This page is part of the Da Vinci Clinical Documentation Exchange (v2.1.0-snapshot: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

• Narrative Content
• XML
• JSON

: CDex Inline Task Example 22 - XML Representation

Raw xml | Download

<Task xmlns="http://hl7.org/fhir">
  <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>
      <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>
  <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="trackingid1012"/>
  </identifier>
  <status value="requested"/>
  <intent value="order"/>
  <code>
    <coding>
      <system
              value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
      <code value="attachment-request-questionnaire"/>
    </coding>
    <text value="Attachment Request Questionnaire"/>
  </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="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-paLineNumber">
      <valueInteger value="1"/>
    </extension>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
        <code value="questionnaires-needed"/>
      </coding>
    </type>
    <valueCanonical value="http://example.org/cdex-questionnaire-example1"/>
  </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="purpose-of-use"/>
      </coding>
    </type>
    <valueCodeableConcept>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="COVAUTH"/>
        <display value="coverage authorization"/>
      </coding>
    </valueCodeableConcept>
  </input>
</Task>