Da Vinci Payer Data Exchange
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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 2.2.0 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

: Provider Treatment Attestation Consent Example for Bulk Member Match - JSON Representation

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{
  "resourceType" : "Consent",
  "id" : "provider-treatment-attestation-1",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Consent provider-treatment-attestation-1</b></p><a name=\"provider-treatment-attestation-1\"> </a><a name=\"hcprovider-treatment-attestation-1\"> </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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-provider-treatment-relationship-consent.html\">Provider Attestation to Treatment Relationship</a></p></div><h2>Participants</h2><table class=\"grid\"><tr><td><b>Role</b></td><td><b>Details</b></td></tr><tr><td title=\"Who the consent applies to\">Patient</td><td><a href=\"Patient-1.html\">Johnny Appleseed  Male, DoB: 1986-01-01 ( Member Number)</a></td></tr><tr><td title=\"Who is agreeing to the policy and rules\">Party</td><td><a href=\"Practitioner-4.html\">Dr. Susan Smith</a></td></tr><tr><td title=\"Who manages the consent through its lifecycle.\">Manager</td><td><a href=\"Organization-ProviderOrg1.html\">Provider 1</a></td></tr></table><p>This consent is made under the policy <a href=\"https://example.org/provider-attestation-policy\">https://example.org/provider-attestation-policy</a> .</p><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 : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Rule\">Rule</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Period\">Time Period</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Parties\">Who</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Data\">What</a><span style=\"float: right\"><a href=\"https://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 : var(--ig-left,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_extension.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Consent Provision\" class=\"hierarchy\"/> permit</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></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 : var(--ig-left,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_extension.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Consent Provision\" class=\"hierarchy\"/> permit</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><ul><li>Period: 2024-01-15 --&gt; (ongoing)</li></ul></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><ul><li><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ParticipationType IRCP}\">information recipient</span>: <a href=\"Practitioner-4.html\">Dr. Susan Smith</a></li><li><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleClass PROV}\">healthcare provider</span>: <a href=\"Organization-ProviderOrg1.html\">Provider 1</a></li></ul></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><ul><li>Purpose: <a href=\"http://terminology.hl7.org/6.3.0/CodeSystem-v3-ActReason.html#v3-ActReason-TREAT\">ActReason: TREAT</a> (treatment)</li><li>Purpose: <a href=\"http://terminology.hl7.org/6.3.0/CodeSystem-v3-ActReason.html#v3-ActReason-HPAYMT\">ActReason: HPAYMT</a> (healthcare payment)</li><li>Purpose: <a href=\"http://terminology.hl7.org/6.3.0/CodeSystem-v3-ActReason.html#v3-ActReason-HOPERAT\">ActReason: HOPERAT</a> (healthcare operations)</li></ul></td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"https://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></div>"
  },
  "status" : "active",
  "scope" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
        "code" : "treatment"
      }
    ]
  },
  "category" : [
    {
      "coding" : [
        {
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
          "code" : "IDSCL",
          "display" : "Information Disclosure"
        }
      ]
    },
    {
      "coding" : [
        {
          "system" : "http://loinc.org",
          "code" : "64292-6",
          "display" : "Release of information consent"
        }
      ]
    }
  ],
  "patient" : {
    🔗 "reference" : "Patient/1"
  },
  "dateTime" : "2024-11-14T10:30:00Z",
  "performer" : [
    {
      🔗 "reference" : "Practitioner/4",
      "display" : "Dr. Susan Smith"
    }
  ],
  "organization" : [
    {
      🔗 "reference" : "Organization/ProviderOrg1",
      "display" : "Provider 1"
    }
  ],
  "sourceReference" : {
    🔗 "reference" : "DocumentReference/provider-attestation-doc-1",
    "display" : "Provider Attestation Form"
  },
  "policy" : [
    {
      "authority" : "https://example.org/health-authority",
      "uri" : "https://example.org/provider-attestation-policy"
    }
  ],
  "verification" : [
    {
      "verified" : true,
      "verifiedWith" : {
        🔗 "reference" : "Patient/1",
        "display" : "Patricia Ann Person"
      },
      "verificationDate" : "2024-11-14T10:30:00Z"
    }
  ],
  "provision" : {
    "type" : "permit",
    "period" : {
      "start" : "2024-01-15"
    },
    "actor" : [
      {
        "role" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
              "code" : "IRCP",
              "display" : "information recipient"
            }
          ]
        },
        "reference" : {
          🔗 "reference" : "Practitioner/4",
          "display" : "Dr. Susan Smith"
        }
      },
      {
        "role" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleClass",
              "code" : "PROV",
              "display" : "healthcare provider"
            }
          ]
        },
        "reference" : {
          🔗 "reference" : "Organization/ProviderOrg1",
          "display" : "Provider 1"
        }
      }
    ],
    "purpose" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "TREAT",
        "display" : "treatment"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "HPAYMT",
        "display" : "healthcare payment"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "HOPERAT",
        "display" : "healthcare operations"
      }
    ]
  }
}