# Maintain your Redox repository for Carequality > **Who can use this how-to** > > - Existing customers using Network Onramps All Carequality participants—including those who join via Redox—must respond to requests they receive from other Carequality participants. In some cases, you may receive up to 200K requests per day. With Redox as your Carequality responder, we can respond to incoming patient requests on your behalf. But you must push patient records and documents to your Redox repository so that we can maintain an accurate representation of each of your patients. > **For direct responders** > > If you are your own responder, you must build an infrastructure capable of supporting a large volume of incoming requests. And you must still maintain your own patient and document database so that you can respond to incoming requests with the most accurate data. > **Use curl for technical validation** > > You can copy our code examples and send the test requests with `curl` ([learn more about curl](https://curl.haxx.se/docs/manpage.html)) instead of Postman. If you do, remember to: > > - Replace any variables with your specific data (e.g., your organization's OID) before sending the request. > - `$VARIABLE`: An environment variable you can set in your terminal before running the command. > - `{{variable here}}`: A placeholder for your specific data. > - Add the `source-id` if you have multiple sources. We don’t include `{{source-id}}` in the code examples, so you’ll have to add them yourself. [Learn about including source details](/basics/data-exchange-with-redox/Managing-source-details-in-outgoing-requests). > - Make sure you have a full request for your own use since some of the code examples are abbreviated. > > Check out these troubleshooting guides if you run into errors: > > - [Troubleshoot Carequality errors](/troubleshooting/troubleshoot-carequality-interoperability-framework-errors) > - [Troubleshoot OAuth API key errors](/troubleshooting/troubleshoot-oauth-api-key-errors) ## Maintain your patient database As you create and update patient records in your system, you must make sure that they stay current in your data on demand repository. > **API reference** > > [Review the PatientAdmin data model](https://docs.redoxengine.com/permalink/patient-admin-patient-update) schema for full requirements. ### Create a new patient record Send a `PatientAdmin.NewPatient` request with the new patient’s details: - For production queries, set the `Test` value to `false`. - The destination ID should be the one provided by Redox for your data on demand repository. - For `PatientIdentifiers.ID`, use the MRN or primary ID of the patient in your system. - For `PatientIdentifiers.IDType`, use the value Redox provides. Typically, this means mapping a value like MR to this OID. This OID is linked to the data on demand repository and is required to associate the patient. - For supported patient demographics, [review the PatientAdmin schema](https://docs.redoxengine.com/permalink/patient-admin-new-patient). The values below are examples only and should change for your individual queries. **Example: Create a new patient in Carequality** ```bash curl \ -X POST https://api.redoxengine.com/endpoint \ -H "Content-Type: application/json" \ -H "Authorization: Bearer $API_TOKEN" \ -d '{ "Meta": { "Extensions": { "sender-organization-id": { "url": "https://api.redoxengine.com/extensions/sender-organization-id", "string": "{{ORGANIZATION-OID}}" }, "user-id": { "url": "https://api.redoxengine.com/extensions/user-id", "string": "{{SENDING-USER-NAME}}" }, "user-role": { "url": "https://api.redoxengine.com/extensions/user-role", // The role of the user identified above. This must be a SNOMED CT code. "coding": { "code": "112247003", "display": "Medical Doctor" } }, "purpose-of-use": { "url": "https://api.redoxengine.com/extensions/purpose-of-use", "coding": { "code": "TREATMENT", "display": "Treatment" } } }, "DataModel": "PatientAdmin", "EventType": "NewPatient", "Test": true, "Destinations": [ { "ID": "{{DATA-ON-DEMAND-REPOSITORY-ID}}" } ] }, "Patient": { "Identifiers": [ { "ID": "1234", "IDType": "MR" } ], "Demographics": { "FirstName": "Timothy", "MiddleName": "Paul", "LastName": "Bixby", "DOB": "2008-01-06", "SSN": "101-01-0001", "Sex": "Male", "Race": "White", "IsHispanic": null, "MaritalStatus": "Married", "IsDeceased": null, "DeathDateTime": null, "PhoneNumber": { "Home": "+18088675301", "Office": null, "Mobile": null }, "EmailAddresses": [], "Language": "en", "Citizenship": [], "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "US" } }, "Notes": [], "Contacts": [ { "FirstName": "Barbara", "MiddleName": null, "LastName": "Bixby", "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "US" }, "PhoneNumber": { "Home": "+18088675303", "Office": "+17077543758", "Mobile": "+19189368865" }, "RelationToPatient": "Mother", "EmailAddresses": [ "barb.bixby@test.net" ], "Roles": [ "Emergency Contact" ] } ], "Allergies": [ { "Code": "7982", "Codeset": "RxNorm", "Name": "Penicillin", "Type": { "Code": null, "Codeset": null, "Name": null }, "OnsetDateTime": null, "Reaction": [ { "Code": "28926001", "Codeset": "SNOMED CT", "Name": "Rash" }, { "Code": "247472004", "Codeset": "SNOMED CT", "Name": "Hives" } ], "Severity": { "Code": null, "Codeset": null, "Name": null }, "Status": null } ], "PCP": { "NPI": "4356789876", "ID": "4356789876", "IDType": "NPI", "FirstName": "Pat", "LastName": "Granite", "Credentials": [ "MD" ], "Address": { "StreetAddress": "123 Main St.", "City": "Madison", "State": "WI", "ZIP": "53703", "County": "Dane", "Country": "USA" }, "EmailAddresses": [], "PhoneNumber": { "Office": "+16085551234" }, "Location": { "Type": null, "Facility": null, "Department": null, "Room": null } }, "Guarantor": { "Number": "10001910", "FirstName": "Kent", "MiddleName": null, "LastName": "Bixby", "SSN": null, "DOB": null, "Sex": null, "Spouse": { "FirstName": "Barbara", "LastName": "Bixby" }, "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "USA" }, "PhoneNumber": { "Home": null, "Business": null, "Mobile": null }, "EmailAddresses": [], "Type": null, "RelationToPatient": "Father", "Employer": { "Name": "Accelerator Labs", "Address": { "StreetAddress": "1456 Old Sauk Road", "City": "Madison", "State": "WI", "ZIP": "53719", "County": "Dane", "Country": "USA" }, "PhoneNumber": "+18083451121" } }, "Insurances": [ { "Plan": { "ID": "31572", "IDType": "Payor ID", "Name": "HMO Deductable Plan", "Type": null }, "MemberNumber": null, "Company": { "ID": "60054", "IDType": null, "Name": "aetna (60054 0131)", "Address": { "StreetAddress": "PO Box 14080", "City": "Lexington", "State": "KY", "ZIP": "40512-4079", "County": "Fayette", "Country": "US" }, "PhoneNumber": "+18089541123" }, "GroupNumber": "847025-024-0009", "GroupName": "Accelerator Labs", "EffectiveDate": "2015-01-01", "ExpirationDate": "2020-12-31", "PolicyNumber": "9140860055", "AgreementType": null, "CoverageType": null, "Insured": { "Identifiers": [], "LastName": null, "MiddleName": null, "FirstName": null, "SSN": null, "Relationship": null, "DOB": null, "Sex": null, "Address": { "StreetAddress": null, "City": null, "State": null, "ZIP": null, "County": null, "Country": null } } } ] } } ``` ### Update an existing patient record Send a `PatientAdmin.PatientUpdate` request with the updated details: - For production queries, set the `Test` value to `false`. - The destination ID should be the one provided by Redox for your data on demand repository. - For `PatientIdentifiers.ID`, use the MRN or primary ID of the patient in your system. - For `PatientIdentifiers.IDType`, use the value Redox provides. Typically, this means mapping a value like MR to this OID. This OID is linked to the data on demand repository and is required to associate the patient. - For supported patient demographics, [review the PatientAdmin schema](https://docs.redoxengine.com/permalink/patient-admin-patient-update). The values below are examples only and should change for your individual queries. **Example: Update