resourceType: Task
id: cdex-task-example31
meta:
  extension:
  - url: http://hl7.org/fhir/StructureDefinition/instance-name
    valueString: CDex Task Example 31
  - url: http://hl7.org/fhir/StructureDefinition/instance-description
    valueMarkdown: >-
      **Completed Data Request Requiring a Verification Signature Using Questionnaire:** Completed Task (CDex Task Example 30) with a status of "completed" and output referencing the digitally signed QuestionnaireResponse.
  profile:
  - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-data-request
  tag:
  - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
    code: claims-processing
status: completed
intent: order
code:
  coding:
  - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
    code: data-request-questionnaire
for:
  identifier:
    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
authoredOn: '2022-06-17T16:16:06Z'
lastModified: '2022-06-18T16:16:06Z'
requester:
  identifier:
    system: http://example.org/cdex/payer/payer-ids
    value: Payer123
owner:
  identifier:
    system: http://hl7.org/fhir/sid/us-npi
    value: '9941339108'
reasonReference:
  identifier:
    type:
      coding:
      - system: http://terminology.hl7.org/CodeSystem/v2-0203
        code: FILL
        display: Filler Identifier
      text: Payer Claim ID
    system: http://example.org/cdex/payer/claim-ids
    value: Claim123
input:
- type:
    coding:
    - system: http://hl7.org/fhir/uv/sdc/CodeSystem/temp
      code: questionnaire
  valueCanonical: http://example.org/cdex-questionnaire-example2
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
      code: purpose-of-use
  valueCodeableConcept:
    coding:
    - system: http://terminology.hl7.org/CodeSystem/v3-ActReason
      code: COVERAGE
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
      code: signature-flag
  valueBoolean: true
output:
- type:
    coding:
    - system: http://hl7.org/fhir/uv/sdc/CodeSystem/temp
      code: questionnaire-response
  valueReference:
    reference: QuestionnaireResponse/cdex-questionnaireresponse-example4