Common CQL Assets for FHIR (US-Based)
1.0.0-ballot - STU 1 Ballot United States of America flag

This page is part of the Common CQL Assets for FHIR (US-Based) (v1.0.0-ballot: Informative 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Questionnaire: Example Patient and Coverage Questionnaire (Experimental)

Official URL: http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire Version: 1.0.0-ballot
Standards status: Informative Computable Name: ExamplePatientAndCoverageQuestionnaire

For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.

Generated Narrative: Questionnaire ExamplePatientAndCoverageQuestionnaire

LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. ExamplePatientAndCoverageQuestionnaireFor the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.Questionnairehttp://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire#1.0.0-ballot
... patient-infoPatient Information0..1group
.... patient-info|patient-nameName0..1string
.... patient-info|date-of-birthDate of Birth0..1date
.... patient-info|birth-sexBirth Sex0..1choiceValue Set: Birth Sex
.... patient-info|medical-record-numberMedical Record Number0..1string
.... patient-info|phone-numberPhone Number0..1string
.... patient-info|email-addressEmail Address0..1string
.... patient-info|addressAddress0..1string
.... patient-info|cityCity0..1string
.... patient-info|stateState0..1string
.... patient-info|postal-codePostal Code0..1string
... coverage-infoCoverage Information0..1group
.... coverage-info|member-idMember ID0..1string
.... completing-form|patient-info|policy-numberPolicy Number0..1string
... provider-infoRequesting Provider Information0..1group
.... provider-info|nameRequesting provider name0..1string
.... provider-info|phone-numberPhone0..1string
.... provider-info|addressOrdering provider address0..1string
.... provider-info|npiOrdering provider Tax ID/NPI #0..1string
.... provider-info|faxFax0..1string
... servicing-providerLaboratory performing testing/Servicing Provider0..1group
.... servicing-provider|nameServicing Provider name0..1string
.... servicing-provider|phone-numberPhone0..1string
.... servicing-provider|addressOrdering provider address0..1string
.... servicing-provider|npiOrdering provider Tax ID/NPI #0..1string
.... servicing-provider|faxFax0..1string

doco Documentation for this format