This page is part of the Documentation Templates and Rules (v2.0.1: STU 2.0) 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
• JSON

: QuestionnairePackageInputParamsExample - XML Representation

Raw xml | Download

<Parameters xmlns="http://hl7.org/fhir">
  <id value="QuestionnairePackageInputParamsExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-input-parameters"/>
  </meta>
  <parameter>
    <name value="coverage"/>
    <resource>
      <Coverage>
        <id value="CoverageExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage"/>
        </meta>
        <contained>
          <Organization>
            <id value="OrgExample"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
            </meta>
            <active value="true"/>
            <type>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/organization-type"/>
                <code value="pay"/>
                <display value="Payer"/>
              </coding>
            </type>
            <name value="Insurance Company"/>
            <telecom>
              <system value="phone"/>
              <value value="860-547-5001"/>
              <use value="work"/>
            </telecom>
            <address>
              <line value="680 Asylum Street"/>
              <city value="Hartford"/>
              <state value="CT"/>
              <postalCode value="06155"/>
              <country value="US"/>
            </address>
          </Organization>
        </contained>
        <status value="active"/>
        <subscriber>🔗 
          <reference value="Patient/examplepatient"/>
        </subscriber>
        <subscriberId value="PFP123450000"/>
        <beneficiary>🔗 
          <reference value="Patient/examplepatient"/>
        </beneficiary>
        <relationship>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
            <code value="self"/>
            <display value="Self"/>
          </coding>
        </relationship>
        <period>
          <start value="2022-01-01"/>
          <end value="2023-01-01"/>
        </period>
        <payor>
          <reference value="#OrgExample"/>
        </payor>
        <class>
          <type>
            <coding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
              <code value="plan"/>
              <display value="Plan"/>
            </coding>
          </type>
          <value value="Premim Family Plus"/>
          <name value="Premim Family Plus Plan"/>
        </class>
      </Coverage>
    </resource>
  </parameter>
  <parameter>
    <name value="order"/>
    <resource>
      <ServiceRequest>
        <id value="ServiceRequestExample"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest"/>
        </meta>
        <status value="draft"/>
        <intent value="original-order"/>
        <code>
          <coding>
            <system value="http://loinc.org"/>
            <code value="24338-6"/>
          </coding>
          <text value="Gas panel - Blood"/>
        </code>
        <subject>🔗 
          <reference value="Patient/examplepatient"/>
        </subject>
        <occurrenceDateTime value="2019-05-08T09:33:27+07:00"/>
        <authoredOn value="2019-09-18T07:53:21+07:00"/>
        <requester>🔗 
          <reference value="Practitioner/PractitionerExample"/>
        </requester>
        <reasonCode>
          <coding>
            <system value="http://snomed.info/sct"/>
            <code value="4565000"/>
          </coding>
          <text value="Decreased oxygen affinity"/>
        </reasonCode>
      </ServiceRequest>
    </resource>
  </parameter>
</Parameters>