Da Vinci Clinical Data Exchange (CDex)
1.1.0 - STU1.1 US

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: Cdex Task Example 20 - XML Representation

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<Task xmlns="http://hl7.org/fhir">
  <id value="cdex-task-example20"/>
  <meta>
    <extension url="http://hl7.org/fhir/StructureDefinition/instance-name">
      <valueString value="Cdex Task Example 20"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/instance-description">
      <valueMarkdown
                     value="**Prior-Auth Attachment Request Example:**   Prior Authorization Attachment Request sent by payer to a provider requesting a signed History and physical (H&amp;P) note"/>
    </extension>
    <profile
             value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request"/>
  </meta>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <contained>
    <Patient>
      <id value="patient"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"/>
      </meta>
      <identifier>
        <use value="usual"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp"/>
            <code value="UMB"/>
            <display value="Member Number"/>
          </coding>
          <text value="Member Number"/>
        </type>
        <system value="http://example.org/cdex/payer/member-ids"/>
        <value value="Member123"/>
      </identifier>
      <identifier>
        <use value="usual"/>
        <type>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"/>
            <code value="pat"/>
            <display value="Patient Account Number"/>
          </coding>
          <text value="Patient Account Number"/>
        </type>
        <system value="http://example.org/cdex/provider/patient-ids"/>
        <value value="PA-123"/>
      </identifier>
      <name>
        <family value="Shaw"/>
        <given value="Amy"/>
      </name>
      <birthDate value="1987-02-20"/>
    </Patient>
  </contained>
  <identifier>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
        <code value="tracking-id"/>
        <display value="Tracking Id"/>
      </coding>
      <text value="Re-Association Tracking Control Number"/>
    </type>
    <system value="http://example.org/payer"/>
    <value value="trackingid123"/>
  </identifier>
  <status value="requested"/>
  <intent value="order"/>
  <code>
    <coding>
      <system value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
      <code value="attachment-request"/>
    </coding>
    <text value="Attachment Request"/>
  </code>
  <for>
    <reference value="#patient"/>
  </for>
  <authoredOn value="2022-06-17T16:16:06Z"/>
  <lastModified value="2022-06-17T16:16:06Z"/>
  <requester>
    <identifier>
      <system value="http://example.org/cdex/payer/payer-ids"/>
      <value value="Payer123"/>
    </identifier>
  </requester>
  <owner>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="9941339108"/>
    </identifier>
  </owner>
  <reasonCode>
    <coding>
      <system value="http://hl7.org/fhir/claim-use"/>
      <code value="preauthorization"/>
      <display value="Preauthorization"/>
    </coding>
    <text value="preauthorization"/>
  </reasonCode>
  <reasonReference>
    <identifier>
      <system value="http://example.org/cdex/payer/claim-ids"/>
      <value value="Preauth123"/>
    </identifier>
  </reasonReference>
  <restriction>
    <period>
      <end value="2022-06-21"/>
    </period>
  </restriction>
  <input>
    <extension
               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber">
      <valuePositiveInt value="1"/>
    </extension>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp"/>
        <code value="data-code"/>
      </coding>
    </type>
    <valueCodeableConcept>
      <coding>
        <system value="http://loinc.org"/>
        <code value="11506-3"/>
        <display value="Progress note"/>
      </coding>
      <text value="Progress note"/>
    </valueCodeableConcept>
  </input>
  <input>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
        <code value="signature-flag"/>
      </coding>
    </type>
    <valueBoolean value="true"/>
  </input>
  <input>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
        <code value="payer-url"/>
      </coding>
    </type>
    <valueUrl value="http://example.org/cdex/payer/$submit-attachment"/>
  </input>
  <input>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
        <code value="service-date"/>
      </coding>
    </type>
    <valueDate value="2022-06-13"/>
  </input>
</Task>