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<Task xmlns="http://hl7.org/fhir">
<id value="cdex-task-example19"/>
<text>
<status value="extensions"/>
<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: Member123 (use: usual, ))</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: Member123 (use: usual, ))</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>
</text>
<contained>
<Patient>
<id value="patient"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MB"/>
<display value="Member Number"/>
</coding>
<text value="Member Number"/>
</type>
<system value="http://example.org/cdex/payer/member-ids"/>
<value value="Member123"/>
</identifier>
<name>
<family value="Shaw"/>
<given value="Amy"/>
</name>
<birthDate value="1987-02-20"/>
</Patient>
</contained>
<contained>
<PractitionerRole>
<id value="practitionerrole"/>
<practitioner>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="9941339100"/>
</identifier>
</practitioner>
<organization>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</identifier>
</organization>
</PractitionerRole>
</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-pas/CodeSystem/PASTempCodes"/>
<code value="attachment-request-code"/>
</coding>
<text value="Coded 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>
<reference value="#practitionerrole"/>
</owner>
<reasonCode>
<coding>
<system value="http://hl7.org/fhir/claim-use"/>
<code value="claim"/>
<display value="Claim"/>
</coding>
<text value="claim"/>
</reasonCode>
<reasonReference>
<identifier>
<system value="http://example.org/cdex/payer/claim-ids"/>
<value value="Claim123"/>
</identifier>
</reasonReference>
<restriction>
<period>
<end value="2022-06-21"/>
</period>
</restriction>
<input>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber">
<valueInteger value="1"/>
</extension>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
<code value="attachments-needed"/>
</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-pas/CodeSystem/PASTempCodes"/>
<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>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="purpose-of-use"/>
</coding>
</type>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
<code value="CLMATTCH"/>
<display value="claim attachment"/>
</coding>
</valueCodeableConcept>
</input>
</Task>