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 - XML Representation

Page standards status: Informative

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<Consent xmlns="http://hl7.org/fhir">
  <id value="provider-treatment-attestation-1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
<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>
<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>
  </text>
  <status value="active"/>
  <scope>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/consentscope"/>
      <code value="treatment"/>
    </coding>
  </scope>
  <category>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="IDSCL"/>
      <display value="Information Disclosure"/>
    </coding>
  </category>
  <category>
    <coding>
      <system value="http://loinc.org"/>
      <code value="64292-6"/>
      <display value="Release of information consent"/>
    </coding>
  </category>
  <patient>🔗 
    <reference value="Patient/1"/>
  </patient>
  <dateTime value="2024-11-14T10:30:00Z"/>
  <performer>🔗 
    <reference value="Practitioner/4"/>
    <display value="Dr. Susan Smith"/>
  </performer>
  <organization>🔗 
    <reference value="Organization/ProviderOrg1"/>
    <display value="Provider 1"/>
  </organization>
  <sourceReference>🔗 
    <reference value="DocumentReference/provider-attestation-doc-1"/>
    <display value="Provider Attestation Form"/>
  </sourceReference>
  <policy>
    <authority value="https://example.org/health-authority"/>
    <uri value="https://example.org/provider-attestation-policy"/>
  </policy>
  <verification>
    <verified value="true"/>
    <verifiedWith>🔗 
      <reference value="Patient/1"/>
      <display value="Patricia Ann Person"/>
    </verifiedWith>
    <verificationDate value="2024-11-14T10:30:00Z"/>
  </verification>
  <provision>
    <type value="permit"/>
    <period>
      <start value="2024-01-15"/>
    </period>
    <actor>
      <role>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/>
          <code value="IRCP"/>
          <display value="information recipient"/>
        </coding>
      </role>
      <reference>🔗 
        <reference value="Practitioner/4"/>
        <display value="Dr. Susan Smith"/>
      </reference>
    </actor>
    <actor>
      <role>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v3-RoleClass"/>
          <code value="PROV"/>
          <display value="healthcare provider"/>
        </coding>
      </role>
      <reference>🔗 
        <reference value="Organization/ProviderOrg1"/>
        <display value="Provider 1"/>
      </reference>
    </actor>
    <purpose>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="TREAT"/>
      <display value="treatment"/>
    </purpose>
    <purpose>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HPAYMT"/>
      <display value="healthcare payment"/>
    </purpose>
    <purpose>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HOPERAT"/>
      <display value="healthcare operations"/>
    </purpose>
  </provision>
</Consent>