Da Vinci - Documentation Templates and Rules, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-dtr/ and changes regularly. See the Directory of published versions

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• XML
• JSON

: $questionnaire-package Input Parameters Example - JSON Representation

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{
  "resourceType" : "Parameters",
  "id" : "QuestionnairePackageInputParamsExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-input-parameters"
    ]
  },
  "parameter" : [
    {
      "name" : "coverage",
      "resource" : {
        "resourceType" : "Coverage",
        "id" : "CoverageExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage"
          ]
        },
        "contained" : [
          {
            "resourceType" : "Organization",
            "id" : "OrgExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"
              ]
            },
            "active" : true,
            "type" : [
              {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                    "code" : "pay",
                    "display" : "Payer"
                  }
                ]
              }
            ],
            "name" : "Insurance Company",
            "telecom" : [
              {
                "system" : "phone",
                "value" : "860-547-5001",
                "use" : "work"
              }
            ],
            "address" : [
              {
                "line" : [
                  "680 Asylum Street"
                ],
                "city" : "Hartford",
                "state" : "CT",
                "postalCode" : "06155",
                "country" : "US"
              }
            ]
          }
        ],
        "status" : "active",
        "subscriber" : {
          🔗 "reference" : "Patient/examplepatient"
        },
        "subscriberId" : "PFP123450000",
        "beneficiary" : {
          🔗 "reference" : "Patient/examplepatient"
        },
        "relationship" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code" : "self",
              "display" : "Self"
            }
          ]
        },
        "period" : {
          "start" : "2022-01-01",
          "end" : "2023-01-01"
        },
        "payor" : [
          {
            "reference" : "#OrgExample"
          }
        ],
        "class" : [
          {
            "type" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                  "code" : "plan",
                  "display" : "Plan"
                }
              ]
            },
            "value" : "Premim Family Plus",
            "name" : "Premim Family Plus Plan"
          }
        ]
      }
    },
    {
      "name" : "order",
      "resource" : {
        "resourceType" : "ServiceRequest",
        "id" : "ServiceRequestExample",
        "meta" : {
          "profile" : [
            🔗 "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest"
          ]
        },
        "status" : "active",
        "intent" : "original-order",
        "code" : {
          "coding" : [
            {
              "system" : "http://loinc.org",
              "code" : "24338-6"
            }
          ],
          "text" : "Gas panel - Blood"
        },
        "subject" : {
          🔗 "reference" : "Patient/examplepatient"
        },
        "occurrenceDateTime" : "2019-05-08T09:33:27+07:00",
        "authoredOn" : "2019-09-18T07:53:21+07:00",
        "requester" : {
          🔗 "reference" : "Practitioner/PractitionerExample"
        },
        "reasonCode" : [
          {
            "coding" : [
              {
                "system" : "http://snomed.info/sct",
                "code" : "4565000"
              }
            ],
            "text" : "Decreased oxygen affinity"
          }
        ]
      }
    },
    {
      "name" : "questionnaire",
      "valueCanonical" : "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire"
    }
  ]
}