{
  "resourceType" : "MedicationRequest",
  "id" : "annotated-example",
  "language" : "en",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest annotated-example</b></p><a name=\"annotated-example\"> </a><a name=\"hcannotated-example\"> </a><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\">Language: en</p></div><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p>coverage</blockquote><p><b>value</b>: <a href=\"Coverage-example.html\">Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --&gt; 2012-05-23</a></p><blockquote><p><b>url</b></p>covered</blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p>pa-needed</blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p>doc-needed</blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p>doc-purpose</blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p>info-needed</blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p>billingCode</blockquote><p><b>value</b>: <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-CPT.html#CPT-77067\">Current Procedural Terminology (CPT®): 77067</a> (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed)</p><blockquote><p><b>url</b></p>reason</blockquote><p><b>value</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp gold-card}\">Prior auth waved due to gold-card status</span></p><p><b>category</b>: cat-other</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp policy-link}\">Policy Link</span></p><p><b>value</b>: <a href=\"http://example.org/somepayer/policy123.pdf#abc\">http://example.org/somepayer/policy123.pdf#abc</a></p><p><b>qualification</b>: Additional policy details can be found here</p><blockquote><p><b>url</b></p>detail</blockquote><blockquote><p><b>url</b></p>questionnaire</blockquote><p><b>value</b>: <code>http://example.org/some-payer/Questionnaire/123|1.3.0</code></p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></blockquote><p><b>value</b>: 2019-02-15</p><blockquote><p><b>url</b></p>coverage-assertion-id</blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p>satisfied-pa-id</blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p>contact</blockquote><p><b>value</b>: Help Desk: <a href=\"http://some-payer.org/xyz-sub-org/get-help-here.html\">http://some-payer.org/xyz-sub-org/get-help-here.html</a></p><blockquote><p><b>url</b></p>expiry-date</blockquote><p><b>value</b>: 2019-08-01</p></blockquote><p><b>status</b>: Draft</p><p><b>intent</b>: Original Order</p><p><b>medication</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 616447}\">mycophenolate mofetil 250 MG Oral Capsule [Cellcept]</span></p><p><b>subject</b>: <a href=\"http://example.org/Patient/123\">Jane Smith</a></p><p><b>encounter</b>: <a href=\"http://example.org/Encounter/ABC\">http://example.org/Encounter/ABC</a></p><p><b>authoredOn</b>: 2019-02-15</p><p><b>requester</b>: <a href=\"http://example.org/PractitionerRole/987\">Dr. Jones</a></p><p><b>note</b>: By XYZ Insurance @2019-02-15 15:07:18-0500</p><blockquote><div><p>Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission.</p>\n</div></blockquote><blockquote><p><b>dosageInstruction</b></p><p><b>text</b>: 6 tablets every 12 hours.</p><p><b>timing</b>: Once per 12 hours</p><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>6 tablet</td></tr></table></blockquote></div>"
  },
  "extension" : [{
    "extension" : [{
      "url" : "coverage",
      "valueReference" : {
        "reference" : "Coverage/example"
      }
    },
    {
      "url" : "covered",
      "valueCode" : "conditional"
    },
    {
      "url" : "pa-needed",
      "valueCode" : "satisfied"
    },
    {
      "url" : "doc-needed",
      "valueCode" : "admin"
    },
    {
      "url" : "doc-purpose",
      "valueCode" : "withclaim"
    },
    {
      "url" : "info-needed",
      "valueCode" : "performer"
    },
    {
      "url" : "billingCode",
      "valueCoding" : {
        "system" : "http://www.ama-assn.org/go/cpt",
        "code" : "77067"
      }
    },
    {
      "url" : "reason",
      "valueCodeableConcept" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
          "code" : "gold-card"
        }],
        "text" : "Prior auth waved due to gold-card status"
      }
    },
    {
      "extension" : [{
        "url" : "category",
        "valueCode" : "cat-other"
      },
      {
        "url" : "code",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
            "code" : "policy-link"
          }]
        }
      },
      {
        "url" : "value",
        "valueUrl" : "http://example.org/somepayer/policy123.pdf#abc"
      },
      {
        "url" : "qualification",
        "valueString" : "Additional policy details can be found here"
      }],
      "url" : "detail"
    },
    {
      "url" : "questionnaire",
      "valueCanonical" : "http://example.org/some-payer/Questionnaire/123|1.3.0"
    },
    {
      "url" : "date",
      "valueDate" : "2019-02-15"
    },
    {
      "url" : "coverage-assertion-id",
      "valueString" : "12345ABC"
    },
    {
      "url" : "satisfied-pa-id",
      "valueString" : "XXYYZ"
    },
    {
      "url" : "contact",
      "valueContactDetail" : {
        "name" : "Help Desk",
        "telecom" : [{
          "system" : "url",
          "value" : "http://some-payer.org/xyz-sub-org/get-help-here.html"
        }]
      }
    },
    {
      "url" : "expiry-date",
      "valueDate" : "2019-08-01"
    }],
    "url" : "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
  }],
  "status" : "draft",
  "intent" : "original-order",
  "medicationCodeableConcept" : {
    "coding" : [{
      "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
      "code" : "616447",
      "display" : "mycophenolate mofetil 250 MG Oral Capsule [Cellcept]"
    }]
  },
  "subject" : {
    "reference" : "http://example.org/Patient/123",
    "display" : "Jane Smith"
  },
  "encounter" : {
    "reference" : "http://example.org/Encounter/ABC"
  },
  "authoredOn" : "2019-02-15",
  "requester" : {
    "reference" : "http://example.org/PractitionerRole/987",
    "display" : "Dr. Jones"
  },
  "note" : [{
    "authorString" : "XYZ Insurance",
    "time" : "2019-02-15T15:07:18-05:00",
    "text" : "Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission."
  }],
  "dosageInstruction" : [{
    "text" : "6 tablets every 12 hours.",
    "timing" : {
      "repeat" : {
        "frequency" : 1,
        "period" : 12,
        "periodUnit" : "h"
      }
    },
    "doseAndRate" : [{
      "doseQuantity" : {
        "value" : 6,
        "unit" : "tablet"
      }
    }]
  }]
}