Da Vinci - Coverage Requirements Discovery
2.2.0-snapshot - STU 2.2 Peer Review

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 2.2.0-snapshot 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

Page standards status: Informative

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @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:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest annotated-example</b></p><a name=\"annotated-example\"> </a><a name=\"hcannotated-example\"> </a><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\">Language: en</p></div><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p>coverage</blockquote><p><b>value</b>: <a href=\"Coverage-example.html\">Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --&gt; 2012-05-23</a></p><blockquote><p><b>url</b></p>covered</blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p>pa-needed</blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p>doc-needed</blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p>doc-purpose</blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p>info-needed</blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p>billingCode</blockquote><p><b>value</b>: <a href=\"http://terminology.hl7.org/6.2.0/CodeSystem-CPT.html#CPT-77067\">Current Procedural Terminology (CPT®): 77067</a> (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed)</p><blockquote><p><b>url</b></p>reason</blockquote><p><b>value</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp gold-card}\">Prior auth waved due to gold-card status</span></p><p><b>category</b>: cat-other</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp policy-link}\">Policy Link</span></p><p><b>value</b>: <a href=\"http://example.org/somepayer/policy123.pdf#abc\">http://example.org/somepayer/policy123.pdf#abc</a></p><p><b>qualification</b>: Additional policy details can be found here</p><blockquote><p><b>url</b></p>detail</blockquote><blockquote><p><b>url</b></p>questionnaire</blockquote><p><b>value</b>: <code>http://example.org/some-payer/Questionnaire/123|1.3.0</code></p><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>coverage-assertion-id</blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p>satisfied-pa-id</blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p>contact</blockquote><p><b>value</b>: Help Desk: <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>url</b></p>expiry-date</blockquote><p><b>value</b>: 2019-08-01</p></blockquote><p><b>status</b>: Draft</p><p><b>intent</b>: Original Order</p><p><b>medication</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 616447}\">mycophenolate mofetil 250 MG Oral Capsule [Cellcept]</span></p><p><b>subject</b>: <a href=\"http://example.org/Patient/123\">Jane Smith</a></p><p><b>encounter</b>: <a href=\"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=\"http://example.org/PractitionerRole/987\">Dr. Jones</a></p><p><b>note</b>: By XYZ Insurance @2019-02-15 15:07:18-0500</p><blockquote><div><p>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.</p>\n</div></blockquote><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><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>6 tablet</td></tr></table></blockquote></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
        ( fhir:extension [
    fhir:url [
    fhir:v "coverage"^^xsd:anyURI ;
    fhir:l fhir:coverage       ] ;
    fhir:value [
    a fhir:Reference ;
    fhir:l fhir:Coverage/example ;
    fhir:reference [ fhir:v "Coverage/example" ]       ]     ] [
    fhir:url [
    fhir:v "covered"^^xsd:anyURI ;
    fhir:l fhir:covered       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "conditional"       ]     ] [
    fhir:url [
    fhir:v "pa-needed"^^xsd:anyURI ;
    fhir:l fhir:pa-needed       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "satisfied"       ]     ] [
    fhir:url [
    fhir:v "doc-needed"^^xsd:anyURI ;
    fhir:l fhir:doc-needed       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "admin"       ]     ] [
    fhir:url [
    fhir:v "doc-purpose"^^xsd:anyURI ;
