Da Vinci Payer Data Exchange
1.0.0 - STU1

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

: ExampleProvenancePayerSource - XML Representation

Raw xml | Download



<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>