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

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

: Submit Claim Requestor Example - XML Representation

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<Organization xmlns="http://hl7.org/fhir">
  <id value="UMOExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>identifier</b>: id: 8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes: {https://codesystem.x12.org/005010/98 X3}">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>
  </text>
  <identifier>
    <system value="http://hl7.org/fhir/sid/us-npi"/>
    <value value="8189991234"/>
  </identifier>
  <active value="true"/>
  <type>
    <coding>
      <system value="https://codesystem.x12.org/005010/98"/>
      <code value="X3"/>
    </coding>
  </type>
  <name value="DR. JOE SMITH CORPORATION"/>
  <address>
    <line value="111 1ST STREET"/>
    <city value="SAN DIEGO"/>
    <state value="CA"/>
    <postalCode value="92101"/>
    <country value="US"/>
  </address>
</Organization>