Generated Narrative: Questionnaire ExamplePatientAndCoverageQuestionnaire LinkID Text Cardinality Type Description & Constraints 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. Questionnaire http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire#2.0.0-ballot #xD; patient-info Patient Information 0..1 group #xD; patient-info|patient-name Name 0..1 string #xD; patient-info|date-of-birth Date of Birth 0..1 date #xD; patient-info|birth-sex Birth Sex 0..1 choice Value Set: Birth Sex #xD; patient-info|medical-record-number Medical Record Number 0..1 string #xD; patient-info|phone-number Phone Number 0..1 string #xD; patient-info|email-address Email Address 0..1 string #xD; patient-info|address Address 0..1 string #xD; patient-info|city City 0..1 string #xD; patient-info|state State 0..1 string #xD; patient-info|postal-code Postal Code 0..1 string #xD; coverage-info Coverage Information 0..1 group #xD; coverage-info|member-id Member ID 0..1 string #xD; completing-form|patient-info|policy-number Policy Number 0..1 string #xD; provider-info Requesting Provider Information 0..1 group #xD; provider-info|name Requesting provider name 0..1 string #xD; provider-info|phone-number Phone 0..1 string #xD; provider-info|address Ordering provider address 0..1 string #xD; provider-info|npi Ordering provider Tax ID/NPI # 0..1 string #xD; provider-info|fax Fax 0..1 string #xD; servicing-provider Laboratory performing testing/Servicing Provider 0..1 group #xD; servicing-provider|name Servicing Provider name 0..1 string #xD; servicing-provider|phone-number Phone 0..1 string #xD; servicing-provider|address Ordering provider address 0..1 string #xD; servicing-provider|npi Ordering provider Tax ID/NPI # 0..1 string #xD; servicing-provider|fax Fax 0..1 string #xD; Documentation for this format Contained Resources Metadata Type module-definition from http://terminology.hl7.org/CodeSystem/library-type Dependency Description: USCore model information Resource: US Core Model Informationversion: null6.1.0-derived) Canonical URL: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived Dependency Description: FHIR model information Resource: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1 Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1 Parameters Parameter None Generated using version 0.5.3-cibuild of the sample-content-ig Liquid templates
The patient that is to be used to pre-populate the form
The coverage that is to be used to pre-populate the form
The ServiceRequest that is to be used to pre-populate the form
Example Patient and Coverage Questionnaire
HL7 International / Clinical Decision Support
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.
Laboratory performing testing/Servicing Provider