Agregadas variantes de ITI-65 para MeOW e IT ademas de IPS

Se generaliza el controller para recibir el tipo de documento (LOINC)
en vez de hardcodear el de IPS, y se agregan las rutas y mapeos de
nginx para /fhir/MeOWTransaction, /fhir/MeOWDocument, /fhir/ITTransaction
y /fhir/ITDocument, siguiendo la misma logica que las rutas IPS existentes.

Co-Authored-By: Claude Sonnet 5 <noreply@anthropic.com>

bus-gateway/README.md

@@ -14,7 +14,12 @@ El componente actúa exclusivamente como gateway: no contiene lógica de negocio
 
 | Transacción | Método | Ruta | Descripción |
 |---|---|---|---|
-| ITI-65 | `POST` | `/fhir/Bundle` | Provide Document Bundle: almacena el Bundle en HAPI FHIR, resuelve el ID nacional del paciente vía `$match` en el Bus y registra el DocumentReference en el Document Registry. |
+| ITI-65 | `POST` | `/fhir/IPSTransaction` | Provide Document Bundle (IPS): variante transacción — el cliente envía el Bundle transaction completo (Patient, Bundle document, DocumentReference, List). |
+| ITI-65 | `POST` | `/fhir/IPSDocument` | Provide Document Bundle (IPS): variante document — el cliente envía solo el Bundle IPS (`type: document`); el gateway arma la transacción internamente. |
+| ITI-65 | `POST` | `/fhir/MeOWTransaction` | Provide Document Bundle (MeOW - Medication Overview): variante transacción. |
+| ITI-65 | `POST` | `/fhir/MeOWDocument` | Provide Document Bundle (MeOW - Medication Overview): variante document. |
+| ITI-65 | `POST` | `/fhir/ITTransaction` | Provide Document Bundle (IT - Consultation Note / respuesta de interconsulta): variante transacción. |
+| ITI-65 | `POST` | `/fhir/ITDocument` | Provide Document Bundle (IT - Consultation Note): variante document. |
 | ITI-67 | `GET` | `/fhir/DocumentReference` | Find Document References: busca el paciente por ID local en el MPI para obtener su ID nacional y consulta los DocumentReferences en el Document Registry. |
 | ITI-78 | `GET` | `/fhir/Patient` | Patient Demographics Query: búsqueda de pacientes en el MPI. |
 | ITI-78 | `GET` | `/fhir/Patient/:id` | Patient Demographics Query: obtención de un paciente por ID en el MPI. |
@@ -136,7 +141,7 @@ docker compose logs -f
 
 ## Headers requeridos por transacción
 
-### ITI-65 `POST /fhir/Bundle`
+### ITI-65 `POST /fhir/IPSTransaction`, `/fhir/IPSDocument`, `/fhir/MeOWTransaction`, `/fhir/MeOWDocument`, `/fhir/ITTransaction`, `/fhir/ITDocument`
 
 | Header | Descripción |
 |---|---|

bus-gateway/controllers/iti65.js

@@ -20,6 +20,32 @@ const DNI_SYSTEM = 'http://www.renaper.gob.ar/dni';
 const CUSTODIAN_ID_SYSTEM = 'http://federador.msal.gob.ar/uri';
 const MASTER_ID_SYSTEM = 'urn:ietf:rfc:3986'
 
+/**
+ * Tipos de documento soportados por ITI-65, cada uno con su código LOINC
+ * para DocumentReference.type (y, en la variante "document", también para
+ * el DocumentReference local generado dentro de la transacción).
+ */
+const DOCUMENT_TYPES = {
+    IPS: {
+        label: 'IPS',
+        system: 'http://loinc.org',
+        code: '60591-5',
+        display: 'Patient Summary Document',
+    },
+    MEOW: {
+        label: 'MeOW',
+        system: 'http://loinc.org',
+        code: '56445-0',
+        display: 'Medication summary',
+    },
+    IT: {
+        label: 'IT',
+        system: 'http://loinc.org',
+        code: '57133-1',
+        display: 'Referral note',
+    },
+};
+
 
 function extractResource(resources, resourceType) {
     return resources.filter(r => r.resourceType === resourceType)[0];
@@ -31,7 +57,7 @@ function extractLocalIdentifier(patient) {
     })[0];
 }
 
