provider-treatment-attestation-1
type: Consent
node role: treeRoot
resource.id:
  value: provider-treatment-attestation-1
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Consent provider-treatment-attestation-1 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 #xD; 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) #xD; Documentation for this format
consent.status:
  value: active
consent.scope:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/consentscope
    coding.code:
      value: patient-privacy
consent.category:
  index: 0
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-ActCode
    coding.code:
      value: IDSCL
    coding.display:
      value: Information Disclosure
consent.category:
  index: 1
  codeable concept.coding: http://loinc.org/rdf#64292-6
    index: 0
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 64292-6
    coding.display:
      value: Release of information consent
consent.patient:
  link: http://hl7.org/fhir/us/davinci-pdex/Patient/1
  reference.reference:
    value: Patient/1
consent.date time:
  value: 2024-11-14T10:30:00Z
consent.performer:
  index: 0
  reference.identifier:
    identifier.system:
      value: http://hl7.org/fhir/sid/us-npi
    identifier.value:
      value: 1234567893
  reference.display:
    value: Dr. Susan Smith
consent.organization:
  index: 0
  reference.identifier:
    identifier.system:
      value: http://hl7.org/fhir/sid/us-npi
    identifier.value:
      value: 1982947230
  reference.display:
    value: Provider 1
consent.source reference:
  link: http://hl7.org/fhir/us/davinci-pdex/DocumentReference/provider-attestation-doc-1
  reference.reference:
    value: DocumentReference/provider-attestation-doc-1
  reference.display:
    value: Provider Attestation Form
consent.policy:
  index: 0
  consent.policy.authority:
    value: https://example.org/health-authority
  consent.policy.uri:
    value: https://example.org/provider-attestation-policy
consent.verification:
  index: 0
  consent.verification.verified:
    value: true
  consent.verification.verified with:
    link: http://hl7.org/fhir/us/davinci-pdex/Patient/1
    reference.reference:
      value: Patient/1
    reference.display:
      value: Patricia Ann Person
  consent.verification.verification date:
    value: 2024-11-14T10:30:00Z
consent.provision:
  consent.provision.type:
    value: permit
  consent.provision.period:
    period.start:
      value: 2024-01-15
  consent.provision.actor:
    index: 0
    consent.provision.actor.role:
      codeable concept.coding:
        index: 0
    consent.provision.actor.reference:
      reference.display:
        value: Dr. Susan Smith
  consent.provision.actor:
    index: 1
    consent.provision.actor.role:
      codeable concept.coding:
        index: 0
    consent.provision.actor.reference:
      reference.display:
        value: Provider 1
  consent.provision.purpose:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-ActReason
    coding.code:
      value: TREAT
    coding.display:
      value: treatment
  consent.provision.purpose:
    index: 1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-ActReason
    coding.code:
      value: HPAYMT
    coding.display:
      value: healthcare payment
  consent.provision.purpose:
    index: 2
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-ActReason
    coding.code:
      value: HOPERAT
    coding.display:
      value: healthcare operations

value: IRCP

value: information recipient

value: 1234567893

value: PROV

value: healthcare provider

value: 1982947230