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

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: Additional Information Task Example - JSON Representation

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{
  "resourceType" : "Task",
  "id" : "AdditionalInformationTaskExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-task"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<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 ( Member Number)</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>"
  },
  "identifier" : [
    {
      "system" : "http://example.org/ITEM_TRACE_NUMBER",
      "value" : "1122334"
    }
  ],
  "status" : "requested",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "attachment-request-code"
      }
    ]
  },
  "for" : {
    🔗 "reference" : "Patient/BeneficiaryExample"
  },
  "requester" : {
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "789312"
    }
  },
  "owner" : {
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "789312"
    }
  },
  "reasonCode" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "priorAuthorization"
      }
    ]
  },
  "reasonReference" : {
    🔗 "reference" : "Claim/MedicalServicesAuthorizationExample"
  },
  "input" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
            "code" : "payer-url"
          }
        ]
      },
      "valueUrl" : "http://example.org/payerURL"
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber",
          "valueInteger" : 1
        }
      ],
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
            "code" : "attachments-needed"
          }
        ]
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "28570-0"
          }
        ]
      }
    }
  ]
}