-function generateDocumentReferenceResource(subjectReference, bundleUrl) {
+function generateDocumentReferenceResource(subjectReference, bundleUrl, docType) {
     const documentRefernece = {
         resourceType: 'DocumentReference',
         status: 'current',
@@ -43,9 +69,9 @@ function generateDocumentReferenceResource(subjectReference, bundleUrl) {
         type: {
             coding: [
                 {
-                    system: 'http://loinc.org',
+                    system: docType.system,
-                    code: '60591-5',
+                    code: docType.code,
-                    display: 'Patient Summary Document',
+                    display: docType.display,
                 },
             ],
         },
@@ -77,19 +103,20 @@ async function getResourcesFromTransactionResponse(transactionResponse) {
 }
 
 /**
- * Construye un Bundle de tipo transaction a partir de un Bundle de tipo document (IPS).
+ * Construye un Bundle de tipo transaction a partir de un Bundle de tipo document
- * Genera Patient, Bundle (IPS), DocumentReference y List (SubmissionSet MHD).
+ * (IPS, MeOW, IT, ...). Genera Patient, Bundle (documento), DocumentReference y
+ * List (SubmissionSet MHD).
  * Usa urn:uuid: como fullUrl para que HAPI FHIR resuelva las referencias internas.
  */
-function buildTransactionFromIPSDocument(ipsBundle) {
+function buildTransactionFromDocumentBundle(documentBundle, docType) {
-    if (ipsBundle.type !== 'document') {
+    if (documentBundle.type !== 'document') {
         throw createError(400, 'Bundle must be of type document');
     }
-    const patientEntry = (ipsBundle.entry || []).find(
+    const patientEntry = (documentBundle.entry || []).find(
         e => e.resource && e.resource.resourceType === 'Patient'
     );
     if (!patientEntry) {
-        throw createError(400, 'IPS Bundle must contain a Patient resource');
+        throw createError(400, `${docType.label} Bundle must contain a Patient resource`);
     }
 
     const patientFullUrl = `urn:uuid:${uuidv4()}`;
@@ -108,9 +135,9 @@ function buildTransactionFromIPSDocument(ipsBundle) {
         },
         type: {
             coding: [{
-                system: 'http://loinc.org',
+                system: docType.system,
-                code: '60591-5',
+                code: docType.code,
-                display: 'Patient Summary Document',
+                display: docType.display,
             }]
         },
         date: now,
@@ -158,7 +185,7 @@ function buildTransactionFromIPSDocument(ipsBundle) {
             },
             {
                 fullUrl: bundleFullUrl,
-                resource: ipsBundle,
+                resource: documentBundle,
                 request: { method: 'POST', url: 'Bundle' }
             },
             {
@@ -178,7 +205,7 @@ function buildTransactionFromIPSDocument(ipsBundle) {
  * Lógica central de ITI-65: persiste la transacción en HAPI FHIR, resuelve el
  * paciente en el Bus y registra un DocumentReference apuntando al Bundle guardado.
  */
-async function executeITI65(transaction, token) {
+async function executeITI65(transaction, token, docType) {
     const transactionResponse = await processDocumentBundleTransaction(transaction);
     const resources = await getResourcesFromTransactionResponse(transactionResponse);
 
@@ -193,59 +220,73 @@ async function executeITI65(transaction, token) {
     const nationalPatientId = patientSearchset.entry[0].fullUrl;
     const bundleReference = `${config.baseURL}/fhir/Bundle/${localIPSDocument.id}`;
 
-    const documentReference = generateDocumentReferenceResource(nationalPatientId, bundleReference);
+    const documentReference = generateDocumentReferenceResource(nationalPatientId, bundleReference, docType);
     return createDocumentReference(token, documentReference);
 }
 
+async function acquireToken() {
+    return getBusToken(
+        config.bus.url,
+        config.bus.jwtSecret,
+        config.bus.issuer,
+        [config.bus.mpiScope, config.bus.documentRegistryScope].join(',')
+    );
+}
+
 /**
  * ITI-65: Provide Document Bundle (MHD) — variante transacción
  *
- * POST /fhir/iti65
- *
  * Espera un Bundle de tipo transaction construido por el cliente.
  */
-async function provideIPSTransaction(req, res, next) {
+function provideTransaction(docType) {
-    try {
+    return async function (req, res, next) {
-        const transaction = req.body;
+        try {
-        const token = await getBusToken(
+            const transaction = req.body;
-            config.bus.url,
+            const token = await acquireToken();
-            config.bus.jwtSecret,
+            const result = await executeITI65(transaction, token, docType);
-            config.bus.issuer,
+            return res.status(200).json(result);
-            [config.bus.mpiScope, config.bus.documentRegistryScope].join(',')
+        } catch (err) {
-        );
+            next(err);
-        const result = await executeITI65(transaction, token);
+        }
-        return res.status(200).json(result);
+    };
-    } catch (err) {
-        next(err);
-    }
 }
 
