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 Referral Request Example - JSON Representation

Page standards status: Informative

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{
  "resourceType" : "ServiceRequest",
  "id" : "ReferralRequestExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ServiceRequest ReferralRequestExample</b></p><a name=\"ReferralRequestExample\"> </a><a name=\"hcReferralRequestExample\"> </a><a name=\"ReferralRequestExample-en-US\"> </a><p><b>status</b>: Active</p><p><b>intent</b>: Order</p><p><b>code</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 3}\">Consultation</span></p><p><b>quantity</b>: 1 visit<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  code1 = '1')</span></p><p><b>subject</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( Member Number)</a></p></div>"
  },
  "status" : "active",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "https://codesystem.x12.org/005010/1365",
        "code" : "3",
        "display" : "Consultation"
      }
    ]
  },
  "quantityQuantity" : {
    "value" : 1,
    "unit" : "visit",
    "system" : "http://unitsofmeasure.org",
    "code" : "1"
  },
  "subject" : {
    🔗 "reference" : "Patient/SubscriberExample"
  }
}