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Page standards status: Informative |
This example is based on draft profile elements.
Resource Task "cdex-task-example28"
Profile: CDex Task Attachment Request Profile
identifier: Re-Association Tracking Control Number: trackingid1056
status: requested
intent: order
code: Attachment Request Questionnaire (CDex Temporary Code System#attachment-request-questionnaire)
identifier: Member Number: Member123 (use: USUAL), Patient Account Number: PA-123 (use: USUAL)
name: Amy Shaw
birthDate: 1987-02-20
authoredOn: 2022-06-17 16:16:06+0000
lastModified: 2022-06-17 16:16:06+0000
requester:
practitioner:
organization:
reasonCode: preauthorization (Use#preauthorization "Preauthorization")
reasonReference:
- | Period |
* | ?? --> 2022-06-21 |
input
ServiceLineNumber: 1
type: Questionnaire (Temporary SDC Codes#questionnaire)
input
type: Payer URL (CDex Temporary Code System#payer-url)
input
type: Purpose Of Use (CDex Temporary Code System#purpose-of-use)
value: coverage authorization (ActReason#COVAUTH)
input
type: Signature Flag (CDex Temporary Code System#signature-flag)
value: true
Amy Shaw (no stated gender), DoB: 1987-02-20 ( Member Number: Member123 (use: USUAL))
Other Id: Patient Account Number: PA-123 (use: USUAL)
Generated Narrative: PractitionerRole #practitionerrole
practitioner:
organization: