Da Vinci - Documentation Templates and Rules
2.2.0-ballot - STU 2.2 - Ballot United States of America flag

This page is part of the Documentation Templates and Rules (v2.2.0-ballot: STU 2.2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 2.1.0. For a full list of available versions, see the Directory of published versions

Example Parameters: $questionnaire-package Input Parameters Example

Parameters

coverage

Coverage/CoverageExample

status: Active

subscriber: Anonymous Patient Male, DoB: 1996-12-23

subscriberId: PFP123450000

beneficiary: Anonymous Patient Male, DoB: 1996-12-23

relationship: Self

period: 2022-01-01 --> 2023-01-01

payor: Organization Insurance Company

Classes

-TypeValueName
*PlanPremim Family PlusPremim Family Plus Plan

identifier: Clinical Laboratory Improvement Amendments/10D0202020

active: true

type: Payer

name: Insurance Company

telecom: ph: 860-547-5001(Work)

address: 680 Asylum Street Hartford CT 06155 US

order

ServiceRequest/ServiceRequestExample

status: Active

intent: Original Order

code: Gas panel - Blood

subject: Anonymous Patient Male, DoB: 1996-12-23

occurrence: 2019-05-08 09:33:27+0700

authoredOn: 2019-09-18 07:53:21+0700

requester: Practitioner Jane Doe

reasonCode: Decreased oxygen affinity

questionnairehttp://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire|2.1.0