This page is part of the Da Vinci Payer Data Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
<Provenance xmlns="http://hl7.org/fhir">
<id value="1000004"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2020-07-12T18:26:23.217+00:00"/>
<profile
value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>target</b>: <a href="MedicationDispense-1000001.html">Generated Summary: status: completed; <span title="Codes: {http://hl7.org/fhir/sid/ndc 54458-872-10}">30 TABLET in 1 BLISTER PACK (54458-872-10)</span>; <span title="Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode RF}">Refill</span>; 60; 30</a></p><p><b>recorded</b>: Jul 12, 2020 6:26:23 PM</p><h3>Agents</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Who</b></td></tr><tr><td>*</td><td><span title="Codes: {http://terminology.hl7.org/CodeSystem/provenance-participant-type author}">Author</span></td><td><a href="Organization-2.html">Generated Summary: language: en-US; National Provider Identifier: 345678; active; name: Payer 1</a></td></tr></table><h3>Entities</h3><table class="grid"><tr><td>-</td><td><b>Extension</b></td><td><b>Role</b></td><td><b>What</b></td></tr><tr><td>*</td><td></td><td>source</td><td><span>No reference available</span></td></tr></table></div>
</text>
<target>
<reference value="MedicationDispense/1000001"/>
</target>
<recorded value="2020-07-12T18:26:23.217+00:00"/>
<agent>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
<code value="author"/>
<display value="Author"/>
</coding>
</type>
<who>
<reference value="Organization/2"/>
</who>
</agent>
<entity>
<extension
url="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom">
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource"/>
<code value="ncpdp"/>
<display value="NCPDP Telecommunication"/>
</coding>
</valueCodeableConcept>
</extension>
<role value="source"/>
<what>
<display value="No reference available"/>
</what>
</entity>
</Provenance>