 /**
- * ITI-65: Provide Document Bundle (MHD) — variante IPS document
+ * ITI-65: Provide Document Bundle (MHD) — variante document
  *
- * POST /fhir/Bundle
+ * Espera un Bundle de tipo document. Genera internamente el Bundle transaction
- *
+ * (Patient, Bundle, DocumentReference, List) y ejecuta el mismo flujo que
- * Espera un Bundle de tipo document (IPS). Genera internamente el Bundle
+ * provideTransaction.
- * transaction y ejecuta el mismo flujo que provideDocumentBundle.
  */
-async function provideIPSDocumentBundle(req, res, next) {
+function provideDocumentBundle(docType) {
-    try {
+    return async function (req, res, next) {
-        const ipsBundle = req.body;
+        try {
-        if (!ipsBundle || ipsBundle.resourceType !== 'Bundle') {
+            const documentBundle = req.body;
-            throw createError(400, 'Request body must be a FHIR Bundle resource');
+            if (!documentBundle || documentBundle.resourceType !== 'Bundle') {
+                throw createError(400, 'Request body must be a FHIR Bundle resource');
+            }
+            const transaction = buildTransactionFromDocumentBundle(documentBundle, docType);
+            const token = await acquireToken();
+            const result = await executeITI65(transaction, token, docType);
+            return res.status(200).json(result);
+        } catch (err) {
+            next(err);
         }
-        const transaction = buildTransactionFromIPSDocument(ipsBundle);
+    };
-        const token = await getBusToken(
-            config.bus.url,
-            config.bus.jwtSecret,
-            config.bus.issuer,
-            [config.bus.mpiScope, config.bus.documentRegistryScope].join(',')
-        );
-        const result = await executeITI65(transaction, token);
-        return res.status(200).json(result);
-    } catch (err) {
-        next(err);
-    }
 }
 
-module.exports = { provideIPSTransaction, provideIPSDocumentBundle };
+const provideIPSTransaction = provideTransaction(DOCUMENT_TYPES.IPS);
+const provideIPSDocumentBundle = provideDocumentBundle(DOCUMENT_TYPES.IPS);
+const provideMeOWTransaction = provideTransaction(DOCUMENT_TYPES.MEOW);
+const provideMeOWDocumentBundle = provideDocumentBundle(DOCUMENT_TYPES.MEOW);
+const provideITTransaction = provideTransaction(DOCUMENT_TYPES.IT);
+const provideITDocumentBundle = provideDocumentBundle(DOCUMENT_TYPES.IT);
+
+module.exports = {
+    provideIPSTransaction,
+    provideIPSDocumentBundle,
+    provideMeOWTransaction,
+    provideMeOWDocumentBundle,
+    provideITTransaction,
+    provideITDocumentBundle,
+};

bus-gateway/docs/iti65.mmd

@@ -7,14 +7,15 @@ sequenceDiagram
         participant FederadorNacion as Federador
         participant IndiceNacion as Indice Documentos
     end
-    Note over HIS_A,IndiceNacion: 1. Recepcion Local del Documento Bundle (POST /Bundle)
+    Note over HIS_A,IndiceNacion: Variantes: /IPSTransaction, /IPSDocument, /MeOWTransaction, /MeOWDocument, /ITTransaction, /ITDocument
-    HIS_A->>NodoDominio: ITI65: Provee un nuevo documento IPS (bundle)
+    Note over HIS_A,IndiceNacion: 1. Recepcion Local del Documento Bundle
+    HIS_A->>NodoDominio: ITI65: Provee un nuevo documento (bundle)
     Note right of NodoDominio: El Nodo almacena físicamente el documento y extrae la metadata.
     Note over NodoDominio,FederadorNacion: 2. Resolución de Identidad
     NodoDominio->>FederadorNacion: Busca al paciente por el su identificador local [GET /Patient?identifier=<ID_Local>]
     FederadorNacion-->>NodoDominio: 200 OK (Patient Searchset)
     Note over NodoDominio,IndiceNacion: 3. Enrutamiento de la Petición
-    Note right of NodoDominio: El Nodo genera la referencia al IPS y la asocia al identificador nacional del paciente.
+    Note right of NodoDominio: El Nodo genera la referencia al documento y la asocia al identificador nacional del paciente.
-    NodoDominio->>IndiceNacion: Guarda la referencia al IPS en el índice de documentos [POST /DocumentReference]
+    NodoDominio->>IndiceNacion: Guarda la referencia al documento en el índice de documentos [POST /DocumentReference]
     IndiceNacion-->>NodoDominio: 201 (Created)
     NodoDominio-->>HIS_A: 200 OK (DocumentReference)

