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{
"resourceType" : "Task",
"id" : "cdex-task-example19",
"meta" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
"valueString" : "Cdex Task Example 19"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
"valueMarkdown" : "**Claim Attachment Request Example:** Claim Attachment Request sent by payer to a provider requesting a signed Progress note (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-example19\" </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)</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>: claim <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/R4/codesystem-claim-use.html\">Use</a>#claim \"Claim\")</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>?? --> 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"
}
],
"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" : "claim",
"display" : "Claim"
}
],
"text" : "claim"
},
"reasonReference" : {
"identifier" : {
"system" : "http://example.org/cdex/payer/claim-ids",
"value" : "Claim123"
}
},
"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"
}
]
}