authoredOn: '2022-06-17T16:16:06Z'
code:
  coding:
  - code: attachment-request-questionnaire
    system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
  text: Attachment Request Questionnaire
contained:
- birthDate: '1987-02-20'
  id: patient
  identifier:
  - system: http://example.org/cdex/payer/member-ids
    type:
      coding:
      - code: MB
        display: Member Number
        system: http://terminology.hl7.org/CodeSystem/v2-0203
      text: Member Number
    use: usual
    value: Member123
  - system: http://example.org/cdex/provider/patient-ids
    type:
      coding:
      - code: pat
        display: Patient Account Number
        system: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
      text: Patient Account Number
    use: usual
    value: PA-123
  meta:
    profile:
    - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-patient-demographics
  name:
  - family: Shaw
    given:
    - Amy
  resourceType: Patient
- id: practitionerrole
  meta:
    profile:
    - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-practitionerrole
  organization:
    identifier:
      system: http://hl7.org/fhir/sid/us-npi
      value: '1234567893'
  practitioner:
    identifier:
      system: http://hl7.org/fhir/sid/us-npi
      value: '9941339100'
  resourceType: PractitionerRole
for:
  reference: '#patient'
id: cdex-task-inline-example22

identifier:
- system: http://example.org/payer
  type:
    coding:
    - code: tracking-id
      display: Tracking Id
      system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
    text: Re-Association Tracking Control Number
  value: trackingid1012
# ========== add "administrative reference number ============
- type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
      code: admin-ref-number
      display: Administrative Reference Number
    text: Administrative Reference Number
  system: http://example.org/payer
  value: adminrefnumber4657
# ======================================================================

input:
- extension:
  - url: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber
    valueInteger: 1
  type:
    coding:
    - system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
      code: questionnaire-context
  valueCanonical: http://example.org/cdex-questionnaire-example1
- type:
    coding:
    - code: payer-url
      system: http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes
  valueUrl: http://example.org/cdex/payer/$submit-attachment
- type:
    coding:
    - code: purpose-of-use
      system: http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp
  valueCodeableConcept:
    coding:
    - code: COVAUTH
      display: coverage authorization
      system: http://terminology.hl7.org/CodeSystem/v3-ActReason
intent: order
lastModified: '2022-06-17T16:16:06Z'
meta:
  extension:
  - url: http://hl7.org/fhir/StructureDefinition/instance-name
    valueString: CDex Inline Task Example 22
  - url: http://hl7.org/fhir/StructureDefinition/instance-description
    valueMarkdown: Task example used to create inline [requesting attachments using
      questionnaire transaction](requesting-attachments-questionnaire.html#complete-solicited-attachment-transaction)
  profile:
  - http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-task-attachment-request
owner:
  reference: '#practitionerrole'
reasonCode:
  coding:
  - code: preauthorization
    display: Preauthorization
    system: http://hl7.org/fhir/claim-use
  text: preauthorization
reasonReference:
  identifier:
    system: http://example.org/cdex/payer/claim-ids
    value: Preauth123
requester:
  identifier:
    system: http://example.org/cdex/payer/payer-ids
    value: Payer123
resourceType: Task
restriction:
  period:
    end: '2022-06-21'
status: requested