bus-gateway/routes/iti65.js

@@ -1,11 +1,24 @@
 const express = require('express');
 const router = express.Router();
-const { provideIPSTransaction, provideIPSDocumentBundle } = require('../controllers/iti65');
+const {
+    provideIPSTransaction,
+    provideIPSDocumentBundle,
+    provideMeOWTransaction,
+    provideMeOWDocumentBundle,
+    provideITTransaction,
+    provideITDocumentBundle,
+} = require('../controllers/iti65');
 
-// ITI-65: Provide Document Bundle — variante transaction Bundle
+// ITI-65: Provide Document Bundle — IPS
 router.post('/IPSTransaction', provideIPSTransaction);
-
-// ITI-65: Provide Document Bundle — variante IPS document Bundle (type: document)
 router.post('/IPSDocument', provideIPSDocumentBundle);
 
+// ITI-65: Provide Document Bundle — MeOW (Medication Overview)
+router.post('/MeOWTransaction', provideMeOWTransaction);
+router.post('/MeOWDocument', provideMeOWDocumentBundle);
+
+// ITI-65: Provide Document Bundle — IT (Consultation Note / respuesta de interconsulta)
+router.post('/ITTransaction', provideITTransaction);
+router.post('/ITDocument', provideITDocumentBundle);
+
 module.exports = router;

nginx/http.conf

@@ -35,6 +35,46 @@ http {
             proxy_read_timeout 90s;
         }
 
+        # ITI-65: Provide Document Bundle — MeOW (Medication Overview) transaction Bundle
+        location /fhir/MeOWTransaction {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
+        # ITI-65: Provide Document Bundle — MeOW (Medication Overview) document Bundle
+        location /fhir/MeOWDocument {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
+        # ITI-65: Provide Document Bundle — IT (Consultation Note) transaction Bundle
+        location /fhir/ITTransaction {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
+        # ITI-65: Provide Document Bundle — IT (Consultation Note) document Bundle
+        location /fhir/ITDocument {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
         # ITI-67: Find Document References
         location /fhir/DocumentReference {
             proxy_pass         http://bus_gateway;

nginx/https.conf

@@ -51,6 +51,46 @@ http {
             proxy_read_timeout 90s;
         }
 
+        # ITI-65: Provide Document Bundle — MeOW (Medication Overview) transaction Bundle
+        location /fhir/MeOWTransaction {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
+        # ITI-65: Provide Document Bundle — MeOW (Medication Overview) document Bundle
+        location /fhir/MeOWDocument {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
+        # ITI-65: Provide Document Bundle — IT (Consultation Note) transaction Bundle
+        location /fhir/ITTransaction {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
+        # ITI-65: Provide Document Bundle — IT (Consultation Note) document Bundle
+        location /fhir/ITDocument {
+            proxy_pass         http://bus_gateway;
+            proxy_set_header   Host              $host;
+            proxy_set_header   X-Real-IP         $remote_addr;
+            proxy_set_header   X-Forwarded-For   $proxy_add_x_forwarded_for;
+            proxy_set_header   X-Forwarded-Proto $scheme;
+            proxy_read_timeout 90s;
+        }
+
         # ITI-67: Find Document References
         location /fhir/DocumentReference {
             proxy_pass         http://bus_gateway;

