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

• Narrative Content
• XML
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• TTL

: Questionnaire Task example - XML Representation

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<Task xmlns="http://hl7.org/fhir">
  <id value="questionnaire-example"/>
  <text>
    <status value="generated"/>
    <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 (use: official, ); 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: 1032702 (use: usual, ))</a></p><p><b>encounter</b>: <a href="Encounter-example.html">Encounter: identifier = http://www.amc.nl/zorgportal/identifiers/visits#v1451 (use: official, ); 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.v610@6.1.0&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.v610@6.1.0&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.v610@6.1.0&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>
  </text>
  <basedOn>🔗 
    <reference value="MedicationRequest/example"/>
  </basedOn>
  <status value="ready"/>
  <intent value="order"/>
  <code>
    <coding>
      <system value="http://hl7.org/fhir/uv/sdc/CodeSystem/temp"/>
      <code value="complete-questionnaire"/>
    </coding>
  </code>
  <for>🔗 
    <reference value="Patient/example"/>
  </for>
  <encounter>🔗 
    <reference value="Encounter/example"/>
  </encounter>
  <authoredOn value="2018-08-09"/>
  <requester>
    <reference value="http://example.org/fhir/Organization/payer"/>
  </requester>
  <reasonCode>
    <coding>
      <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
      <code value="reason-prior-auth"/>
    </coding>
    <text value="Needed for prior authorization"/>
  </reasonCode>
  <input>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/uv/sdc/CodeSystem/temp"/>
        <code value="questionnaire"/>
      </coding>
    </type>
    <valueCanonical value="http://example.org/Questionnaire/XYZ|2"/>
  </input>
  <input>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/uv/sdc/CodeSystem/temp"/>
        <code value="response-endpoint"/>
      </coding>
    </type>
    <valueUrl value="http://example.org/somePayer"/>
  </input>
  <input>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
        <code value="after-completion-action"/>
      </coding>
    </type>
    <valueCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
        <code value="prior-auth-include"/>
        <display value="Include in prior authorization"/>
      </coding>
    </valueCodeableConcept>
  </input>
</Task>