Da Vinci - Coverage Requirements Discovery
2.1.0-preview - STU 2 United States of America flag

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

: MedicationRequest annotated example - TTL Representation

Page standards status: Informative

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:MedicationRequest ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "annotated-example"] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MedicationRequest</b><a name=\"annotated-example\"> </a><a name=\"hcannotated-example\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource MedicationRequest &quot;annotated-example&quot; </p></div><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p><code>coverage</code></blockquote><p><b>value</b>: <a href=\"Coverage-example.html\">Coverage/example</a></p><blockquote><p><b>url</b></p><code>covered</code></blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p><code>pa-needed</code></blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p><code>doc-needed</code></blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p><code>doc-purpose</code></blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p><code>info-needed</code></blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p><code>billingCode</code></blockquote><p><b>value</b>: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed (Details: http://www.ama-assn.org/go/cpt code 77067 = 'Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed', stated as 'null')</p><blockquote><p><b>url</b></p><code>reason</code></blockquote><p><b>value</b>: In-network required unless exigent circumstances <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-temp.html\">CRD Temporary Codes</a>#gold-card)</span></p><p><b>code</b>: Authorization out-of-network only <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-temp.html\">CRD Temporary Codes</a>#auth-out-network-only)</span></p><blockquote><p><b>url</b></p><code>detail</code></blockquote><blockquote><p><b>url</b></p><code>questionnaire</code></blockquote><p><b>value</b>: <a href=\"http://example.org/some-payer/Questionnaire/123\">http://example.org/some-payer/Questionnaire/123|1.3.0</a></p><blockquote><p><b>url</b></p><code>response</code></blockquote><p><b>value</b>: <a name=\"hcqr\"> </a></p><blockquote><p/><p><a name=\"qr\"> </a></p><p><a name=\"hcqr\"> </a></p><p><b>questionnaire</b>: <a href=\"http://example.org/some-payer/Questionnaire/123\">http://example.org/some-payer/Questionnaire/123|1.3.0</a></p><p><b>status</b>: in-progress</p><p><b>subject</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&amp;canonical=http://example.org/Patient/123\">http://example.org/Patient/123: Jane Smith</a></p><p><b>authored</b>: 2019-02-15</p><p><b>author</b>: <span>: Some payer app name</span></p><blockquote><p><b>item</b></p><p><b>linkId</b>: A1234</p><p><b>text</b>: How many previous treatments have been tried for this issue?</p><h3>Answers</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>2</td></tr></table></blockquote></blockquote><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></blockquote><p><b>value</b>: 2019-02-15</p><blockquote><p><b>url</b></p><code>coverage-assertion-id</code></blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p><code>satisfied-pa-id</code></blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p><code>contact</code></blockquote><p><b>value</b>: <a href=\"http://some-payer.org/xyz-sub-org/get-help-here.html\">http://some-payer.org/xyz-sub-org/get-help-here.html</a></p></blockquote><p><b>status</b>: draft</p><p><b>intent</b>: original-order</p><p><b>medication</b>: mycophenolate mofetil 250 MG Oral Capsule [Cellcept] <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-rxNorm.html\">RxNorm</a>#616447)</span></p><p><b>subject</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&amp;canonical=http://example.org/Patient/123\">http://example.org/Patient/123: Jane Smith</a></p><p><b>encounter</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&amp;canonical=http://example.org/Encounter/ABC\">http://example.org/Encounter/ABC</a></p><p><b>authoredOn</b>: 2019-02-15</p><p><b>requester</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&amp;canonical=http://example.org/PractitionerRole/987\">http://example.org/PractitionerRole/987: Dr. Jones</a></p><p><b>note</b>: Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission. (By XYZ Insurance @Feb 15, 2019, 8:07:18 PM)</p><blockquote><p><b>dosageInstruction</b></p><p><b>text</b>: 6 tablets every 12 hours.</p><p><b>timing</b>: Once per 12 hours</p><blockquote><p><b>doseAndRate</b></p></blockquote></blockquote><hr/><blockquote><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The linkId for the item\">LinkId</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the the itemcan appear in the instance\">Definition</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Answer</a><span style=\"float: right\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireResponseRoot\" class=\"hierarchy\"/> qr</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire:http://example.org/some-payer/Questionnaire/123|1.3.0</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> A1234</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How many previous treatments have been tried for this issue?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">2</td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></blockquote></div>"