    fhir:l fhir:doc-purpose       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "withclaim"       ]     ] [
    fhir:url [
    fhir:v "info-needed"^^xsd:anyURI ;
    fhir:l fhir:info-needed       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "performer"       ]     ] [
    fhir:url [
    fhir:v "billingCode"^^xsd:anyURI ;
    fhir:l fhir:billingCode       ] ;
    fhir:value [
    a fhir:Coding ;
    fhir:system [
    fhir:v "http://www.ama-assn.org/go/cpt"^^xsd:anyURI ;
    fhir:l <http://www.ama-assn.org/go/cpt>         ] ;
    fhir:code [ fhir:v "77067" ]       ]     ] [
    fhir:url [
    fhir:v "reason"^^xsd:anyURI ;
    fhir:l fhir:reason       ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp>           ] ;
    fhir:code [ fhir:v "gold-card" ]         ] ) ;
    fhir:text [ fhir:v "Prior auth waved due to gold-card status" ]       ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "category"^^xsd:anyURI ;
    fhir:l fhir:category         ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "cat-other"         ]       ] [
    fhir:url [
    fhir:v "code"^^xsd:anyURI ;
    fhir:l fhir:code         ] ;
    fhir:value [
    a fhir:CodeableConcept ;
              ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp>             ] ;
    fhir:code [ fhir:v "policy-link" ]           ] )         ]       ] [
    fhir:url [
    fhir:v "value"^^xsd:anyURI ;
    fhir:l fhir:value         ] ;
    fhir:value [
    a fhir:Url ;
    fhir:v "http://example.org/somepayer/policy123.pdf#abc"^^xsd:anyURI ;
    fhir:l <http://example.org/somepayer/policy123.pdf#abc>         ]       ] [
    fhir:url [
    fhir:v "qualification"^^xsd:anyURI ;
    fhir:l fhir:qualification         ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "Additional policy details can be found here"         ]       ] ) ;
    fhir:url [
    fhir:v "detail"^^xsd:anyURI ;
    fhir:l fhir:detail       ]     ] [
    fhir:url [
    fhir:v "questionnaire"^^xsd:anyURI ;
    fhir:l fhir:questionnaire       ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://example.org/some-payer/Questionnaire/123|1.3.0"^^xsd:anyURI ;
    fhir:l <http://example.org/some-payer/Questionnaire/123?version=1.3.0>       ]     ] [
    fhir:url [
    fhir:v "date"^^xsd:anyURI ;
    fhir:l fhir:date       ] ;
    fhir:value [
    a fhir:Date ;
    fhir:v "2019-02-15"^^xsd:date       ]     ] [
    fhir:url [
    fhir:v "coverage-assertion-id"^^xsd:anyURI ;
    fhir:l fhir:coverage-assertion-id       ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "12345ABC"       ]     ] [
    fhir:url [
    fhir:v "satisfied-pa-id"^^xsd:anyURI ;
    fhir:l fhir:satisfied-pa-id       ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "XXYYZ"       ]     ] [
    fhir:url [
    fhir:v "contact"^^xsd:anyURI ;
    fhir:l fhir:contact       ] ;
    fhir:value [
    a fhir:ContactDetail ;
    fhir:name [ fhir:v "Help Desk" ] ;
            ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://some-payer.org/xyz-sub-org/get-help-here.html" ]         ] )       ]     ] [
    fhir:url [
    fhir:v "expiry-date"^^xsd:anyURI ;
    fhir:l fhir:expiry-date       ] ;
    fhir:value [
    a fhir:Date ;
    fhir:v "2019-08-01"^^xsd:date       ]     ] ) ;
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information>     ]
      ] ) ; #
      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:l <http://www.nlm.nih.gov/research/umls/rxnorm>       ] ;
    fhir:code [ fhir:v "616447" ] ;
    fhir:display [ fhir:v "mycophenolate mofetil 250 MG Oral Capsule [Cellcept]" ]     ] )
      ] ; #
      fhir:subject [
    fhir:l <http://example.org/Patient/123> ;
    fhir:reference [ fhir:v "http://example.org/Patient/123" ] ;
    fhir:display [ fhir:v "Jane Smith" ]
      ] ; #
      fhir:encounter [
    fhir:l <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:l <http://example.org/PractitionerRole/987> ;
    fhir:reference [ fhir:v "http://example.org/PractitionerRole/987" ] ;
    fhir:display [ fhir:v "Dr. Jones" ]
      ] ; #
      fhir:note ( [
    fhir:author [
    a fhir:String ;
    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" ]       ]     ] )
      ] ) . #