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 Subscriber Example - XML Representation

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<Patient xmlns="http://hl7.org/fhir">
  <id value="SubscriberExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>MilitaryStatus</b>: <span title="Codes: {https://codesystem.x12.org/005010/584 RU}">RU</span></p><p><b>identifier</b>: id: 12345678901</p><p><b>name</b>: JOE SMITH </p><p><b>gender</b>: male</p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus">
    <valueCodeableConcept>
      <coding>
        <system value="https://codesystem.x12.org/005010/584"/>
        <code value="RU"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <identifier>
    <system value="http://example.org/MIN"/>
    <value value="12345678901"/>
  </identifier>
  <name>
    <family value="SMITH"/>
    <given value="JOE"/>
  </name>
  <gender value="male"/>
</Patient>