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{
"resourceType" : "Task",
"id" : "cdex-task-example19",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Task cdex-task-example19</b></p><a name=\"cdex-task-example19\"> </a><a name=\"hccdex-task-example19\"> </a><a name=\"cdex-task-example19-en-US\"> </a><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>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes attachment-request-code}\">Coded Attachment Request</span></p><p><b>for</b>: <a href=\"#hccdex-task-example19/patient\">Amy Shaw (no stated gender), DoB: 1987-02-20 ( Member Number:\u00a0Member123\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>authoredOn</b>: 2022-06-17 16:16:06+0000</p><p><b>lastModified</b>: 2022-06-17 16:16:06+0000</p><p><b>requester</b>: Identifier: <code>http://example.org/cdex/payer/payer-ids</code>/Payer123</p><p><b>owner</b>: <a href=\"#hccdex-task-example19/practitionerrole\">PractitionerRole</a></p><p><b>reasonCode</b>: <span title=\"Codes:{http://hl7.org/fhir/claim-use claim}\">claim</span></p><p><b>reasonReference</b>: Identifier: <code>http://example.org/cdex/payer/claim-ids</code>/Claim123</p><h3>Restrictions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Period</b></td></tr><tr><td style=\"display: none\">*</td><td>?? --> 2022-06-21</td></tr></table><blockquote><p><b>input</b></p><p><b>PALineNumber</b>: 1</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes attachments-needed}\">Attachments Needed</span></p><p><b>value</b>: <span title=\"Codes:{http://loinc.org 11506-3}\">Progress note</span></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp signature-flag}\">Signature Flag</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes payer-url}\">Payer URL</span></p><p><b>value</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=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>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp service-date}\">Service Date</span></p><p><b>value</b>: 2022-06-13</p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp purpose-of-use}\">Purpose Of Use</span></p><p><b>value</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActReason CLMATTCH}\">claim attachment</span></p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Patient #patient</b></p><a name=\"cdex-task-example19/patient\"> </a><a name=\"hccdex-task-example19/patient\"> </a><a name=\"cdex-task-example19/patient-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Amy Shaw (no stated gender), DoB: 1987-02-20 ( Member Number:\u00a0Member123\u00a0(use:\u00a0usual,\u00a0))</p><hr/></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: PractitionerRole #practitionerrole</b></p><a name=\"cdex-task-example19/practitionerrole\"> </a><a name=\"hccdex-task-example19/practitionerrole\"> </a><a name=\"cdex-task-example19/practitionerrole-en-US\"> </a><p><b>practitioner</b>: Identifier: <a href=\"http://terminology.hl7.org/5.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/9941339100</p><p><b>organization</b>: Identifier: <a href=\"http://terminology.hl7.org/5.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p></blockquote></div>"
},
"contained" : [
{
"resourceType" : "Patient",
"id" : "patient",
"identifier" : [
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB",
"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"
},
{
"resourceType" : "PractitionerRole",
"id" : "practitionerrole",
"practitioner" : {
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "9941339100"
}
},
"organization" : {
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1234567893"
}
}
}
],
"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-pas/CodeSystem/PASTempCodes",
"code" : "attachment-request-code"
}
],
"text" : "Coded 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" : {
"reference" : "#practitionerrole"
},
"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-paLineNumber",
"valueInteger" : 1
}
],
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
"code" : "attachments-needed"
}
]
},
"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-pas/CodeSystem/PASTempCodes",
"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"
},
{
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
"code" : "purpose-of-use"
}
]
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"code" : "CLMATTCH",
"display" : "claim attachment"
}
]
}
}
]
}