tests/fixtures/iti65/bundle-document-it.json

@@ -0,0 +1,121 @@
+{
+  "resourceType": "Bundle",
+  "type": "document",
+  "timestamp": "2026-04-23T07:50:00-03:00",
+  "entry": [
+    {
+      "fullUrl": "urn:uuid:5ca8da35-efb1-498a-93bc-ed34524a360f",
+      "resource": {
+        "resourceType": "Patient",
+        "identifier": [
+          {
+            "system": "urn:oid:2.16.858.1.858.1.1.1",
+            "value": "123456789"
+          }
+        ],
+        "active": true,
+        "name": [
+          {
+            "use": "official",
+            "family": "Pérez",
+            "given": [
+              "Juan"
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:4d58cb4f-1f8b-4f94-9877-bb5a0de47955",
+      "resource": {
+        "resourceType": "Composition",
+        "status": "final",
+        "type": {
+          "coding": [
+            {
+              "system": "http://loinc.org",
+              "code": "11488-4",
+              "display": "Consultation note"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "urn:uuid:5ca8da35-efb1-498a-93bc-ed34524a360f"
+        },
+        "date": "2026-04-23T07:50:00-03:00",
+        "author": [
+          {
+            "display": "Dra. Especialista - Nodo Panamá"
+          }
+        ],
+        "title": "Informe de Contra-referencia Dermatológica",
+        "section": [
+          {
+            "title": "Motivo de Interconsulta",
+            "code": {
+              "coding": [
+                {
+                  "system": "http://loinc.org",
+                  "code": "42349-1",
+                  "display": "Reason for referral"
+                }
+              ]
+            },
+            "text": {
+              "status": "generated",
+              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Se solicita segunda opinión para evaluación de lesión pigmentada en región escapular, con el fin de descartar malignidad tras hallazgos clínicos iniciales en Uruguay.</p></div>"
+            }
+          },
+          {
+            "title": "Revisión de Evidencia",
+            "code": {
+              "coding": [
+                {
+                  "system": "http://loinc.org",
+                  "code": "30954-2",
+                  "display": "Relevant diagnostic tests"
+                }
+              ]
+            },
+            "text": {
+              "status": "generated",
+              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Se re-evaluaron los resultados del IPS (Bundle/2313), específicamente el DiagnosticReport/biopsia-001 y las imágenes dermatoscópicas adjuntas.</p></div>"
+            }
+          },
+          {
+            "title": "Juicio Clínico",
+            "code": {
+              "coding": [
+                {
+                  "system": "http://loinc.org",
+                  "code": "51848-0",
+                  "display": "Assessment note"
+                }
+              ]
+            },
+            "text": {
+              "status": "generated",
+              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Tras el análisis de la evidencia, se concluye que la morfología de la lesión es compatible con un Nevus Displásico. No se identifican criterios histológicos de melanoma.</p></div>"
+            }
+          },
+          {
+            "title": "Recomendaciones",
+            "code": {
+              "coding": [
+                {
+                  "system": "http://loinc.org",
+                  "code": "18776-5",
+                  "display": "Plan of care"
+                }
+              ]
+            },
+            "text": {
+              "status": "generated",
+              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li>Control dermatoscópico cada 6 meses.</li><li>Uso de fotoprotección (FPS 50+).</li><li>No se requiere intervención quirúrgica inmediata.</li></ul></div>"
+            }
+          }
+        ]
+      }
+    }
+  ]
+}

