Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-epdx/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: Treatment Attestation Form Example 1 - JSON Representation

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{
  "resourceType" : "DocumentReference",
  "id" : "treatment-attestation-form-001",
  "meta" : {
    "lastUpdated" : "2024-12-16T10:00:00Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Signed Treatment Relationship Attestation Form for Robert Johnson</p></div>"
  },
  "status" : "current",
  "docStatus" : "final",
  "type" : {
    "coding" : [
      {
        "system" : "http://loinc.org",
        "code" : "64292-6",
        "display" : "Release of information consent Document"
      }
    ]
  },
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://loinc.org",
          "code" : "64292-6",
          "display" : "Release of information consent Document"
        }
      ]
    }
  ],
  "subject" : {
    🔗 "reference" : "Patient/patient-prov-001",
    "display" : "Robert Michael Johnson"
  },
  "date" : "2024-12-16T09:30:00Z",
  "author" : [
    {
      🔗 "reference" : "Practitioner/provider-001",
      "display" : "Dr. John Smith"
    }
  ],
  "custodian" : {
    🔗 "reference" : "Organization/provider-org-001",
    "display" : "Example Provider Organization"
  },
  "description" : "Signed attestation form documenting active treatment relationship between Dr. Smith and patient Robert Johnson",
  "content" : [
    {
      "attachment" : {
        "contentType" : "application/pdf",
        "language" : "en-US",
        "title" : "Treatment Relationship Attestation Form",
        "creation" : "2024-12-16T09:30:00Z"
      },
      "format" : {
        "system" : "http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem",
        "code" : "urn:ihe:iti:xds:2017:mimeTypeSufficient",
        "display" : "mimeType Sufficient"
      }
    }
  ],
  "context" : {
    "period" : {
      "start" : "2024-01-01"
    }
  }
}