Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

## : Submit Claim Beneficiary Example - XML Representation

Page standards status: Informative

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    <Patient xmlns="http://hl7.org/fhir">
      <id value="BeneficiaryExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-beneficiary"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Patient BeneficiaryExample</b></p><a name="BeneficiaryExample"> </a><a name="hcBeneficiaryExample"> </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-profile-beneficiary.html">PAS Beneficiary Patient</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">JESSE SMITH  Female, DoB: 1947-01-18 ( Member Number)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Known multipleBirth status of Patient">Multiple Birth:</td><td colspan="3">1</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3">US </td></tr></table></div>
      </text>
      <identifier>
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
            <code value="MB"/>
          </coding>
        </type>
        <system value="http://example.org/MIN"/>
        <value value="12345678902"/>
      </identifier>
      <name>
        <family value="SMITH"/>
        <given value="JESSE"/>
      </name>
      <gender value="female"/>
      <birthDate value="1947-01-18"/>
      <address>
        <country value="US"/>
      </address>
      <multipleBirthInteger value="1"/>
    </Patient>