US Prescription Drug Monitoring Program (PDMP)
1.0.0 - STU1 United States of America flag

This page is part of the US Prescription Drug Monitoring Program (PDMP) (v1.0.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: pdmp-history-input-parameters-4-delegate - XML Representation

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<Parameters xmlns="http://hl7.org/fhir">
  <id value="pdmp-history-input-parameters-4-delegate"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-parameters-request"/>
  </meta>
  <parameter>
    <name value="patient"/>
    <resource>
      <Patient>
        <id value="patient-req-4"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/pdmp/StructureDefinition/pdmp-patient"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Patient: Jules Julien</div>
        </text>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="MR"/>
              <display value="Medical record number"/>
            </coding>
          </type>
          <system value="http://highview-va.example.org/mrn"/>
          <value value="10035666601"/>
        </identifier>
        <active value="true"/>
        <name>
          <family value="Julien"/>
          <given value="Jules"/>
        </name>
        <gender value="female"/>
        <birthDate value="1980-05-20"/>
        <address>
          <line value="10023 Santa Clara Blvd"/>
          <state value="MA"/>
          <postalCode value="01742"/>
        </address>
      </Patient>
    </resource>
  </parameter>
  <parameter>
    <name value="authorized-practitioner"/>
    <resource>
      <Practitioner>
        <id value="practitioner-req-4"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Mari Kimble MD</div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1665015602"/>
        </identifier>
        <name>
          <family value="Kimble"/>
        </name>
      </Practitioner>
    </resource>
  </parameter>
  <parameter>
    <name value="authorized-practitioner-role"/>
    <resource>
      <PractitionerRole>
        <id value="practitionerrole-req-4"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Mari Kimble, Internal Medicine, Highview VA Clinic</div>
        </text>
        <practitioner>
          <reference value="Practitioner/practitioner-req-4"/>
          <display value="Mari Kimble"/>
        </practitioner>
        <organization>
          <reference value="Organization/organization-req-4"/>
          <display value="Highview VA Clinic"/>
        </organization>
        <specialty>
          <coding>
            <system value="http://nucc.org/provider-taxonomy"/>
            <code value="207R00000X"/>
            <display value="Internal Medicine Physician"/>
          </coding>
        </specialty>
        <telecom>
          <system value="phone"/>
          <value value="508-856-1234"/>
        </telecom>
      </PractitionerRole>
    </resource>
  </parameter>
  <parameter>
    <name value="authorized-practitioner-organization"/>
    <resource>
      <Organization>
        <id value="organization-req-4"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Highview VA Clinic</div>
        </text>
        <active value="true"/>
        <name value="Highview VA Clinic"/>
        <telecom>
          <system value="phone"/>
          <value value="508-856-5555"/>
        </telecom>
        <address>
          <line value="2002 Highview Ln"/>
          <city value="Worcester"/>
          <state value="MA"/>
          <postalCode value="01604"/>
        </address>
      </Organization>
    </resource>
  </parameter>
  <parameter>
    <name value="delegate-practitioner"/>
    <resource>
      <Practitioner>
        <id value="practitioner-req-4-del"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner|6.1.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Boris Bartok</div>
        </text>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1554505606"/>
        </identifier>
        <name>
          <family value="Bartok"/>
        </name>
      </Practitioner>
    </resource>
  </parameter>
  <parameter>
    <name value="delegate-practitioner-role"/>
    <resource>
      <PractitionerRole>
        <id value="practitionerrole-req-4-del"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole|6.1.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Boris Bartok RN, Highview VA Clinic</div>
        </text>
        <practitioner>
          <reference value="Practitioner/practitioner-req-4-del"/>
          <display value="Mari Kimble"/>
        </practitioner>
        <organization>
          <reference value="Organization/organization-req-4-del"/>
          <display value="Highview VA Clinic"/>
        </organization>
        <specialty>
          <coding>
            <system value="http://nucc.org/provider-taxonomy"/>
            <code value="163W00000X"/>
            <display value="Registered Nurse"/>
          </coding>
        </specialty>
        <telecom>
          <system value="phone"/>
          <value value="508-856-9999"/>
        </telecom>
      </PractitionerRole>
    </resource>
  </parameter>
  <parameter>
    <name value="delegate-organization"/>
    <resource>
      <Organization>
        <id value="organization-req-4-del"/>
        <meta>
          <profile
                   value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|6.1.0"/>
        </meta>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml">Highview VA Clinic</div>
        </text>
        <active value="true"/>
        <name value="Highview VA Clinic"/>
        <telecom>
          <system value="phone"/>
          <value value="508-856-5555"/>
        </telecom>
        <address>
          <line value="2002 Highview Ln"/>
          <city value="Worcester"/>
          <state value="MA"/>
          <postalCode value="01604"/>
        </address>
      </Organization>
    </resource>
  </parameter>
  <parameter>
    <name value="pre-stage-only"/>
    <valueBoolean value="false"/>
  </parameter>
</Parameters>