Da Vinci Prior Authorization Support (PAS) FHIR IG
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This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Submit Claim Beneficiary Example - JSON Representation

Page standards status: Informative

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{
  "resourceType" : "Patient",
  "id" : "BeneficiaryExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Patient BeneficiaryExample</b></p><a name=\"BeneficiaryExample\"> </a><a name=\"hcBeneficiaryExample\"> </a><a name=\"BeneficiaryExample-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">JESSE SMITH  Female, DoB: 1947-01-18 ( Member Number)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Known multipleBirth status of Patient\">Multiple Birth:</td><td colspan=\"3\">1</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\">US </td></tr></table></div>"
  },
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "MB"
          }
        ]
      },
      "system" : "http://example.org/MIN",
      "value" : "12345678902"
    }
  ],
  "name" : [
    {
      "family" : "SMITH",
      "given" : [
        "JESSE"
      ]
    }
  ],
  "gender" : "female",
  "birthDate" : "1947-01-18",
  "address" : [
    {
      "country" : "US"
    }
  ],
  "multipleBirthInteger" : 1
}