Da Vinci Clinical Data Exchange (CDex)
2.0.0 - STU2
Da Vinci Clinical Data Exchange (CDex)
2.0.0 - STU2
This page is part of the Da Vinci Clinical Documentation Exchange (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 
| Page standards status: Informative |
<Task xmlns="http://hl7.org/fhir">
<id value="cdex-task-example28"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: Task</b><a name="cdex-task-example28"> </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 "cdex-task-example28" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-cdex-task-attachment-request.html">CDex Task Attachment Request Profile</a></p></div><p><b>identifier</b>: Re-Association Tracking Control Number: trackingid1056</p><p><b>status</b>: requested</p><p><b>intent</b>: order</p><p><b>code</b>: Attachment Request Questionnaire <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#attachment-request-questionnaire)</span></p><p><b>for</b>: <a name="patient"> </a></p><blockquote><p/><p><a name="patient"> </a></p><p><b>identifier</b>: Member Number: Member123 (use: USUAL), Patient Account Number: PA-123 (use: USUAL)</p><p><b>name</b>: Amy Shaw </p><p><b>birthDate</b>: 1987-02-20</p></blockquote><p><b>authoredOn</b>: 2022-06-17 16:16:06+0000</p><p><b>lastModified</b>: 2022-06-17 16:16:06+0000</p><p><b>requester</b>: <span/></p><p><b>owner</b>: <a name="practitionerrole"> </a></p><blockquote><p/><p><a name="practitionerrole"> </a></p><p><b>practitioner</b>: <span/></p><p><b>organization</b>: <span/></p></blockquote><p><b>reasonCode</b>: preauthorization <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/R4/codesystem-claim-use.html">Use</a>#preauthorization "Preauthorization")</span></p><p><b>reasonReference</b>: <span/></p><h3>Restrictions</h3><table class="grid"><tr><td>-</td><td><b>Period</b></td></tr><tr><td>*</td><td>?? --> 2022-06-21</td></tr></table><blockquote><p><b>input</b></p><p><b>ServiceLineNumber</b>: 1</p><p><b>type</b>: Questionnaire <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://hl7.org/fhir/uv/sdc/STU3/CodeSystem-temp.html">Temporary SDC Codes</a>#questionnaire)</span></p><p><b>value</b>: <a href="Questionnaire-cdex-questionnaire-example2.html">Home Oxygen Therapy Questionnaire</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Payer URL <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#payer-url)</span></p><p><b>value</b>: <a href="http://example.org/cdex/payer/$submit-attachment">http://example.org/cdex/payer/$submit-attachment</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Purpose Of Use <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#purpose-of-use)</span></p><p><b>value</b>: coverage authorization <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-v3-ActReason.html">ActReason</a>#COVAUTH)</span></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: Signature Flag <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="CodeSystem-cdex-temp.html">CDex Temporary Code System</a>#signature-flag)</span></p><p><b>value</b>: true</p></blockquote><hr/><blockquote><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;"><b>Amy Shaw </b> (no stated gender), DoB: 1987-02-20 ( Member Number: Member123 (use: USUAL))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Other Ids (see the one above)">Other Id:</td><td colspan="3">Patient Account Number: PA-123 (use: USUAL)</td></tr></table></blockquote><hr/><blockquote><p><b>Generated Narrative: PractitionerRole #practitionerrole</b><a name="practitionerrole"> </a></p><p><b>practitioner</b>: <span/></p><p><b>organization</b>: <span/></p></blockquote></div>
</text>
<contained>
<Patient>
<id value="patient"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics"/>
</meta>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-hrex/CodeSystem/hrex-temp"/>
<code value="UMB"/>
<display value="Member Number"/>
</coding>
<text value="Member Number"/>
</type>
<system value="http://example.org/cdex/payer/member-ids"/>
<value value="Member123"/>
</identifier>
<identifier>
<use value="usual"/>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType"/>
<code value="pat"/>
<display value="Patient Account Number"/>
</coding>
<text value="Patient Account Number"/>
</type>
<system value="http://example.org/cdex/provider/patient-ids"/>
<value value="PA-123"/>
</identifier>
<name>
<family value="Shaw"/>
<given value="Amy"/>
</name>
<birthDate value="1987-02-20"/>
</Patient>
</contained>
<contained>
<PractitionerRole>
<id value="practitionerrole"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole"/>
</meta>
<practitioner>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="9941339100"/>
</identifier>
</practitioner>
<organization>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</identifier>
</organization>
</PractitionerRole>
</contained>
<identifier>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="tracking-id"/>
<display value="Tracking Id"/>
</coding>
<text value="Re-Association Tracking Control Number"/>
</type>
<system value="http://example.org/payer"/>
<value value="trackingid1056"/>
</identifier>
<status value="requested"/>
<intent value="order"/>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="attachment-request-questionnaire"/>
</coding>
<text value="Attachment Request Questionnaire"/>
</code>
<for>
<reference value="#patient"/>
</for>
<authoredOn value="2022-06-17T16:16:06Z"/>
<lastModified value="2022-06-17T16:16:06Z"/>
<requester>
<identifier>
<system value="http://example.org/cdex/payer/payer-ids"/>
<value value="Payer123"/>
</identifier>
</requester>
<owner>
<reference value="#practitionerrole"/>
</owner>
<reasonCode>
<coding>
<system value="http://hl7.org/fhir/claim-use"/>
<code value="preauthorization"/>
<display value="Preauthorization"/>
</coding>
<text value="preauthorization"/>
</reasonCode>
<reasonReference>
<identifier>
<system value="http://example.org/cdex/payer/claim-ids"/>
<value value="Preauth123"/>
</identifier>
</reasonReference>
<restriction>
<period>
<end value="2022-06-21"/>
</period>
</restriction>
<input>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceLineNumber">
<valuePositiveInt value="1"/>
</extension>
<type>
<coding>
<system value="http://hl7.org/fhir/uv/sdc/CodeSystem/temp"/>
<code value="questionnaire"/>
</coding>
</type>
<valueCanonical value="http://example.org/cdex-questionnaire-example2"/>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="payer-url"/>
</coding>
</type>
<valueUrl value="http://example.org/cdex/payer/$submit-attachment"/>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="purpose-of-use"/>
</coding>
</type>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
<code value="COVAUTH"/>
<display value="coverage authorization"/>
</coding>
</valueCodeableConcept>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="signature-flag"/>
</coding>
</type>
<valueBoolean value="true"/>
</input>
</Task>
IG © 2023+ HL7 International - Patient Care Work Group. Package hl7.fhir.us.davinci-cdex#2.0.0 based on FHIR 4.0.1. Generated 2023-03-22
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