an existing patient in Carequality** ```bash curl \ -X POST https://api.redoxengine.com/endpoint \ -H "Content-Type: application/json" \ -H "Authorization: Bearer $API_TOKEN" \ -d '{ "Meta": { "Extensions": { "sender-organization-id": { "url": "https://api.redoxengine.com/extensions/sender-organization-id", "string": "{{ORGANIZATION-OID}}" }, "user-id": { "url": "https://api.redoxengine.com/extensions/user-id", "string": "{{SENDING-USER-NAME}}" }, "user-role": { "url": "https://api.redoxengine.com/extensions/user-role", "coding": { "code": "112247003", "display": "Medical Doctor" } }, "purpose-of-use": { "url": "https://api.redoxengine.com/extensions/purpose-of-use", "coding": { "code": "TREATMENT", "display": "Treatment" } } }, "DataModel": "PatientAdmin", "EventType": "PatientUpdate", "Test": true, "Destinations": [ { "ID": "{{DATA-ON-DEMAND-REPOSITORY-ID}}" } ] }, "Patient": { "Identifiers": [ { "ID": "1234", "IDType": "MR" } ], "Demographics": { "FirstName": "Timothy", "MiddleName": "Paul", "LastName": "Bixby", "DOB": "2008-01-06", "SSN": "101-01-0001", "Sex": "Male", "Race": "White", "IsHispanic": null, "MaritalStatus": "Married", "IsDeceased": null, "DeathDateTime": null, "PhoneNumber": { "Home": "+18088675301", "Office": null, "Mobile": null }, "EmailAddresses": [], "Language": "en", "Citizenship": [], "Address": { "StreetAddress": "4435 Victoria Ln", "City": "Madison", "State": "WI", "ZIP": "53719", "County": "Dane", "Country": "US" } }, "Notes": [], "Contacts": [ { "FirstName": "Barbara", "MiddleName": null, "LastName": "Bixby", "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "US" }, "PhoneNumber": { "Home": "+18088675303", "Office": "+17077543758", "Mobile": "+19189368865" }, "RelationToPatient": "Mother", "EmailAddresses": [ "barb.bixby@test.net" ], "Roles": [ "Emergency Contact" ] } ], "Diagnoses": [ { "Code": "R07.0", "Codeset": "ICD-10", "Name": "Pain in throat", "Type": null, "DocumentedDateTime": null } ], "Allergies": [ { "Code": "7982", "Codeset": "RxNorm", "Name": "Penicillin", "Type": { "Code": null, "Codeset": null, "Name": null }, "OnsetDateTime": null, "Reaction": [ { "Code": "28926001", "Codeset": "SNOMED CT", "Name": "Rash" }, { "Code": "247472004", "Codeset": "SNOMED CT", "Name": "Hives" } ], "Severity": { "Code": null, "Codeset": null, "Name": null }, "Status": null } ], "PCP": { "NPI": "4356789876", "ID": "4356789876", "IDType": "NPI", "FirstName": "Pat", "LastName": "Granite", "Credentials": [ "MD" ], "Address": { "StreetAddress": "123 Main St.", "City": "Madison", "State": "WI", "ZIP": "53703", "County": "Dane", "Country": "USA" }, "EmailAddresses": [], "PhoneNumber": { "Office": "+16085551234" }, "Location": { "Type": null, "Facility": null, "Department": null, "Room": null } }, "Insurances": [ { "Plan": { "ID": "31572", "IDType": "Payor ID", "Name": "HMO Deductable Plan", "Type": null }, "MemberNumber": null, "Company": { "ID": "60054", "IDType": null, "Name": "aetna (60054 0131)", "Address": { "StreetAddress": "PO Box 14080", "City": "Lexington", "State": "KY", "ZIP": "40512-4079", "County": "Fayette", "Country": "US" }, "PhoneNumber": "+18089541123" }, "GroupNumber": "847025-024-0009", "GroupName": "Accelerator Labs", "EffectiveDate": "2015-01-01", "ExpirationDate": "2020-12-31", "PolicyNumber": "9140860055", "AgreementType": null, "CoverageType": null, "Insured": { "Identifiers": [], "LastName": null, "MiddleName": null, "FirstName": null, "SSN": null, "Relationship": null, "DOB": null, "Sex": null, "Address": { "StreetAddress": null, "City": null, "State": null, "ZIP": null, "County": null, "Country": null } } } ], "Guarantor": { "Number": "10001910", "FirstName": "Kent", "MiddleName": null, "LastName": "Bixby", "SSN": null, "DOB": null, "Sex": null, "Spouse": { "FirstName": "Barbara", "LastName": "Bixby" }, "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "USA" }, "PhoneNumber": { "Home": null, "Business": null, "Mobile": null }, "EmailAddresses": [], "Type": null, "RelationToPatient": "Father", "Employer": { "Name": "Accelerator