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

: Specialty Rx Task - Consent Request 2 - Completed - XML Representation

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<Task xmlns="http://hl7.org/fhir">
  <id value="specialty-rx-task-consent-request-2-completed"/>
  <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><a name="specialty-rx-task-consent-request-2-completed"> </a></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 &quot;specialty-rx-task-consent-request-2-completed&quot; </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>: completed</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-characteristic.html">Specialty Rx Code System - Task Characteristic</a>#obtain-consent)</span></p><p><b>description</b>: Have the patient complete the attached consent form and capture a PDF of the signed form in a Consent</p><p><b>for</b>: <a href="Patient-specialty-rx-patient-1.html">Patient/specialty-rx-patient-1</a> &quot; DOE&quot;</p><p><b>authoredOn</b>: 2021-12-08</p><p><b>requester</b>: <span>: Our Pharmacy</span></p><p><b>owner</b>: <span>: Jane Smith MD</span></p><p><b>reasonReference</b>: <span>: Humira Injector Pen - 2020-03-10</span></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-characteristic.html">Specialty Rx Code System - Task Characteristic</a>#consent-form-reference)</span></td><td><a href="Consent-specialty-rx-consent-requested-1.html">Consent/specialty-rx-consent-requested-1: Consent form to be completed</a></td></tr></table><h3>Outputs</h3><table class="grid"><tr><td>-</td><td><b>Type</b></td><td><b>Value[x]</b></td></tr><tr><td>*</td><td>Completed and signed consent form <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-specialty-rx-task-characteristic.html">Specialty Rx Code System - Task Characteristic</a>#completed-consent-reference)</span></td><td><a href="Consent-specialty-rx-consent-1.html">Consent/specialty-rx-consent-1</a></td></tr></table></div>
  </text>
  <status value="completed"/>
  <intent value="plan"/>
  <code>
    <coding>
      <system
              value="http://hl7.org/fhir/us/specialty-rx/CodeSystem/specialty-rx-task-characteristic"/>
      <code value="obtain-consent"/>
      <display value="Obtain Consent for Product Fulfillment"/>
    </coding>
  </code>
  <description
               value="Have the patient complete the attached consent form and capture a PDF of the signed form in a Consent"/>
  <for>
    <reference value="Patient/specialty-rx-patient-1"/>
  </for>
  <authoredOn value="2021-12-08"/>
  <requester>
    <identifier>
      <system
              value="http://terminology.hl7.org/CodeSystem/NCPDPProviderIdentificationNumber"/>
      <value value="0999017"/>
    </identifier>
    <display value="Our Pharmacy"/>
  </requester>
  <owner>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="9941339108"/>
    </identifier>
    <display value="Jane Smith MD"/>
  </owner>
  <reasonReference>
    <identifier>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="PLAC"/>
          <display value="Placer Identifier"/>
        </coding>
      </type>
      <value value="prescription-70222056"/>
    </identifier>
    <display value="Humira Injector Pen - 2020-03-10"/>
  </reasonReference>
  <input>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/specialty-rx/CodeSystem/specialty-rx-task-characteristic"/>
        <code value="consent-form-reference"/>
        <display value="Consent Form Reference"/>
      </coding>
    </type>
    <valueReference>
      <reference value="Consent/specialty-rx-consent-requested-1"/>
      <type value="Consent"/>
      <display value="Consent form to be completed"/>
    </valueReference>
  </input>
  <output>
    <type>
      <coding>
        <system
                value="http://hl7.org/fhir/us/specialty-rx/CodeSystem/specialty-rx-task-characteristic"/>
        <code value="completed-consent-reference"/>
      </coding>
      <text value="Completed and signed consent form"/>
    </type>
    <valueReference>
      <reference value="Consent/specialty-rx-consent-1"/>
      <type value="Consent"/>
    </valueReference>
  </output>
</Task>