Da Vinci Prior Authorization Support (PAS) FHIR IG
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) 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 Subscriber Example - XML Representation

Page standards status: Informative

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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="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;"><b>JOE SMITH </b> male, DoB Unknown ( id: 12345678901)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="A patient's military status."><a href="StructureDefinition-extension-militaryStatus.html">null:</a></td><td colspan="3"><ul><li><span title="Codes: {https://codesystem.x12.org/005010/584 RU}">RU</span></li></ul></td></tr></table></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>