Labs", "Address": { "StreetAddress": "1456 Old Sauk Road", "City": "Madison", "State": "WI", "ZIP": "53719", "County": "Dane", "Country": "USA" }, "PhoneNumber": "+18083451121" } } } } ``` ### Merge duplicate patient records Send a `PatientAdmin.PatientMerge` request to merge the patient records in your data on demand repository and replace the previous identifiers with the new one. - For production queries, set the `Test` value to `false`. - The destination ID should be the one provided by Redox for your data on demand repository. - For `PatientIdentifiers.ID`, include a new MRN or primary ID of the patient in your system. Also use the corresponding `PatientIdentifiers.IDType`. - For `PreviousIdentifiers`, include the the former patient ID and ID type values for the duplicate records. - For supported patient demographics, [review the PatientAdmin schema](https://docs.redoxengine.com/permalink/patient-admin-patient-merge). The values below are examples only and should change for your individual queries. **Example: Merge patient records in Carequality** ```bash curl \ -X POST https://api.redoxengine.com/endpoint \ -H "Content-Type: application/json" \ -H "Authorization: Bearer $API_TOKEN" \ -d '{ "Meta": { "Extensions": { "sender-organization-id": { "url": "https://api.redoxengine.com/extensions/sender-organization-id", "string": "{{ORGANIZATION-OID}}" }, "user-id": { "url": "https://api.redoxengine.com/extensions/user-id", "string": "{{SENDING-USER-NAME}}" }, "user-role": { "url": "https://api.redoxengine.com/extensions/user-role", "coding": { "code": "112247003", "display": "Medical Doctor" } }, "purpose-of-use": { "url": "https://api.redoxengine.com/extensions/purpose-of-use", "coding": { "code": "TREATMENT", "display": "Treatment" } } }, "DataModel": "PatientAdmin", "EventType": "PatientMerge", "Test": true, "Destinations": [ { "ID": "{{DATA-ON-DEMAND-REPOSITORY-ID}}" } ] }, "Patient": { "Identifiers": [ { "ID": "1235", "IDType": "MR" } ], "PreviousIdentifiers": [ { "ID": "1234", "IDType": "MR" } ], "Demographics": { "FirstName": "Timothy", "MiddleName": "Paul", "LastName": "Bixby", "DOB": "2008-01-06", "SSN": "101-01-0001", "Sex": "Male", "Race": "White", "IsHispanic": null, "MaritalStatus": "Married", "IsDeceased": null, "DeathDateTime": null, "PhoneNumber": { "Home": "+18088675301", "Office": null, "Mobile": null }, "EmailAddresses": [], "Language": "en", "Citizenship": [], "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "US" } }, "Notes": [] } } ``` ## Save patient documents > **Rules for returned data** > > As a clinical network participant, you must include certain data when you're returning data to the network. [Check out the rules for returned data](https://docs.redoxengine.com/permalink/1ldmpAmaxAriJ7Ei0zYn3Q/#what-data-is-exchanged). After providing care for a patient, save the patient summary documents to your data on demand repository so that we can respond to requests for documents. We recommend using the `ClinicalSummary.VisitPush` request with all the available unique clinical information that you produce. Be mindful of these requirements and best practices: | **Field** | **Notes** | | --- | --- | | `Header.Patient.Identifiers[].IDType` | At least one patient identifier should include an ID Type that matches the patient identification OID used in the `PatientAdmin` messages. | | `Header.Document.ID` | This ID must be globally unique across Carequality as either a GUID or an internally unique ID prefixed with your organizational OID. Our examples use the OID prefix. | | `Header.Document.Type` `Header.Document.TypeCode` | These values should be a LOINC code. Typically, you should use the code for a Continuity of Care Document (i.e., `34133-9`). When sending a document related to a single patient visit, you should use these codes: Use Progress Notes (i.e., `11506-3`) for outpatient/ambulatory visits. Use discharge summary (i.e., `18842-5`) for inpatient/hospital visits. | | `Header.Document.Custodian.Name` | We