Da Vinci Clinical Data Exchange (CDex), published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions
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<Task xmlns="http://hl7.org/fhir">
<contained>
<Patient>
<id value="patient"/>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MB"/>
<display value="Member Number"/>
</coding>
<text value="Member Number"/>
</type>
<system value="http://example.org/cdex/payer/member-ids"/>
<value value="Member123"/>
</identifier>
<name>
<family value="Shaw"/>
<given value="Amy"/>
</name>
<birthDate value="1987-02-20"/>
</Patient>
</contained>
<contained>
<PractitionerRole>
<id value="practitionerrole"/>
<practitioner>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="9941339100"/>
</identifier>
</practitioner>
<organization>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</identifier>
</organization>
</PractitionerRole>
</contained>
<identifier>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="tracking-id"/>
<display value="Tracking Id"/>
</coding>
<text value="Re-Association Tracking Control Number"/>
</type>
<system value="http://example.org/payer"/>
<value value="trackingid123"/>
</identifier>
<status value="requested"/>
<intent value="order"/>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
<code value="attachment-request-code"/>
</coding>
<text value="Coded Attachment Request"/>
</code>
<for>
<reference value="#patient"/>
</for>
<authoredOn value="2022-06-17T16:16:06Z"/>
<lastModified value="2022-06-17T16:16:06Z"/>
<requester>
<identifier>
<system value="http://example.org/cdex/payer/payer-ids"/>
<value value="Payer123"/>
</identifier>
</requester>
<owner>
<reference value="#practitionerrole"/>
</owner>
<reasonCode>
<coding>
<system value="http://hl7.org/fhir/claim-use"/>
<code value="claim"/>
<display value="Claim"/>
</coding>
<text value="claim"/>
</reasonCode>
<reasonReference>
<identifier>
<system value="http://example.org/cdex/payer/claim-ids"/>
<value value="Claim123"/>
</identifier>
</reasonReference>
<restriction>
<period>
<end value="2022-06-21"/>
</period>
</restriction>
<input>
<extension
url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber">
<valueInteger value="1"/>
</extension>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
<code value="attachments-needed"/>
</coding>
</type>
<valueCodeableConcept>
<coding>
<system value="http://loinc.org"/>
<code value="11506-3"/>
<display value="Progress note"/>
</coding>
<text value="Progress note"/>
</valueCodeableConcept>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="signature-flag"/>
</coding>
</type>
<valueBoolean value="true"/>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes"/>
<code value="payer-url"/>
</coding>
</type>
<valueUrl value="http://example.org/cdex/payer/$submit-attachment"/>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="service-date"/>
</coding>
</type>
<valueDate value="2022-06-13"/>
</input>
<input>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp"/>
<code value="purpose-of-use"/>
</coding>
</type>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
<code value="CLMATTCH"/>
<display value="claim attachment"/>
</coding>
</valueCodeableConcept>
</input>
</Task>