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
Page standards status: Informative |
<Task xmlns="http://hl7.org/fhir">
<status value="requested"/>
<intent value="order"/>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="data-request-questionnaire"/>
</coding>
</code>
<for>
<identifier>
<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>
</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>
<reasonReference>
<identifier>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="FILL"/>
<display value="Filler Identifier"/>
</coding>
<text value="Payer Claim ID"/>
</type>
<system value="http://example.org/cdex/payer/claim-ids"/>
<value value="Claim123"/>
</identifier>
</reasonReference>
<input>
<type>
<coding>
<system value="http://hl7.org/fhir/uv/sdc/CodeSystem/temp"/>
<code value="questionnaire"/>
</coding>
</type>
<valueCanonical value="http://example.org/cdex-questionnaire-example1"/>
</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="COVERAGE"/>
</coding>
</valueCodeableConcept>
</input>
</Task>