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 Referral Request Example - XML Representation

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<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="ReferralRequestExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>status</b>: active</p><p><b>intent</b>: order</p><p><b>code</b>: <span title="Codes: {http://codesystem.x12.org/005010/1365 3}">Consultation</span></p><p><b>quantity</b>: 1 {visit}</p><p><b>subject</b>: <a href="Patient-SubscriberExample.html">Generated Summary: id: 12345678901; JOE SMITH ; gender: male</a></p></div>
  </text>
  <status value="active"/>
  <intent value="order"/>
  <code>
    <coding>
      <system value="http://codesystem.x12.org/005010/1365"/>
      <code value="3"/>
      <display value="Consultation"/>
    </coding>
  </code>
  <quantityQuantity>
    <value value="1"/>
    <system value="http://unitsofmeasure.org"/>
    <code value="{visit}"/>
  </quantityQuantity>
  <subject>
    <reference value="Patient/SubscriberExample"/>
  </subject>
</ServiceRequest>