Da Vinci Prior Authorization Support (PAS) FHIR IG
2.1.0 - STU 2.1 United States of America flag

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 - XML Representation

Page standards status: Informative

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<Patient xmlns="http://hl7.org/fhir">
  <id value="BeneficiaryExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="MB"/>
      </coding>
    </type>
    <system value="http://example.org/MIN"/>
    <value value="12345678902"/>
  </identifier>
  <name>
    <family value="SMITH"/>
    <given value="JESSE"/>
  </name>
  <gender value="female"/>
  <birthDate value="1947-01-18"/>
  <address>
    <country value="US"/>
  </address>
  <multipleBirthInteger value="1"/>
</Patient>