
"display": "Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver."
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"code": "99335",
"display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver."
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"code": "99336",
"display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver."
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"code": "99337",
"display": "Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver."
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"display": "Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family."
},
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"code": "99342",
"display": "Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family."
},
{
"code": "99343",
"display": "Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family."
},
{
"code": "99344",
"display": "Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family."
},
{
"code": "99345",
"display": "Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family."
},
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"code": "99347",
"display": "Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family."
},
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"code": "99348",
"display": "Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family."
},
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"code": "99349",
"display": "Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family."
},
{
"code": "99350",
"display": "Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family."
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},
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"system": "http://snomed.info/sct",
"version": "2018-03",
"concept": [
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"code": "185460008",
"display": "Home visit request by patient (procedure)"
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{
"code": "185462000",
"display": "Home visit request by relative (procedure)"
},
{
"code": "185466002",
"display": "Home visit for urgent condition (procedure)"
},
{
"code": "185467006",
"display": "Home visit for acute condition (procedure)"
},
{
"code": "185468001",
"display": "Home visit for chronic condition (procedure)"
},
{
"code": "185470005",
"display": "Home visit elderly assessment (procedure)"
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{
"code": "225929007",
"display": "Joint home visit (procedure)"
},
{
"code": "315205008",
"display": "Bank holiday home visit (procedure)"
},
{
"code": "439708006",
"display": "Home visit (procedure)"
},
{
"code": "698704008",
"display": "Home visit for rheumatology service (procedure)"
},
{
"code": "704126008",
"display": "Home visit for anticoagulant drug monitoring (procedure)"
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