tests/fixtures/iti65/bundle-document-meow.json

@@ -0,0 +1,177 @@
+{
+  "resourceType": "Bundle",
+  "id": "medication-overview-example",
+  "meta": {
+    "profile": [
+      "http://profiles.ihe.net/PHARM/MEOW/StructureDefinition/MedicationOverview"
+    ]
+  },
+  "identifier": {
+    "system": "urn:ietf:rfc:3986",
+    "value": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a71"
+  },
+  "type": "document",
+  "timestamp": "2025-06-17T18:36:18+00:00",
+  "entry": [
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a72",
+      "resource": {
+        "resourceType": "Composition",
+        "id": "composition-example",
+        "meta": {
+          "profile": [
+            "http://profiles.ihe.net/PHARM/MEOW/StructureDefinition/MedicationOverviewComposition"
+          ]
+        },
+        "status": "final",
+        "type": {
+          "coding": [
+            {
+              "system": "http://loinc.org",
+              "code": "56445-0",
+              "display": "Medication summary"
+            }
+          ]
+        },
+        "subject": {
+          "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+        },
+        "date": "2025-06-17T18:36:18+00:00",
+        "author": [
+          {
+            "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+          }
+        ],
+        "title": "Medication Overview",
+        "section": [
+          {
+            "title": "Medicamentos",
+            "code": {
+              "coding": [
+                {
+                  "system": "http://loinc.org",
+                  "code": "55112-7",
+                  "display": "Document summary"
+                }
+              ]
+            },
+            "text": {
+              "status": "generated",
+              "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Resumen de medicamentos</p></div>"
+            },
+            "entry": [
+              {
+                "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a74"
+              },
+              {
+                "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a75"
+              }
+            ]
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "patient-example",
+        "identifier": [
+          {
+            "system": "http://hospital.example.org",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "family": "Doe",
+            "given": [
+              "John"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "1970-01-01"
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a74",
+      "resource": {
+        "resourceType": "MedicationStatement",
+        "id": "medication-statement-1",
+        "status": "active",
+        "medicationCodeableConcept": {
+          "coding": [
+            {
+              "system": "http://snomed.info/sct",
+              "code": "1222004",
+              "display": "Metronidazole-containing product"
+            }
+          ],
+          "text": "Metronidazole-containing product"
+        },
+        "subject": {
+          "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+        },
+        "effectiveDateTime": "2025-01-01",
+        "effectivePeriod": {
+          "start": "2025-01-01",
+          "end": "2025-12-31"
+        },
+        "dateAsserted": "2025-06-17T18:36:18+00:00",
+        "dosage": [
+          {
+            "text": "500 mg daily",
+            "route": {
+              "text": "Oral"
+            }
+          }
+        ],
+        "reasonCode": [
+          {
+            "text": "Infection"
+          }
+        ]
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a75",
+      "resource": {
+        "resourceType": "MedicationStatement",
+        "id": "medication-statement-2",
+        "status": "active",
+        "medicationCodeableConcept": {
+          "coding": [
+            {
+              "system": "http://snomed.info/sct",
+              "code": "796001",
+              "display": "Digoxin-containing product"
+            }
+          ],
+          "text": "Digoxin-containing product"
+        },
+        "subject": {
+          "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+        },
+        "effectiveDateTime": "2025-01-01",
+        "effectivePeriod": {
+          "start": "2025-01-01"
+        },
+        "dateAsserted": "2025-06-17T18:36:18+00:00",
+        "dosage": [
+          {
+            "text": "0.125 mg daily",
+            "route": {
+              "text": "Oral"
+            }
+          }
+        ],
+        "reasonCode": [
+          {
+            "text": "Heart failure"
+          }
+        ]
+      }
+    }
+  ]
+}

