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: CDex Inline Task Example 22 - JSON Representation

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{
  "resourceType" : "Task",
  "contained" : [
    {
      "resourceType" : "Patient",
      "id" : "patient",
      "identifier" : [
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                "code" : "MB",
                "display" : "Member Number"
              }
            ],
            "text" : "Member Number"
          },
          "system" : "http://example.org/cdex/payer/member-ids",
          "value" : "Member123"
        },
        {
          "use" : "usual",
          "type" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
                "code" : "pat",
                "display" : "Patient Account Number"
              }
            ],
            "text" : "Patient Account Number"
          },
          "system" : "http://example.org/cdex/provider/patient-ids",
          "value" : "PA-123"
        }
      ],
      "name" : [
        {
          "family" : "Shaw",
          "given" : [
            "Amy"
          ]
        }
      ],
      "birthDate" : "1987-02-20"
    },
    {
      "resourceType" : "PractitionerRole",
      "id" : "practitionerrole",
      "practitioner" : {
        "identifier" : {
          "system" : "http://hl7.org/fhir/sid/us-npi",
          "value" : "9941339100"
        }
      },
      "organization" : {
        "identifier" : {
          "system" : "http://hl7.org/fhir/sid/us-npi",
          "value" : "1234567893"
        }
      }
    }
  ],
  "identifier" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
            "code" : "tracking-id",
            "display" : "Tracking Id"
          }
        ],
        "text" : "Re-Association Tracking Control Number"
      },
      "system" : "http://example.org/payer",
      "value" : "trackingid1012"
    }
  ],
  "status" : "requested",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "attachment-request-questionnaire"
      }
    ],
    "text" : "Attachment Request Questionnaire"
  },
  "for" : {
    "reference" : "#patient"
  },
  "authoredOn" : "2022-06-17T16:16:06Z",
  "lastModified" : "2022-06-17T16:16:06Z",
  "requester" : {
    "identifier" : {
      "system" : "http://example.org/cdex/payer/payer-ids",
      "value" : "Payer123"
    }
  },
  "owner" : {
    "reference" : "#practitionerrole"
  },
  "reasonCode" : {
    "coding" : [
      {
        "system" : "http://hl7.org/fhir/claim-use",
        "code" : "preauthorization",
        "display" : "Preauthorization"
      }
    ],
    "text" : "preauthorization"
  },
  "reasonReference" : {
    "identifier" : {
      "system" : "http://example.org/cdex/payer/claim-ids",
      "value" : "Preauth123"
    }
  },
  "restriction" : {
    "period" : {
      "end" : "2022-06-21"
    }
  },
  "input" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber",
          "valueInteger" : 1
        }
      ],
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
            "code" : "questionnaires-needed"
          }
        ]
      },
      "valueCanonical" : "http://example.org/cdex-questionnaire-example1"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
            "code" : "payer-url"
          }
        ]
      },
      "valueUrl" : "http://example.org/cdex/payer/$submit-attachment"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
            "code" : "purpose-of-use"
          }
        ]
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
            "code" : "COVAUTH",
            "display" : "coverage authorization"
          }
        ]
      }
    }
  ]
}