recommend populating this value since it tells other Carequality participants where the data came from. If this field isn’t populated, the value defaults to the `Meta.Source.Name`, which is set based on the source you’re sending the request from. We encourage you to populate as much of the `Header.Document.Custodian.Name` object as possible. Most entries use the same data as their directory, but you may want more or less granularity. | | `Documents[].Author.Location` | Some external systems use this to display the location the document originated from when viewing a list documents. When looking at an individual document, `Custodian.Name` is typically used instead. Typically, the `Author` and `Custodian` values are the same, but they may differ. If not supplied, Redox sets this to the directory entry name you’ve saved to Carequality. See the difference between [Author](https://build.fhir.org/ig/HL7/CDA-core-2.0/StructureDefinition-Author.html) and [Custodian](https://build.fhir.org/ig/HL7/CDA-core-2.0/StructureDefinition-Custodian.html). | > **API reference** > > [Review the Clinical Summary data model](https://docs.redoxengine.com/permalink/clinical-summary) schema for more technical details. Since `ClinicalSummary.VisitPush` is lengthy, we include an abbreviated example below. [Check out an unabbreviated example](https://docs.redoxengine.com/permalink/clinical-summary-visit-push) or view the Postman package. **Example: Save a patient document (abbreviated)** ```bash curl \ -X POST https://api.redoxengine.com/endpoint \ -H "Content-Type: application/json" \ -H "Authorization: Bearer $API_TOKEN" \ -d '{ "Meta": { "DataModel": "Clinical Summary", "EventType": "VisitPush", "Test": true, "Destinations": [ { "ID": "{{DATA-ON-DEMAND-REPOSITORY-ID}}" } ] }, "Header": { "DirectAddressFrom": null, "DirectAddressTo": null, "Document": { "Author": { "ID": "4356789876", "IDType": "NPI", "Type": null, "FirstName": "Pat", "LastName": "Granite", "Credentials": [ "MD" ], "Address": { "StreetAddress": "123 Main St.", "City": "Madison", "State": "WI", "ZIP": "53703", "County": "Dane", "Country": "USA" }, "EmailAddresses": [], "PhoneNumber": { "Office": "+16085551234" }, "Location": { ... } }, "ID": "{{REDOX-PARENT-OID}}^67890", "Locale": "US", "Title": "Community Health and Hospitals: Annual Physical", "DateTime": "2012-09-12T00:00:00.000Z", "Type": "Progress Note", "TypeCode": { "Code": "11506-3", "CodeSystem": "2.16.840.1.113883.6.1", "CodeSystemName": "LOINC", "Name": "Progress Note" }, "Visit": { "Location": { "Type": "Outpatient Clinic", "Facility": "RHS Vista Oaks Clinic", "Department": "Vista Oaks Clinic", "Room": null }, "StartDateTime": "2020-11-12T00:18:30.592Z", "EndDateTime": "2020-11-12T00:18:30.592Z", "Reason": "Annual Physical", "VisitNumber": "30311442" } }, "Patient": { "Identifiers": [ { "ID": "1234", "IDType": "MR" } ], "FirstName": "Timothy", "MiddleName": "Paul", "LastName": "Bixby", "DOB": "2008-01-06", "SSN": "101-01-0001", "Sex": "Male", "Race": "White", "IsHispanic": null, "MaritalStatus": "Married", "IsDeceased": null, "DeathDateTime": null, "PhoneNumber": { "Home": "+18088675301", }, "EmailAddresses": [], "Language": "en", "Citizenship": [], "Address": { "StreetAddress": "4762 Hickory Street", "City": "Monroe", "State": "WI", "ZIP": "53566", "County": "Green", "Country": "US" } }, "PCP": { ... } }, "AdvanceDirectivesText": " Directive Description Verification Supporting Document(s) Resuscitation status Do not resuscitate Dr. Robert Dolin, Nov 07, 1999 Advance directive ", "AdvanceDirectives": [ { "Type": { "Code": "304251008", "CodeSystem": "2.16.840.1.113883.6.96", "CodeSystemName": "SNOMED CT", "Name": "Resuscitation", "AltCodes": [] }, "Code": "304253006", "CodeSystem": "2.16.840.1.113883.6.96", "CodeSystemName": "SNOMED CT", "Name": "Do not resuscitate", "AltCodes": [], "StartDate": "2011-02-13T05:00:00.000Z", "EndDate": null, "ExternalReference": "AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf", "VerifiedBy": [ { "FirstName": "Robert", "LastName": "Dolin", "Credentials": "Dr.", "DateTime": null } ], "Custodians": [ { "FirstName": "Robert", "LastName": "Dolin", "Credentials": "Dr.", "Address": { ... } } ] } ], "AllergyText": " Substance Reaction Severity Status Penicillin G benzathine Hives Moderate to severe Inactive Codeine Shortness of Breath Moderate Active Aspirin Hives Mild to moderate Active ", "Allergies": [ ... ] ... } ], "AssessmentText": "Recurrent GI bleed of unknown etiology; hypotension perhaps secondary to this but as likely secondary to polypharmacy.Acute on chronic anemia secondary to #1.Azotemia, acute renal failure with volume loss secondary to #1.Hyperkalemia secondary to #3 and on ACE and K+ supplement.Other chronic diagnoses as noted above, currently stable.Also, this person has back problems.", "Assessment": { "Diagnoses": [ { "Value": "Displacement of lumbar intervertebral disc without myelopathy", "DateTime": "2009-11-01T05:00:00.000Z", "IsNegativeIndicator": false, "Codes": [ { "Code": "202708005", "CodeSystem": "2.16.840.1.113883.6.96", "CodeSystemName": "SNOMED-CT", "Name": "Herniated lumbar intervertebral disc" }, { ... } ] }, { "Value": "Thoracic or lumbosacral neuritis or radiculitis, unspecified", "DateTime": "2009-11-01T05:00:00.000Z", "IsNegativeIndicator": false, "Codes": [ { "Code": "M54.16", "CodeSystem": "2.16.840.1.113883.6.90", "CodeSystemName": "ICD-10", "Name": "Right lumbar radiculopathy" } ] } ] }, "ChiefComplaintText": "Dark stools.", "EncountersText": " Encounter Performer Location Date Pnuemonia Dr Henry Seven Community Health and Hospitals 20120806 ", "Encounters": [ { "Identifiers": [ { "ID": "2376492", "IDType": "URMC Epic CSN" }, ... ], "Type": { "Code": "99222", "CodeSystem": "2.16.840.1.113883.6.12", "CodeSystemName": "CPT", "Name": "InPatient Admission", "AltCodes": [] }, "DateTime": "2012-08-06T04:00:00.000Z", "EndDateTime": null, "Providers": [ ... ], "Diagnosis": [ { "Code": "233604007", "CodeSystem": "2.16.840.1.113883.6.96", "CodeSystemName": "SNOMED CT", "Name": "Pneumonia", "AltCodes": [] } ], "ReasonForVisit": [ { "Code": "233604007", "CodeSystem": "2.16.840.1.113883.6.96", "CodeSystemName": "SNOMED CT", "Name": "Pneumonia", "AltCodes": [] } ] } ], "FamilyHistoryText": "Father (deceased) Diagnosis Age At Onset Myocardial Infarction (cause of death) 57 Diabetes 40 ", "FamilyHistory": [ ... ], "HistoryOfPresentIllnessText": "Kelp, Lonnie Ray Sr., MD PHD - 10/21/2014 8:07 PM PSTDate: 10/21/2014 Pre-procedure diagnosis: L5 S1 Acute Lumbar Radiculopathy (Right) Post-procedure diagnosis: Same Procedure: 1) L5S1 Transforaminal Epidural Steroid injection(Right) 2) Fluoroscopic Guidance for needle placement Complications: None CONSENT: Today's procedure, its potential benefits as well as its risks and potential side effects were reviewed. Discussed risks of the procedure include bleeding, infection, nerve irritation or damage, reactions to the medications, headache, failure of the pain to improve, and exacerbation of the pain were explained to the patient, who verbalized understanding and who wished to proceed. Informed consent was signed. DESCRIPTION OF PROCEDURES: After written informed consent was obtained, the patient was taken to the fluoroscopy suite. Anatomical landmarks were identified by way of fluoroscopy in multiple views. Strict aseptic technique was utilized. A 22-gauge 3-1/2-inch needle was then incrementally advanced using multiple fluoroscopic views from an oblique approach into the Right L5S1 lumbar intervertebral space. Both AP and lateral views were used to confirm final needle placement. After negative aspiration, Omniopaque 240 contrast was injected which delineated epidural without vascular flow and a normal epidurogram under fluoroscopy in the lateral and AP view. After negative aspiration was reconfirmed, a 1.0 mL of 0.25% Bupivicaine and 1mL of 40 mg/mL of Kenalog was slowly injected into the epidural space. All needles were removed intact. Hemostasis was maintained. There were no complications. The