tests/fixtures/iti65/bundle-transaction-it.json

@@ -0,0 +1,188 @@
+{
+  "resourceType": "Bundle",
+  "type": "transaction",
+  "entry": [
+    {
+      "fullUrl": "urn:uuid:5ca8da35-efb1-498a-93bc-ed34524a360f",
+      "resource": {
+        "resourceType": "Patient",
+        "identifier": [
+          {
+            "system": "urn:oid:2.16.858.1.858.1.1.1",
+            "value": "123456789"
+          }
+        ],
+        "active": true,
+        "name": [
+          {
+            "use": "official",
+            "family": "Pérez",
+            "given": [
+              "Juan"
+            ]
+          }
+        ]
+      },
+      "request": {
+        "method": "POST",
+        "url": "Patient"
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:15f62e6b-f4d9-43d8-91f5-ee963a34339c",
+      "resource": {
+        "resourceType": "DocumentReference",
+        "status": "current",
+        "docStatus": "final",
+        "type": {
+          "coding": [
+            {
+              "system": "http://loinc.org",
+              "code": "57133-1",
+              "display": "Referral note"
+            }
+          ],
+          "text": "Informe de Contra-referencia Dermatológica"
+        },
+        "subject": {
+          "reference": "urn:uuid:5ca8da35-efb1-498a-93bc-ed34524a360f"
+        },
+        "date": "2026-04-23T07:50:00-03:00",
+        "author": [
+          {
+            "display": "Dra. Especialista - Nodo Panamá"
+          }
+        ],
+        "description": "Respuesta a interconsulta - Caso Dermatología",
+        "content": [
+          {
+            "attachment": {
+              "contentType": "application/fhir+json",
+              "url": "urn:uuid:03e4a890-b152-481a-9ca5-685e03550a08"
+            }
+          }
+        ],
+        "context": {
+          "related": [
+            {
+              "identifier": {
+                "system": "https://salud.gub.uy/interconsultas",
+                "value": "UY-PA-2026-998877"
+              }
+            }
+          ]
+        }
+      },
+      "request": {
+        "method": "POST",
+        "url": "DocumentReference"
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:03e4a890-b152-481a-9ca5-685e03550a08",
+      "resource": {
+        "resourceType": "Bundle",
+        "type": "document",
+        "timestamp": "2026-04-23T07:50:00-03:00",
+        "entry": [
+          {
+            "fullUrl": "urn:uuid:4d58cb4f-1f8b-4f94-9877-bb5a0de47955",
+            "resource": {
+              "resourceType": "Composition",
+              "status": "final",
+              "type": {
+                "coding": [
+                  {
+                    "system": "http://loinc.org",
+                    "code": "11488-4",
+                    "display": "Consultation note"
+                  }
+                ]
+              },
+              "subject": {
+                "reference": "urn:uuid:5ca8da35-efb1-498a-93bc-ed34524a360f"
+              },
+              "date": "2026-04-23T07:50:00-03:00",
+              "author": [
+                {
+                  "display": "Dra. Especialista - Nodo Panamá"
+                }
+              ],
+              "title": "Informe de Contra-referencia Dermatológica",
+              "section": [
+                {
+                  "title": "Motivo de Interconsulta",
+                  "code": {
+                    "coding": [
+                      {
+                        "system": "http://loinc.org",
+                        "code": "42349-1",
+                        "display": "Reason for referral"
+                      }
+                    ]
+                  },
+                  "text": {
+                    "status": "generated",
+                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Se solicita segunda opinión para evaluación de lesión pigmentada en región escapular, con el fin de descartar malignidad tras hallazgos clínicos iniciales en Uruguay.</p></div>"
+                  }
+                },
+                {
+                  "title": "Revisión de Evidencia",
+                  "code": {
+                    "coding": [
+                      {
+                        "system": "http://loinc.org",
+                        "code": "30954-2",
+                        "display": "Relevant diagnostic tests"
+                      }
+                    ]
+                  },
+                  "text": {
+                    "status": "generated",
+                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Se re-evaluaron los resultados del IPS (Bundle/2313), específicamente el DiagnosticReport/biopsia-001 y las imágenes dermatoscópicas adjuntas.</p></div>"
+                  }
+                },
+                {
+                  "title": "Juicio Clínico",
+                  "code": {
+                    "coding": [
+                      {
+                        "system": "http://loinc.org",
+                        "code": "51848-0",
+                        "display": "Assessment note"
+                      }
+                    ]
+                  },
+                  "text": {
+                    "status": "generated",
+                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Tras el análisis de la evidencia, se concluye que la morfología de la lesión es compatible con un Nevus Displásico. No se identifican criterios histológicos de melanoma.</p></div>"
+                  }
+                },
+                {
+                  "title": "Recomendaciones",
+                  "code": {
+                    "coding": [
+                      {
+                        "system": "http://loinc.org",
+                        "code": "18776-5",
+                        "display": "Plan of care"
+                      }
+                    ]
+                  },
+                  "text": {
+                    "status": "generated",
+                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><ul><li>Control dermatoscópico cada 6 meses.</li><li>Uso de fotoprotección (FPS 50+).</li><li>No se requiere intervención quirúrgica inmediata.</li></ul></div>"
+                  }
+                }
+              ]
+            }
+          }
+        ]
+      },
+      "request": {
+        "method": "POST",
+        "url": "Bundle"
+      }
+    }
+  ]
+}

