Common CQL Artifacts for FHIR (US-Based)
1.0.0 - Informative 1

Common CQL Artifacts for FHIR (US-Based) - Downloaded Version null See the Directory of published versions

## Questionnaire: Example Patient and Coverage Questionnaire (Experimental)

Official URL: http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire | Version: 1.0.0
Standards status: Informative | Computable Name: ExamplePatientAndCoverageQuestionnaire

For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.

LinkID | Text | Cardinality | Type | Description & Constraints
--- | --- | --- | --- | ---
ExamplePatientAndCoverageQuestionnaire | For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed. |  | Questionnaire | http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire#1.0.0
patient-info | Patient Information | 0..1 | group |
patient-info|patient-name | Name | 0..1 | string |
patient-info|date-of-birth | Date of Birth | 0..1 | date |
patient-info|birth-sex | Birth Sex | 0..1 | choice | Value Set: Birth Sex
patient-info|medical-record-number | Medical Record Number | 0..1 | string |
patient-info|phone-number | Phone Number | 0..1 | string |
patient-info|email-address | Email Address | 0..1 | string |
patient-info|address | Address | 0..1 | string |
patient-info|city | City | 0..1 | string |
patient-info|state | State | 0..1 | string |
patient-info|postal-code | Postal Code | 0..1 | string |
coverage-info | Coverage Information | 0..1 | group |
coverage-info|member-id | Member ID | 0..1 | string |
completing-form|patient-info|policy-number | Policy Number | 0..1 | string |
provider-info | Requesting Provider Information | 0..1 | group |
provider-info|name | Requesting provider name | 0..1 | string |
provider-info|phone-number | Phone | 0..1 | string |
provider-info|address | Ordering provider address | 0..1 | string |
provider-info|npi | Ordering provider Tax ID/NPI # | 0..1 | string |
provider-info|fax | Fax | 0..1 | string |
servicing-provider | Laboratory performing testing/Servicing Provider | 0..1 | group |
servicing-provider|name | Servicing Provider name | 0..1 | string |
servicing-provider|phone-number | Phone | 0..1 | string |
servicing-provider|address | Ordering provider address | 0..1 | string |
servicing-provider|npi | Ordering provider Tax ID/NPI # | 0..1 | string |
servicing-provider|fax | Fax | 0..1 | string |
Documentation for this format