Da Vinci Clinical Data Exchange (CDex)
2.0.0-ballot - Ballot US

This page is part of the Da Vinci Clinical Documentation Exchange (v2.0.0-ballot: STU2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

: Cdex Task Example 20 - JSON Representation

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{
  "resourceType" : "Task",
  "id" : "cdex-task-example20",
  "meta" : {
    "extension" : [
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
        "valueString" : "Cdex Task Example 20"
      },
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
        "valueMarkdown" : "**Prior-Auth Attachment Request Example:**   Prior Authorization Attachment Request sent by payer to a provider requesting a signed History and physical (H&P) note"
      }
    ],
    "profile" : [
      "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Task</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Task \"cdex-task-example20\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdex-task-attachment-request.html\">CDex Task Attachment Request Profile</a></p></div><p><b>identifier</b>: Re-Association Tracking Control Number: trackingid123</p><p><b>status</b>: requested</p><p><b>intent</b>: order</p><p><b>code</b>: Attachment Request <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-cdex-temp.html\">CDex Temporary Code System</a>#attachment-request)</span></p><p><b>for</b>: <a name=\"patient\"> </a></p><blockquote><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Patient \"patient\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-cdex-patient-demographics.html\">CDex Patient Demographics Profile</a></p></div><p><b>identifier</b>: Member Number: Member123 (USUAL), Patient Account Number: PA-123 (USUAL)</p><p><b>name</b>: Amy Shaw </p><p><b>birthDate</b>: 1987-02-20</p></blockquote><p><b>authoredOn</b>: 2022-06-17 04:16:06+0000</p><p><b>lastModified</b>: 2022-06-17 04:16:06+0000</p><p><b>requester</b>: <span></span></p><p><b>owner</b>: <span></span></p><p><b>reasonCode</b>: preauthorization <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-claim-use.html\">Use</a>#preauthorization \"Preauthorization\")</span></p><p><b>reasonReference</b>: <span></span></p><h3>Restrictions</h3><table class=\"grid\"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>?? --&gt; 2022-06-21</td></tr></table><blockquote><p><b>input</b></p><p><b>ServiceLineNumber</b>: 1</p><p><b>type</b>: data code input <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/us/davinci-hrex/STU1/CodeSystem-hrex-temp.html\">HRex Temporary Code System</a>#data-code)</span></p><p><b>value</b>: Progress note <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://loinc.org/\">LOINC</a>#11506-3)</span></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Signature Flag <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-cdex-temp.html\">CDex Temporary Code System</a>#signature-flag)</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Payer URL <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-cdex-temp.html\">CDex Temporary Code System</a>#payer-url)</span></p><p><b>value</b>: <a href=\"http://example.org/cdex/payer/$submit-attachment\">http://example.org/cdex/payer/$submit-attachment</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Service Date <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-cdex-temp.html\">CDex Temporary Code System</a>#service-date)</span></p><p><b>value</b>: 2022-06-13</p></blockquote></div>"
  },
  "contained" : [
    {
      "resourceType" : "Patient",
      "id" : "patient",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"
        ]
      },
      "identifier" : [
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
                "code" : "UMB",
                "display" : "Member Number"
              }
            ],
            "text" : "Member Number"
          },
          "system" : "http://example.org/cdex/payer/member-ids",
          "value" : "Member123"
        },
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                "code" : "pat",
                "display" : "Patient Account Number"
              }
            ],
            "text" : "Patient Account Number"
          },
          "system" : "http://example.org/cdex/provider/patient-ids",
          "value" : "PA-123"
        }
      ],
      "name" : [
        {
          "family" : "Shaw",
          "given" : [
            "Amy"
          ]
        }
      ],
      "birthDate" : "1987-02-20"
    }
  ],
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
            "code" : "tracking-id",
            "display" : "Tracking Id"
          }
        ],
        "text" : "Re-Association Tracking Control Number"
      },
      "system" : "http://example.org/payer",
      "value" : "trackingid123"
    }
  ],
  "status" : "requested",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
        "code" : "attachment-request"
      }
    ],
    "text" : "Attachment Request"
  },
  "for" : {
    "reference" : "#patient"
  },
  "authoredOn" : "2022-06-17T16:16:06Z",
  "lastModified" : "2022-06-17T16:16:06Z",
  "requester" : {
    "identifier" : {
      "system" : "http://example.org/cdex/payer/payer-ids",
      "value" : "Payer123"
    }
  },
  "owner" : {
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "9941339108"
    }
  },
  "reasonCode" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/claim-use",
        "code" : "preauthorization",
        "display" : "Preauthorization"
      }
    ],
    "text" : "preauthorization"
  },
  "reasonReference" : {
    "identifier" : {
      "system" : "http://example.org/cdex/payer/claim-ids",
      "value" : "Preauth123"
    }
  },
  "restriction" : {
    "period" : {
      "end" : "2022-06-21"
    }
  },
  "input" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber",
          "valuePositiveInt" : 1
        }
      ],
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp",
            "code" : "data-code"
          }
        ]
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "11506-3",
            "display" : "Progress note"
          }
        ],
        "text" : "Progress note"
      }
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
            "code" : "signature-flag"
          }
        ]
      },
      "valueBoolean" : true
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
            "code" : "payer-url"
          }
        ]
      },
      "valueUrl" : "http://example.org/cdex/payer/$submit-attachment"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
            "code" : "service-date"
          }
        ]
      },
      "valueDate" : "2022-06-13"
    }
  ]
}