tests/fixtures/iti65/bundle-transaction-meow.json

@@ -0,0 +1,258 @@
+{
+  "resourceType": "Bundle",
+  "id": "iti65-transaction-medication",
+  "type": "transaction",
+  "entry": [
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73",
+      "resource": {
+        "resourceType": "Patient",
+        "id": "patient-example",
+        "identifier": [
+          {
+            "system": "http://hospital.example.org",
+            "value": "12345"
+          }
+        ],
+        "name": [
+          {
+            "family": "Doe",
+            "given": [
+              "John"
+            ]
+          }
+        ],
+        "gender": "male",
+        "birthDate": "1970-01-01"
+      },
+      "request": {
+        "method": "POST",
+        "url": "Patient"
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a80",
+      "resource": {
+        "resourceType": "DocumentReference",
+        "status": "current",
+        "docStatus": "final",
+        "type": {
+          "coding": [
+            {
+              "system": "http://loinc.org",
+              "code": "56445-0",
+              "display": "Medication summary"
+            }
+          ],
+          "text": "Medication Overview"
+        },
+        "subject": {
+          "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+        },
+        "date": "2025-06-17T18:36:18+00:00",
+        "author": [
+          {
+            "display": "Dra. Especialista"
+          }
+        ],
+        "description": "Medication Overview - Patient Medication Summary",
+        "content": [
+          {
+            "attachment": {
+              "contentType": "application/fhir+json",
+              "url": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a71"
+            }
+          }
+        ]
+      },
+      "request": {
+        "method": "POST",
+        "url": "DocumentReference"
+      }
+    },
+    {
+      "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a71",
+      "resource": {
+        "resourceType": "Bundle",
+        "id": "medication-overview-example",
+        "meta": {
+          "profile": [
+            "http://profiles.ihe.net/PHARM/MEOW/StructureDefinition/MedicationOverview"
+          ]
+        },
+        "identifier": {
+          "system": "urn:ietf:rfc:3986",
+          "value": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a71"
+        },
+        "type": "document",
+        "timestamp": "2025-06-17T18:36:18+00:00",
+        "entry": [
+          {
+            "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a72",
+            "resource": {
+              "resourceType": "Composition",
+              "id": "composition-example",
+              "meta": {
+                "profile": [
+                  "http://profiles.ihe.net/PHARM/MEOW/StructureDefinition/MedicationOverviewComposition"
+                ]
+              },
+              "status": "final",
+              "type": {
+                "coding": [
+                  {
+                    "system": "http://loinc.org",
+                    "code": "56445-0",
+                    "display": "Medication summary"
+                  }
+                ]
+              },
+              "subject": {
+                "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+              },
+              "date": "2025-06-17T18:36:18+00:00",
+              "author": [
+                {
+                  "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+                }
+              ],
+              "title": "Medication Overview",
+              "section": [
+                {
+                  "title": "Medicamentos",
+                  "code": {
+                    "coding": [
+                      {
+                        "system": "http://loinc.org",
+                        "code": "55112-7",
+                        "display": "Document summary"
+                      }
+                    ]
+                  },
+                  "text": {
+                    "status": "generated",
+                    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Resumen de medicamentos</p></div>"
+                  },
+                  "entry": [
+                    {
+                      "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a74"
+                    },
+                    {
+                      "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a75"
+                    }
+                  ]
+                }
+              ]
+            }
+          },
+          {
+            "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73",
+            "resource": {
+              "resourceType": "Patient",
+              "id": "patient-example",
+              "identifier": [
+                {
+                  "system": "http://hospital.example.org",
+                  "value": "12345"
+                }
+              ],
+              "name": [
+                {
+                  "family": "Doe",
+                  "given": [
+                    "John"
+                  ]
+                }
+              ],
+              "gender": "male",
+              "birthDate": "1970-01-01"
+            }
+          },
+          {
+            "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a74",
+            "resource": {
+              "resourceType": "MedicationStatement",
+              "id": "medication-statement-1",
+              "status": "active",
+              "medicationCodeableConcept": {
+                "coding": [
+                  {
+                    "system": "http://snomed.info/sct",
+                    "code": "1222004",
+                    "display": "Metronidazole-containing product"
+                  }
+                ],
+                "text": "Metronidazole-containing product"
+              },
+              "subject": {
+                "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+              },
+              "effectiveDateTime": "2025-01-01",
+              "effectivePeriod": {
+                "start": "2025-01-01",
+                "end": "2025-12-31"
+              },
+              "dateAsserted": "2025-06-17T18:36:18+00:00",
+              "dosage": [
+                {
+                  "text": "500 mg daily",
+                  "route": {
+                    "text": "Oral"
+                  }
+                }
+              ],
+              "reasonCode": [
+                {
+                  "text": "Infection"
+                }
+              ]
+            }
+          },
+          {
+            "fullUrl": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a75",
+            "resource": {
+              "resourceType": "MedicationStatement",
+              "id": "medication-statement-2",
+              "status": "active",
+              "medicationCodeableConcept": {
+                "coding": [
+                  {
+                    "system": "http://snomed.info/sct",
+                    "code": "796001",
+                    "display": "Digoxin-containing product"
+                  }
+                ],
+                "text": "Digoxin-containing product"
+              },
+              "subject": {
+                "reference": "urn:uuid:68c15694-52f1-4171-bc01-e63d666d2a73"
+              },
+              "effectiveDateTime": "2025-01-01",
+              "effectivePeriod": {
+                "start": "2025-01-01"
+              },
+              "dateAsserted": "2025-06-17T18:36:18+00:00",
+              "dosage": [
+                {
+                  "text": "0.125 mg daily",
+                  "route": {
+                    "text": "Oral"
+                  }
+                }
+              ],
+              "reasonCode": [
+                {
+                  "text": "Heart failure"
+                }
+              ]
+            }
+          }
+        ]
+      },
+      "request": {
+        "method": "POST",
+        "url": "Bundle"
+      }
+    }
+  ]
+}