  ] ; # 
  fhir:contained ( [
a fhir:QuestionnaireResponse ;
fhir:id [ fhir:v "qr" ] ;
fhir:questionnaire [
fhir:v "http://example.org/some-payer/Questionnaire/123|1.3.0"^^xsd:anyURI ;
fhir:link <http://example.org/some-payer/Questionnaire/123|1.3.0>     ] ;
fhir:status [ fhir:v "in-progress" ] ;
fhir:subject [
fhir:link <http://example.org/Patient/123> ;
fhir:reference [ fhir:v "http://example.org/Patient/123" ] ;
fhir:display [ fhir:v "Jane Smith" ]     ] ;
fhir:authored [ fhir:v "2019-02-15"^^xsd:date ] ;
fhir:author [
fhir:identifier [
fhir:system [ fhir:v "http://some-payer.org/xyz-sub-org/identifiers/application-ids"^^xsd:anyURI ] ;
fhir:value [ fhir:v "payer-CRD-service-id" ]       ] ;
fhir:display [ fhir:v "Some payer app name" ]     ] ;
    ( fhir:item [
fhir:linkId [ fhir:v "A1234" ] ;
fhir:text [ fhir:v "How many previous treatments have been tried for this issue?" ] ;
      ( fhir:answer [
fhir:value [ fhir:v "2"^^xsd:integer ]       ] )     ] )
  ] ) ; # 
  fhir:extension ( [
    ( fhir:extension [
fhir:url [ fhir:v "coverage"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "Coverage/example" ]       ]     ] [
fhir:url [ fhir:v "covered"^^xsd:anyURI ] ;
fhir:value [ fhir:v "conditional" ]     ] [
fhir:url [ fhir:v "pa-needed"^^xsd:anyURI ] ;
fhir:value [ fhir:v "satisfied" ]     ] [
fhir:url [ fhir:v "doc-needed"^^xsd:anyURI ] ;
fhir:value [ fhir:v "admin" ]     ] [
fhir:url [ fhir:v "doc-purpose"^^xsd:anyURI ] ;
fhir:value [ fhir:v "withclaim" ]     ] [
fhir:url [ fhir:v "info-needed"^^xsd:anyURI ] ;
fhir:value [ fhir:v "performer" ]     ] [
fhir:url [ fhir:v "billingCode"^^xsd:anyURI ] ;
fhir:value [
a fhir:Coding ;
fhir:system [ fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ] ;
fhir:code [ fhir:v "77067" ]       ]     ] [
fhir:url [ fhir:v "reason"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
        ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"^^xsd:anyURI ] ;
fhir:code [ fhir:v "gold-card" ]         ] ) ;
fhir:text [ fhir:v "In-network required unless exigent circumstances" ]       ]     ] [
      ( fhir:extension [
fhir:url [ fhir:v "code"^^xsd:anyURI ] ;
fhir:value [
a fhir:CodeableConcept ;
          ( fhir:coding [
fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"^^xsd:anyURI ] ;
fhir:code [ fhir:v "auth-out-network-only" ]           ] )         ]       ] [
fhir:url [ fhir:v "value"^^xsd:anyURI ] ;
fhir:value [ fhir:v "true"^^xsd:boolean ]       ] [
fhir:url [ fhir:v "qualification"^^xsd:anyURI ] ;
fhir:value [ fhir:v "Out-of-network prior auth does not apply if delivery occurs at a service site designated as 'remote'" ]       ] ) ;
fhir:url [ fhir:v "detail"^^xsd:anyURI ]     ] [
fhir:url [ fhir:v "questionnaire"^^xsd:anyURI ] ;
fhir:value [
fhir:v "http://example.org/some-payer/Questionnaire/123|1.3.0"^^xsd:anyURI ;
fhir:link <http://example.org/some-payer/Questionnaire/123|1.3.0>       ]     ] [
fhir:url [ fhir:v "response"^^xsd:anyURI ] ;
fhir:value [
a fhir:Reference ;
fhir:reference [ fhir:v "#qr" ]       ]     ] [
fhir:url [ fhir:v "date"^^xsd:anyURI ] ;
fhir:value [ fhir:v "2019-02-15"^^xsd:date ]     ] [
fhir:url [ fhir:v "coverage-assertion-id"^^xsd:anyURI ] ;
fhir:value [ fhir:v "12345ABC" ]     ] [
fhir:url [ fhir:v "satisfied-pa-id"^^xsd:anyURI ] ;
fhir:value [ fhir:v "XXYYZ" ]     ] [
fhir:url [ fhir:v "contact"^^xsd:anyURI ] ;
fhir:value [
a fhir:ContactPoint ;
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://some-payer.org/xyz-sub-org/get-help-here.html" ]       ]     ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"^^xsd:anyURI ]
  ] ) ; # 
  fhir:status [ fhir:v "draft"] ; # 
  fhir:intent [ fhir:v "original-order"] ; # 
  fhir:medication [
a fhir:CodeableConcept ;
    ( fhir:coding [
fhir:system [ fhir:v "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "616447" ] ;
fhir:display [ fhir:v "mycophenolate mofetil 250 MG Oral Capsule [Cellcept]" ]     ] )
  ] ; # 
  fhir:subject [
fhir:link <http://example.org/Patient/123> ;
fhir:reference [ fhir:v "http://example.org/Patient/123" ] ;
fhir:display [ fhir:v "Jane Smith" ]
  ] ; # 
  fhir:encounter [
fhir:link <http://example.org/Encounter/ABC> ;
fhir:reference [ fhir:v "http://example.org/Encounter/ABC" ]
  ] ; # 
  fhir:authoredOn [ fhir:v "2019-02-15"^^xsd:date] ; # 
  fhir:requester [
fhir:link <http://example.org/PractitionerRole/987> ;
fhir:reference [ fhir:v "http://example.org/PractitionerRole/987" ] ;
fhir:display [ fhir:v "Dr. Jones" ]
  ] ; # 
  fhir:note ( [
fhir:author [ fhir:v "XYZ Insurance" ] ;
fhir:time [ fhir:v "2019-02-15T15:07:18-05:00"^^xsd:dateTime ] ;
fhir:text [ fhir:v "Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission." ]
  ] ) ; # 
  fhir:dosageInstruction ( [
fhir:text [ fhir:v "6 tablets every 12 hours." ] ;
fhir:timing [
fhir:repeat [
fhir:frequency [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:period [ fhir:v "12"^^xsd:decimal ] ;
fhir:periodUnit [ fhir:v "h" ]       ]     ] ;
    ( fhir:doseAndRate [
fhir:dose [
a fhir:Quantity ;
fhir:value [ fhir:v "6"^^xsd:decimal ] ;
fhir:unit [ fhir:v "tablet" ]       ]     ] )
  ] ) . #