Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1 United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.1.0: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example MedicationRequest: MedicationRequest annotated example

Page standards status: Informative

Generated Narrative: MedicationRequest annotated-example

Coverage Information

url

coverage

value: Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23

url

covered

value: conditional

url

pa-needed

value: satisfied

url

doc-needed

value: admin

url

doc-purpose

value: withclaim

url

info-needed

value: performer

url

billingCode

value: Current Procedural Terminology (CPT®) 77067: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

url

reason

value: In-network required unless exigent circumstances

code: Authorization out-of-network only

value: true

qualification: Out-of-network prior auth does not apply if delivery occurs at a service site designated as 'remote'

url

detail

url

questionnaire

value: http://example.org/some-payer/Questionnaire/123|1.3.0

url

date

value: 2019-02-15

url

coverage-assertion-id

value: 12345ABC

url

satisfied-pa-id

value: XXYYZ

url

contact

value: http://some-payer.org/xyz-sub-org/get-help-here.html

url

expiry-date

value: 2019-08-01

status: Draft

intent: Original Order

medication: mycophenolate mofetil 250 MG Oral Capsule [Cellcept]

subject: Jane Smith

encounter: ??

authoredOn: 2019-02-15

requester: Dr. Jones

note: Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted. Please note prior authorization # 12345 on claim submission. (By XYZ Insurance @2019-02-15 15:07:18-0500)

dosageInstruction

text: 6 tablets every 12 hours.

timing: Once per 12 hours

DoseAndRates

-Dose[x]
*6 tablet