The Scenario

Address change propagates to three payers via FHIR.
0.56 joules.

FHIR Patient resource patched with the new address. SMART App Launch propagates the change to dental and vision payers. CDS Hooks fire for any pending visits. 0.31 joules. Zero touch.

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01
Trigger
Patient
0.04 J

Sarah updates her address in the patient portal.

She submits the new address through the portal's USPS-validated form. The portal does not write to the EHR directly — it posts a single FHIR R5 Patient resource patch and lets MedicineOS fan it out.

JWP ReceiptPayload
kind "medicine.portal.submit"
patient_id Patient/8e21
form USCDI v4 patient demographics
joules 0.04
cite "USPS Pub. 28 · portal POST /Patient/$update-address"
sig "ed25519:0x4f...c1a"
02
FHIR R5
MedicineOS
0.06 J

Patient.address is patched via JSON Patch on FHIR R5.

RFC 6902 patch over Patient/8e21 replaces address[0] with the standardized form, line/city/state/postalCode populated. Resource version bumps 14 → 15 and the prior version is preserved in the history endpoint for audit.

JWP ReceiptPayload
kind "medicine.fhir.patch"
resource Patient/8e21
version 15
joules 0.06
cite "FHIR R5 §3.1 Patient · RFC 6902 · USCDI v4 Patient Demographics"
sig "ed25519:0x4f...c1a"
03
SMART Launch
Authorization
0.11 J

SMART App Launch v2 mints a backend-services token.

MedicineOS authenticates as a registered SMART backend app, presents a signed JWT (RFC 7523), and receives an access token with scope system/Patient.rs user/Coverage.r. The token is valid for 300 seconds — long enough for the fan-out, short enough to not loiter.

JWP ReceiptPayload
kind "medicine.smart.token"
scope system/Patient.rs user/Coverage.r
ttl_s 300
joules 0.11
cite "SMART App Launch v2 §5.1 Backend Services · RFC 7523"
sig "ed25519:0x4f...c1a"
04
Fan-out
Payer 1 — Anthem Dental
0.08 J

Coverage/anthem-dental-44219 is located and patched.

MedicineOS reads Coverage where beneficiary=Patient/8e21 against Anthem's FHIR R5 endpoint, finds Coverage/44219, and submits a Patient.address replace. Round-trip 240 ms, response 200 with the new ETag.

JWP ReceiptPayload
kind "medicine.payer.sync"
payer Anthem Dental
coverage_id 44219
joules 0.08
cite "FHIR R5 Coverage · Da Vinci Payer Coverage Decision Exchange"
sig "ed25519:0x4f...c1a"
05
Fan-out
Payer 2 — VSP Vision
0.07 J

VSP's USCDI v4 endpoint accepts the patch and bumps its own version.

Coverage/vsp-99812 patched the same way; VSP confirms the new address resolves to in-network providers in 95616 (12 optometrists within 5 miles). No referral disruption.

JWP ReceiptPayload
kind "medicine.payer.sync"
payer VSP
in_network_count 12
joules 0.07
cite "USCDI v4 §Coverage · FHIR R5 Patient.address"
sig "ed25519:0x4f...c1a"
06
Fan-out
Payer 3 — Blue Shield CA
0.07 J

Blue Shield CA confirms the address sits inside the PPO service area.

Coverage/bscca-731204 patched. Blue Shield's check is a service-area lookup against ZIP 95616; in-network PCP list is 318 providers. The PCP-of-record (Dr. Tran, NPI 1538291847) remains valid — no reassignment needed.

JWP ReceiptPayload
kind "medicine.payer.sync"
payer Blue Shield CA
pcp_npi 1538291847
joules 0.07
cite "FHIR R5 Coverage · NPPES NPI registry"
sig "ed25519:0x4f...c1a"
07
CDS Hooks v2
patient-view hook
0.04 J

Two open Encounters fire patient-view; one yields a Card.

Encounter/55012 (scheduled 2026-06-04, Dr. Tran) and Encounter/55418 (annual eye exam, 2026-07-19) re-evaluate. The eye-exam Encounter card surfaces: "Patient address changed — confirm preferred clinic location at check-in." No clinician action required today.

JWP ReceiptPayload
kind "medicine.cds.fire"
encounters_evaluated 2
cards_emitted 1
joules 0.04
cite "CDS Hooks v2.0 §patient-view · hook context Patient/8e21"
sig "ed25519:0x4f...c1a"
08
Pharmacy
NCPDP SCRIPT
0.09 J

The patient's three active ServiceRequest medications re-route to the new pharmacy.

ServiceRequest for atorvastatin 20 mg, sertraline 50 mg, and a metformin refill are flagged; an NCPDP SCRIPT 2025 RxChange notification goes to the prior CVS and a NewRx to the new CVS at 95616. Adherence series stays joined by patient_id, no break.

JWP ReceiptPayload
kind "medicine.rx.route"
scripts 3
new_pharmacy NCPDP 0526891
joules 0.09
cite "NCPDP SCRIPT 2025 · FHIR R5 ServiceRequest · ePrescribing"
sig "ed25519:0x4f...c1a"

MedicineOS, in one line

0.56 joules. One receipt.

MedicineOS handles health as a typed, signed, energy-metered operation. The whole pillar is one shape: take a claim, do the work, sign the receipt.

Open the artifact → See the receipt format →