Da Vinci Prior Authorization Support (PAS) FHIR IG
1.1.0 - STU 1

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.1.0: STU 1.1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Submit Claim Referral Request Example - JSON Representation

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{
  "resourceType" : "ServiceRequest",
  "id" : "ReferralRequestExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></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 \"ReferralRequestExample\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-profile-servicerequest.html\">PAS Service Request</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (1365#3)</span></p><p><b>quantity</b>: 1 {visit}<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM code {visit} = '{visit}')</span></p><p><b>subject</b>: <a href=\"Patient-SubscriberExample.html\">Patient/SubscriberExample</a> \" SMITH\"</p></div>"
  },
  "status" : "active",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "http://codesystem.x12.org/005010/1365",
        "code" : "3",
        "display" : "Consultation"
      }
    ]
  },
  "quantityQuantity" : {
    "value" : 1,
    "system" : "http://unitsofmeasure.org",
    "code" : "{visit}"
  },
  "subject" : {
    "reference" : "Patient/SubscriberExample"
  }
}