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<Task xmlns="http://hl7.org/fhir">
<id value="cdex-task-example31"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-data-request"/>
<tag>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="claims-processing"/>
</tag>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Task</b><a name="cdex-task-example31"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Task "cdex-task-example31" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-cdex-task-data-request.html">CDex Task Data Request Profile</a></p><p style="margin-bottom: 0px">Tag: <span title="{http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp}">http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp</span></p></div><p><b>status</b>: completed</p><p><b>intent</b>: order</p><p><b>code</b>: Data Request Questionnaire <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#data-request-questionnaire)</span></p><p><b>for</b>: <span/></p><p><b>authoredOn</b>: 2022-06-17 16:16:06+0000</p><p><b>lastModified</b>: 2022-06-18 16:16:06+0000</p><p><b>requester</b>: <span/></p><p><b>owner</b>: <span/></p><p><b>reasonReference</b>: <span/></p><blockquote><p><b>input</b></p><p><b>type</b>: Questionnaire <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/uv/sdc/STU3/CodeSystem-temp.html">Temporary SDC Codes</a>#questionnaire)</span></p><p><b>value</b>: <a href="Questionnaire-cdex-questionnaire-example2.html">Home Oxygen Therapy Questionnaire</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Purpose Of Use <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#purpose-of-use)</span></p><p><b>value</b>: coverage under policy or program <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-ActReason.html">ActReason</a>#COVERAGE)</span></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Signature Flag <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#signature-flag)</span></p><p><b>value</b>: true</p></blockquote><h3>Outputs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Questionnaire Response <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/uv/sdc/STU3/CodeSystem-temp.html">Temporary SDC Codes</a>#questionnaire-response)</span></td><td><a href="QuestionnaireResponse-cdex-questionnaireresponse-example4.html">QuestionnaireResponse/cdex-questionnaireresponse-example4</a></td></tr></table></div>
</text>
<status value="completed"/>
<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://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp"/>
<code value="UMB"/>
<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="2022-06-18T16:16:06Z"/>
<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-example2"/>
</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>
<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>
<output>
<type>
<coding>
<system value="http://hl7.org/fhir/uv/sdc/CodeSystem/temp"/>
<code value="questionnaire-response"/>
</coding>
</type>
<valueReference>
<reference
value="QuestionnaireResponse/cdex-questionnaireresponse-example4"/>
</valueReference>
</output>
</Task>
IG © 2023+ HL7 International - Patient Care Work Group. Package hl7.fhir.us.davinci-cdex#2.0.0 based on FHIR 4.0.1. Generated 2023-03-22
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