area was cleaned and a Band-Aid placed as necessary. The patient tolerated the procedure well and all needles were removed intact. After a period of observation, the patient was noted to be hemodynamically stable and neurovascularly intact following the procedure as prior to the procedure, and was ultimately discharged to home with supervision in good condition. The patient was instructed to schedule an appointment in the office within 2 weeks. Lonnie Ray Kelp Sr., MD PHD ", "ImmunizationText": " Vaccine Date Status Influenza virus vaccine, IM May 2012 Completed Tetanus and diphtheria toxoids, IM Apr 2012 Completed ", "Immunizations": [ ... ], "InstructionsText": "Please carefully follow the subsequent instructions and patient education: FlossBrush teeth twice daily Scarf tying instructions may be found online.", "InsurancesText": null, "Insurances": [ { "Plan": { ... } } ], "InterventionsText": "Patient practiced use of novel prosthesis including movements formerly neglected including distal extension and retroflexive hyperextension.", "MedicalEquipmentText": " Supply/Device Date Supplied Automatic implantable cardioverter/defibrillator Nov 1999 Total hip replacement prosthesis 1998 Wheelchair 1999 ", "MedicalEquipment": [ ... ], "MedicationsText": " Medication Directions Start Date Status Indications Fill Instructions Albuterol 0.09 MG/ACTUAT inhalant solution 0.09 MG/ACTUAT inhalant solution, 2 puffs once 20120806 Active Pneumonia (233604007 SNOMED CT) Generic Substitition Allowed ", "Medications": [ ... ], "MedicationsAdministeredText": " Medication Start Date Status Albuterol 0.09 MG/ACTUAT inhalant solution 0.09 MG/ACTUAT inhalant solution, 2 puffs once 20120806 Active ", "MedicationsAdministered": [ ... ], "ObjectiveText": "Chest: clear to ausc. No rales, normal breath soundsHeart: RR, PMI in normal location and no heave or evidence ofcardiomegaly,normal heart sounds, no murm or gallop", "PhysicalExamText": "All examinations performed within normal limits. WNL Nothing to report here.", "PlanOfCareText": " Planned Activity Planned Date Consultation with Dr George Potomac for Asthma 20120820 Chest X-ray 20120826 Sputum Culture 20120820 ", "PlanOfCare": { ... }, "ProblemsText": "Pneumonia : Status - ResolvedAsthma : Status - Active", "Problems": [ ... ], "ProceduresText": " Procedure Date Chest X-Ray 8/7/2012 ", "Procedures": { ... }, "ReasonForReferralText": " Incoming Referral Reason Specialty Diagnoses / Procedures Referred By Contact Referred To Contact Consult, Test & Treat (Routine) BA-Physical Medicine / Physical Medicine and Rehab DiagnosesRadiculopathy, lumbar regionL5S1 TTRANSFORMINAL ESIL5S1 TTRANSFORMINAL ESIProceduresPR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVELINJECTION Kelp, Lonnie Ray Sr., MD PHD Kelp, Lonnie Ray Sr., MD PHD ", "ReasonForVisitText": "Light stools.", "ResultText": " LABORATORY INFORMATION Chemistries and drug levels HGB (M 13-18 g/dl; F 12-16 g/dl) 13.2 WBC (4.3-10.8 10+3/ul) 6.7 PLT (135-145 meq/l) 123 (L) ", "Results": [ ... ], "ReviewOfSystemsText": "Patient denies recent history of fever or malaise. Positive for weakness and shortness of breath. One episode of melena. No recent headaches. Positive for osteoarthritis in hips, knees and hands.", "SocialHistoryText": " Social History Element Description Effective Dates smoking Former Smoker (1 pack per day 20050501 to 20110227 smoking Current Everyday Smoker 2 packs per day 20110227 - today ", "SocialHistory": { ... }, "SubjectiveText": " Complaints of rectal bleeding, fatigue and a change in bowel patterns. Has several days of constipation alternating with diarrhea. ", "VitalSignsText": " Date / Time: Nov 1, 2011 August 6, 2012 Height 69 inches 69 inches Weight 189 lbs 194 lbs Blood Pressure 132/86 mmHg 145/88 mmHg ", "VitalSigns": [ ... ] } ``` ## Manage patient consent By default, we treat each patient as “consented” if their data is saved into a Redox repository. If a patient declines consent, however, you can send a `PatientAdmin.PatientUpdate` with