This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.1.0-preview: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

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: Questionnaire Task example - JSON Representation

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{
  "resourceType" : "Task",
  "id" : "questionnaire-example",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Task questionnaire-example</b></p><a name=\"questionnaire-example\"> </a><a name=\"hcquestionnaire-example\"> </a><a name=\"questionnaire-example-en-US\"> </a><p><b>basedOn</b>: <a href=\"MedicationRequest-example.html\">MedicationRequest: identifier = http://www.bmc.nl/portal/prescriptions#12345689\u00a0(use:\u00a0official,\u00a0); status = draft; intent = order; medication[x] = -&gt;Medication Azithromycin 250 mg oral tablet; authoredOn = 2015-01-15; reasonCode = Traveler's Diarrhea (disorder); note = Patient told to take with food</a></p><p><b>status</b>: Ready</p><p><b>intent</b>: order</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/sdc/CodeSystem/temp complete-questionnaire}\">Complete Questionnaire</span></p><p><b>for</b>: <a href=\"Patient-example.html\">Amy V. Shaw  Female, DoB: 1987-02-20 ( Medical Record Number:\u00a01032702\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>encounter</b>: <a href=\"Encounter-example.html\">Encounter: identifier = http://www.amc.nl/zorgportal/identifiers/visits#v1451\u00a0(use:\u00a0official,\u00a0); status = in-progress; class = ambulatory (ActCode#AMB); type = Patient-initiated encounter; priority = Non-urgent cardiological admission; reasonCode = Heart valve replacement</a></p><p><b>authoredOn</b>: 2018-08-09</p><p><b>requester</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v311@3.1.1&amp;canonical=http://example.org/fhir/Organization/payer\">??</a></p><p><b>reasonCode</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp reason-prior-auth}\">Needed for prior authorization</span></p><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/sdc/CodeSystem/temp questionnaire}\">Questionnaire</span></p><p><b>value</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v311@3.1.1&amp;canonical=http://example.org/Questionnaire/XYZ|2\">http://example.org/Questionnaire/XYZ|2</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/uv/sdc/CodeSystem/temp response-endpoint}\">Response Endpoint</span></p><p><b>value</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v311@3.1.1&amp;canonical=http://example.org/somePayer\">http://example.org/somePayer</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp after-completion-action}\">After-completion action</span></p><p><b>value</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp prior-auth-include}\">Include in prior authorization</span></p></blockquote></div>"
  },
  "basedOn" : [
    {
      🔗 "reference" : "MedicationRequest/example"
    }
  ],
  "status" : "ready",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
        "code" : "complete-questionnaire"
      }
    ]
  },
  "for" : {
    🔗 "reference" : "Patient/example"
  },
  "encounter" : {
    🔗 "reference" : "Encounter/example"
  },
  "authoredOn" : "2018-08-09",
  "requester" : {
    "reference" : "http://example.org/fhir/Organization/payer"
  },
  "reasonCode" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
        "code" : "reason-prior-auth"
      }
    ],
    "text" : "Needed for prior authorization"
  },
  "input" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
            "code" : "questionnaire"
          }
        ]
      },
      "valueCanonical" : "http://example.org/Questionnaire/XYZ|2"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
            "code" : "response-endpoint"
          }
        ]
      },
      "valueUrl" : "http://example.org/somePayer"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
            "code" : "after-completion-action"
          }
        ]
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
            "code" : "prior-auth-include",
            "display" : "Include in prior authorization"
          }
        ]
      }
    }
  ]
}