Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 2) 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

: Submit Claim Subscriber Example - JSON Representation

Page standards status: Informative

Raw json | Download


{
  "resourceType" : "Patient",
  "id" : "SubscriberExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>JOE SMITH </b> male, DoB Unknown ( id:\u00a012345678901)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"A patient's military status.\"><a href=\"StructureDefinition-extension-militaryStatus.html\">null:</a></td><td colspan=\"3\"><ul><li><span title=\"Codes: {https://codesystem.x12.org/005010/584 RU}\">RU</span></li></ul></td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://codesystem.x12.org/005010/584",
            "code" : "RU"
          }
        ]
      }
    }
  ],
  "identifier" : [
    {
      "system" : "http://example.org/MIN",
      "value" : "12345678901"
    }
  ],
  "name" : [
    {
      "family" : "SMITH",
      "given" : [
        "JOE"
      ]
    }
  ],
  "gender" : "male"
}