Da Vinci Payer Data Exchange
2.1.1 - STU 2.1

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 2.1.1 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 Attestation Document Reference - XML Representation

Page standards status: Informative

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    <DocumentReference xmlns="http://hl7.org/fhir">
      <id value="provider-attestation-doc-1"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: DocumentReference provider-attestation-doc-1</b></p><a name="provider-attestation-doc-1"> </a><a name="hcprovider-attestation-doc-1"> </a><p><b>status</b>: Current</p><p><b>docStatus</b>: Final</p><p><b>type</b>: <span title="Codes:{http://loinc.org 64292-6}">Release of information consent</span></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/consentcategorycodes treat}">Treatment</span></p><p><b>subject</b>: <a href="Patient-1.html">Patricia Ann Person</a></p><p><b>date</b>: 2024-11-14 10:30:00+0000</p><p><b>author</b>: <a href="Practitioner-4.html">Dr. Susan Smith</a></p><p><b>authenticator</b>: <a href="Organization-ProviderOrg1.html">Provider 1</a></p><p><b>custodian</b>: <a href="Organization-ProviderOrg1.html">Provider 1</a></p><blockquote><p><b>content</b></p><h3>Attachments</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ContentType</b></td><td><b>Url</b></td><td><b>Title</b></td><td><b>Creation</b></td></tr><tr><td style="display: none">*</td><td>application/pdf</td><td><a href="https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&amp;canonical=https://example.org/provider1/attestations/2024/attestation-001.pdf">https://example.org/provider1/attestations/2024/attestation-001.pdf</a></td><td>Provider Treatment Relationship Attestation Form</td><td>2024-11-14 10:30:00+0000</td></tr></table><p><b>format</b>: IHE.FormatCode.codesystem: urn:ihe:iti:xds:2017:mimeTypeSufficient (urn:ihe:iti:xds:2017:mimeTypeSufficient)</p></blockquote><h3>Contexts</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Period</b></td><td><b>Related</b></td></tr><tr><td style="display: none">*</td><td>2024-01-15 --&gt; (ongoing)</td><td><a href="Encounter-6.html">Encounter: status = finished; class = Ambulatory (ActCode#AMB); type = Consultation</a></td></tr></table></div>
      </text>
      <status value="current"/>
      <docStatus value="final"/>
      <type>
        <coding>
          <system value="http://loinc.org"/>
          <code value="64292-6"/>
          <display value="Release of information consent"/>
        </coding>
      </type>
      <category>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/>
          <code value="treat"/>
          <display value="Treatment"/>
        </coding>
      </category>
      <subject>🔗
        <reference value="Patient/1"/>
        <display value="Patricia Ann Person"/>
      </subject>
      <date value="2024-11-14T10:30:00Z"/>
      <author>🔗
        <reference value="Practitioner/4"/>
        <display value="Dr. Susan Smith"/>
      </author>
      <authenticator>🔗
        <reference value="Organization/ProviderOrg1"/>
        <display value="Provider 1"/>
      </authenticator>
      <custodian>🔗
        <reference value="Organization/ProviderOrg1"/>
        <display value="Provider 1"/>
      </custodian>
      <content>
        <attachment>
          <contentType value="application/pdf"/>
          <url
               value="https://example.org/provider1/attestations/2024/attestation-001.pdf"/>
          <title value="Provider Treatment Relationship Attestation Form"/>
          <creation value="2024-11-14T10:30:00Z"/>
        </attachment>
        <format>
          <system value="http://ihe.net/fhir/ValueSet/IHE.FormatCode.codesystem"/>
          <code value="urn:ihe:iti:xds:2017:mimeTypeSufficient"/>
        </format>
      </content>
      <context>
        <period>
          <start value="2024-01-15"/>
        </period>
        <related>🔗
          <reference value="Encounter/6"/>
        </related>
      </context>
    </DocumentReference>