This page is part of the Da Vinci Payer Data Exchange (v2.2.0: STU2.2) 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

• Narrative Content
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Example Consent: Provider Treatment Attestation Consent Example for Bulk Member Match

Participants

Role	Details
Patient	Johnny Appleseed Male, DoB: 1986-01-01 ( Member Number)
Party	Dr. Susan Smith (Identifier: United States National Provider Identifier/1234567893)
Manager	Provider 1 (Identifier: United States National Provider Identifier/1982947230)

This consent is made under the policy https://example.org/provider-attestation-policy .

Rule	Time Period	Who	What
permit
permit	Period: 2024-01-15 --> (ongoing)	information recipient: Dr. Susan Smith (Identifier: United States National Provider Identifier/1234567893) healthcare provider: Provider 1 (Identifier: United States National Provider Identifier/1982947230)	Purpose: ActReason: TREAT (treatment) Purpose: ActReason: HPAYMT (healthcare payment) Purpose: ActReason: HOPERAT (healthcare operations)
Documentation for this format