resourceType: Parameters
id: cdex-parameters-example5
meta:
  extension:
    - url: "http://hl7.org/fhir/StructureDefinition/instance-name"
      valueString: CDex Parameters Example 5
    - url: "http://hl7.org/fhir/StructureDefinition/instance-description"
      valueMarkdown: '**Completed QuestionnaireResponse Attachment Example:** Parameters Resource example showing how it is used to submit a solicited attachment using the `$submit-attachment` operation for a prior authorization. The attachment parameter payload is a QuestionnaireResponse completed using DTR in response to a Questionnaire sent in the Attachments request.'
  profile:
    - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-parameters-submit-attachment
parameter:
  - name: TrackingId
    valueIdentifier:
      system: http://example.org/payer-acns
      value: trackingid1012
# ========== add "administrative reference number ============
  - name: AdminRefNumber
    valueIdentifier:
      system: http://example.org/payer-refnos
      value: adminrefnumber4657
# ==============================================================
  - name: AttachTo
    valueCode: preauthorization
  - name: PayerId
    valueIdentifier:
      system: "http://example.org/cdex/payer/payer-ids"
      value: payer123
  - name: OrganizationId
    valueIdentifier:
      system: "http://hl7.org/fhir/sid/us-npi"
      value: "1234567893"
  - name: ProviderId
    valueIdentifier:
      system: "http://hl7.org/fhir/sid/us-npi"
      value: "9941339100"
  - name: MemberId
    valueIdentifier:
      system: "http://example.org/cdex/payer/member-ids"
      value: "Member123"
  # -
  #     name: ServiceDate
  #     valueDateTime: '2022-12-15'
  - name: Attachment
    part:
      - name: LineItem
        valueString: "1"
      # -
      #     name: Code
      #     valueCodeableConcept:
      #         coding:
      #             -
      #                 system: 'http://loinc.org'
      #                 code: 11506-3
      #                 display: Progress note
      #         text: Progress note
      - name: Content
        resource:
          resourceType: QuestionnaireResponse
          id: cdex-questionnaireresponse-example1
          questionnaire: "http://example.org/cdex-questionnaire-example1"
          status: completed
          subject:
            identifier:
              use: usual
              type:
                coding:
                  - system: http://terminology.hl7.org/CodeSystem/v2-0203
                    code: MB
                    display: Member Number
                text: Member Number
              system: http://example.org/cdex/payer/member-ids
              value: Member123
            display: Amy Shaw
          authored: "2022-06-17"
          author:
            identifier:
              system: http://hl7.org/fhir/sid/us-npi
              value: "9941339100"
          item:
            - linkId: "1"
              text: >-
                Relevant Patient Diagnoses (conditions that might be expected to improve
                with oxygen therapy)
              answer:
                - valueString: Examplitis
            - linkId: "2"
              text: Order Reason
              answer:
                - valueCoding:
                    system: "http://example.org"
                    code: "4"
                    display: Replacement