the Consent extension ([learn about extensions](/api-reference/redox-data-model-api/extensions-for-data-models) or [review available Redox extensions](https://docs.redoxengine.com/datamodels/extensions/)). You can toggle the patient’s consent status to declined by sending an empty `codeableConcept` with the Consent extension. **Example: Declined patient consent in Consent extension ** ```json curl \ -X POST https://api.redoxengine.com/endpoint \ -H "Content-Type: application/json" \ -H "Authorization: Bearer $API_TOKEN" \ -d '{ "Meta": { "Extensions": { "sender-organization-id": { "url": "https://api.redoxengine.com/extensions/sender-organization-id", "string": "{{ORGANIZATION-OID}}" }, "user-id": { "url": "https://api.redoxengine.com/extensions/user-id", "string": "{{SENDING-USER-NAME}}" }, "user-role": { "url": "https://api.redoxengine.com/extensions/user-role", "coding": { "code": "112247003", "display": "Medical Doctor" } }, "purpose-of-use": { "url": "https://api.redoxengine.com/extensions/purpose-of-use", "coding": { "code": "TREATMENT", "display": "Treatment" } } }, "DataModel": "PatientAdmin", "EventType": "PatientUpdate", "Test": true, "Destinations": [ { "ID": "{{DATA-ON-DEMAND-REPOSITORY-ID}}" } ] }, "Patient": { "Identifiers": [ { "ID": "1234", "IDType": "MR" } ], "Demographics": { { ... } }, "Notes": [], "Contacts": [ { ... } ], "Diagnoses": [ { ... } ], "Allergies": [ { ... } ], "PCP": { { ... } }, "Insurances": [ { ... } ], "Guarantor": { ... }, "Extensions": { "consent-type": { "url": "https://api.redoxengine.com/extensions/consent-type", "codeableConcept": [] }, } } } ``` > **API reference** > > [Review the PatientAdmin data model](https://docs.redoxengine.com/permalink/patient-admin-patient-update) schema for full requirements. When a patient’s consent status changes, any of their existing data in the repository will no longer be returned in query responses. To update a patient’s consent, you must send a `PatientAdmin.PatientUpdate` with `codeableConcept` populated as it is in the example below. This text toggles a patient’s consent status again so that data can be returned in query responses. **Example: Toggle a patient’s consent with the Consent extension ** ```json { "url": "https://api.redoxengine.com/extensions/consent-type", "codeableConcept": [ { "text": "Treatment", "coding": [ { "system": "2.16.840.1.113883.3.18.7.1", "code": "TREATMENT", "display": "Treatment" } ] }, { "text": "Request of the Individual", "coding": [ { "system": "2.16.840.1.113883.3.18.7.1", "code": "REQUEST", "display": "Request of the Individual" } ] }, ] } ``` > **Onramp to Carequality resources** > > **Basic information** > > - [Interact with clinical networks](/how-to-use-redox/interact-with-clinical-networks) > - [Carequality identity and organization structure](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/carequality-identity-and-organization-structure) > - [Carequality FAQ](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/carequality-interoperability-framework-faq) > - [Carequality test patients](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/test-sandbox-for-onramp-to-Carequality) (contains patient data to use when testing) > > **How-to** > > - [Set up your onramp to Carequality](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/set-up-your-onramp-to-carequality) > - [Create and maintain an organization record](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/create-a-carequality-organization-record) > - [Search for patient records](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/search-for-patient-records) > - [Request patient documents](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/request-patient-documents) > - [Maintain your Redox repository](/how-to-use-redox/interact-with-clinical-networks/onramp-to-carequality/maintain-your-redox-repository-for-carequality) > > **Troubleshooting** > > - [Common Carequality errors](/troubleshooting/troubleshoot-carequality-interoperability-framework-errors)