Specialty Medication Enrollment
2.0.0-ballot - STU 2 Ballot US

This page is part of the Specialty Medication Enrollment (v2.0.0-ballot: STU2 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

: Specialty Rx Task - Consent Request Contained - XML Representation

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<Task xmlns="http://hl7.org/fhir">
  <id value="specialty-rx-task-consent-request-contained"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/specialty-rx/StructureDefinition/specialty-rx-task-consent-request"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Task</b></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Task "specialty-rx-task-consent-request-contained" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-specialty-rx-task-consent-request.html">Specialty Rx Task - Consent Request</a></p></div><p><b>status</b>: requested</p><p><b>intent</b>: plan</p><p><b>code</b>: Obtain Consent for Product Fulfillment <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-specialty-rx-task-type.html">Specialty Rx Code System - Task Type</a>#obtain-consent)</span></p><p><b>description</b>: Have patient, Amy Shaw, complete the attached consent form</p><p><b>for</b>: <a href="Patient-specialty-rx-patient-1.html">Patient/specialty-rx-patient-1: Amy Shaw</a> " DOE"</p><p><b>authoredOn</b>: 2022-05-05</p><p><b>requester</b>: <span>: Bryant Avenue Pharmacy</span></p><p><b>owner</b>: <a href="Practitioner-specialty-rx-practitioner-1.html">Practitioner/specialty-rx-practitioner-1: Melissa Jenkins, MD</a> " SMITH"</p><h3>Inputs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Consent Form Reference <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-specialty-rx-task-input-type.html">Specialty Rx Code System - Task Input Type</a>#consent-form-reference)</span></td><td><a name="consent-request"> </a><blockquote><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Consent "consent-request" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-specialty-rx-consent-requested.html">Specialty Rx ConsentRequested</a></p></div><p><b>status</b>: proposed</p><p><b>scope</b>: Privacy Consent <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.1.0/CodeSystem-consentscope.html">Consent Scope Codes</a>#patient-privacy)</span></p><p><b>category</b>: Consent Document <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://loinc.org/">LOINC</a>#59284-0)</span></p><p><b>patient</b>: <a href="Patient-specialty-rx-patient-1.html">Patient/specialty-rx-patient-1: Amy Shaw</a> " DOE"</p><p><b>dateTime</b>: 2022-05-05 09:35:39-0500</p><p><b>performer</b>: <a href="Patient-specialty-rx-patient-1.html">Patient/specialty-rx-patient-1: Amy Shaw</a> " DOE"</p><p><b>organization</b>: <a href="Organization-us-core-organization-clinic-1.html">Organization/us-core-organization-clinic-1: Acme Clinic</a> "Acme Clinic"</p><p><b>source</b>: </p><p><b>policyRule</b>: opt-in <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-ActCode.html">ActCode</a>#OPTIN)</span></p></blockquote></td></tr></table></div>
  </text>
  <contained>
    <Consent>
      <id value="consent-request"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/specialty-rx/StructureDefinition/specialty-rx-consent-requested"/>
      </meta>
      <status value="proposed"/>
      <scope>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/consentscope"/>
          <code value="patient-privacy"/>
        </coding>
      </scope>
      <category>
        <coding>
          <system value="http://loinc.org"/>
          <code value="59284-0"/>
          <display value="Consent Document"/>
        </coding>
      </category>
      <patient>
        <reference value="Patient/specialty-rx-patient-1"/>
        <display value="Amy Shaw"/>
      </patient>
      <dateTime value="2022-05-05T09:35:39.415-05:00"/>
      <performer>
        <reference value="Patient/specialty-rx-patient-1"/>
        <display value="Amy Shaw"/>
      </performer>
      <organization>
        <reference value="Organization/us-core-organization-clinic-1"/>
        <display value="Acme Clinic"/>
      </organization>
      <sourceAttachment>
        <contentType value="application/pdf"/>
        <data
              value="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"/>
        <title value="Xamproxitelopeldoleodl Patient Consent Form"/>
        <creation value="2021-12-01T16:35:00.000-05:00"/>
      </sourceAttachment>
      <policyRule>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
          <code value="OPTIN"/>
          <display value="opt-in"/>
        </coding>
      </policyRule>
    </Consent>
  </contained>
  <status value="requested"/>
  <intent value="plan"/>
  <code>
    <coding>
      <system
              value="http://hl7.org/fhir/us/specialty-rx/CodeSystem/specialty-rx-task-type"/>
      <code value="obtain-consent"/>
      <display value="Obtain Consent for Product Fulfillment"/>
    </coding>
    <text value="Obtain Consent for Product Fulfillment"/>
  </code>
  <description
               value="Have patient, Amy Shaw, complete the attached consent form"/>
  <for>
    <reference value="Patient/specialty-rx-patient-1"/>
    <identifier>
      <use value="usual"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="MR"/>
          <display value="Medical Record Number"/>
        </coding>
        <text value="Medical Record Number"/>
      </type>
      <system
              value="https://specialty-fhir.azurewebsites.net/responder/dynamic/fhir"/>
      <value value="P100001"/>
    </identifier>
    <display value="Amy Shaw"/>
  </for>
  <authoredOn value="2022-05-05"/>
  <requester>
    <identifier>
      <use value="official"/>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="5026456111"/>
    </identifier>
    <display value="Bryant Avenue Pharmacy"/>
  </requester>
  <owner>
    <reference value="Practitioner/specialty-rx-practitioner-1"/>
    <identifier>
      <use value="official"/>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="1111111111"/>
    </identifier>
    <display value="Melissa Jenkins, MD"/>
  </owner>
  <input>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/specialty-rx/CodeSystem/specialty-rx-task-input-type"/>
        <code value="consent-form-reference"/>
        <display value="Consent Form Reference"/>
      </coding>
      <text value="Consent Form Reference"/>
    </type>
    <valueReference>
      <reference value="#consent-request"/>
      <type value="Consent"/>
      <display value="Xamproxitelopeldoleodl Patient Consent Form"/>
    </valueReference>
  </input>
</Task>