This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) 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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: Additional Information Task Example - XML Representation

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<Task xmlns="http://hl7.org/fhir">
  <id value="AdditionalInformationTaskExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Task AdditionalInformationTaskExample</b></p><a name="AdditionalInformationTaskExample"> </a><a name="hcAdditionalInformationTaskExample"> </a><a name="AdditionalInformationTaskExample-en-US"> </a><p><b>identifier</b>: <code>http://example.org/ITEM_TRACE_NUMBER</code>/1122334</p><p><b>status</b>: Requested</p><p><b>intent</b>: order</p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes attachment-request-code}">Attach Request Code</span></p><p><b>for</b>: <a href="Patient-BeneficiaryExample.html">JESSE SMITH  Female, DoB: 1947-01-18 ( http://example.org/MIN#12345678902)</a></p><p><b>requester</b>: Identifier: <a href="http://terminology.hl7.org/5.3.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/789312</p><p><b>owner</b>: Identifier: <a href="http://terminology.hl7.org/5.3.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/789312</p><p><b>reasonCode</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes priorAuthorization}">Prior Authorization Information Request</span></p><p><b>reasonReference</b>: <a href="Claim-MedicalServicesAuthorizationExample.html">Claim: identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><blockquote><p><b>input</b></p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes payer-url}">Payer URL</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/payerURL">http://example.org/payerURL</a></p></blockquote><blockquote><p><b>input</b></p><p><b>PALineNumber</b>: 1</p><p><b>type</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes attachments-needed}">Attachments Needed</span></p><p><b>value</b>: <span title="Codes:{http://loinc.org 28570-0}">Procedure note</span></p></blockquote></div>
  </text>
  <identifier>
    <system value="http://example.org/ITEM_TRACE_NUMBER"/>
    <value value="1122334"/>
  </identifier>
  <status value="requested"/>
  <intent value="order"/>
  <code>
    <coding>
      <system
              value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
      <code value="attachment-request-code"/>
    </coding>
  </code>
  <for>🔗 
    <reference value="Patient/BeneficiaryExample"/>
  </for>
  <requester>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="789312"/>
    </identifier>
  </requester>
  <owner>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="789312"/>
    </identifier>
  </owner>
  <reasonCode>
    <coding>
      <system
              value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
      <code value="priorAuthorization"/>
    </coding>
  </reasonCode>
  <reasonReference>🔗 
    <reference value="Claim/MedicalServicesAuthorizationExample"/>
  </reasonReference>
  <input>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
        <code value="payer-url"/>
      </coding>
    </type>
    <valueUrl value="http://example.org/payerURL"/>
  </input>
  <input>
    <extension
               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber">
      <valueInteger value="1"/>
    </extension>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
        <code value="attachments-needed"/>
      </coding>
    </type>
    <valueCodeableConcept>
      <coding>
        <system value="http://loinc.org"/>
        <code value="28570-0"/>
      </coding>
    </valueCodeableConcept>
  </input>
</Task>