This page is part of the Da Vinci Clinical Documentation Exchange (v2.1.0-snapshot: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions
<Parameters xmlns="http://hl7.org/fhir">
<parameter>
<name value="TrackingId"/>
<valueIdentifier>
<system value="http://example.org/payer"/>
<value value="trackingid1012"/>
</valueIdentifier>
</parameter>
<parameter>
<name value="AttachTo"/>
<valueCode value="preauthorization"/>
</parameter>
<parameter>
<name value="PayerId"/>
<valueIdentifier>
<system value="http://example.org/cdex/payer/payer-ids"/>
<value value="payer123"/>
</valueIdentifier>
</parameter>
<parameter>
<name value="OrganizationId"/>
<valueIdentifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</valueIdentifier>
</parameter>
<parameter>
<name value="ProviderId"/>
<valueIdentifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="9941339100"/>
</valueIdentifier>
</parameter>
<parameter>
<name value="MemberId"/>
<valueIdentifier>
<system value="http://example.org/cdex/payer/member-ids"/>
<value value="Member123"/>
</valueIdentifier>
</parameter>
<parameter>
<name value="Attachment"/>
<part>
<name value="LineItem"/>
<valueString value="1"/>
</part>
<part>
<name value="Content"/>
<resource>
<QuestionnaireResponse>
<id value="cdex-questionnaireresponse-example1"/>
<questionnaire
value="http://example.org/cdex-questionnaire-example1"/>
<status value="completed"/>
<subject>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MB"/>
<display value="Member Number"/>
</coding>
<text value="Member Number"/>
</type>
<system value="http://example.org/cdex/payer/member-ids"/>
<value value="Member123"/>
</identifier>
<display value="Amy Shaw"/>
</subject>
<authored value="2022-06-17"/>
<author>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="9941339100"/>
</identifier>
</author>
<item>
<linkId value="1"/>
<text
value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
<answer>
<valueString value="Examplitis"/>
</answer>
</item>
<item>
<linkId value="2"/>
<text value="Order Reason"/>
<answer>
<valueCoding>
<system value="http://example.org"/>
<code value="4"/>
<display value="Replacement"/>
</valueCoding>
</answer>
</item>
</QuestionnaireResponse>
</resource>
</part>
</parameter>
</Parameters>