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

## : Homecare Authorization Update Bundle Example - TTL Representation

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:Bundle ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "HomecareAuthorizationUpdateBundleExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle>     ] )
      ] ; #
      fhir:identifier [
    fhir:system [ fhir:v "http://example.org/SUBMITTER_TRANSACTION_IDENTIFIER"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "A12345" ]
      ] ; #
      fhir:type [ fhir:v "collection"] ; #
      fhir:timestamp [ fhir:v "2005-05-02T11:01:00+05:00"^^xsd:dateTime] ; #
      fhir:entry ( [
    fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample"^^xsd:anyURI ] ;
        ( fhir:resource <http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample> )
      ] [
    fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/UMOExample"^^xsd:anyURI ] ;
        ( fhir:resource <http://example.org/fhir/Organization/UMOExample> )
      ] [
    fhir:fullUrl [ fhir:v "http://example.org/fhir/Organization/InsurerExample"^^xsd:anyURI ] ;
        ( fhir:resource <http://example.org/fhir/Organization/InsurerExample> )
      ] [
    fhir:fullUrl [ fhir:v "http://example.org/fhir/Coverage/InsuranceExample"^^xsd:anyURI ] ;
        ( fhir:resource <http://example.org/fhir/Coverage/InsuranceExample> )
      ] [
    fhir:fullUrl [ fhir:v "http://example.org/fhir/Patient/SubscriberExample"^^xsd:anyURI ] ;
        ( fhir:resource <http://example.org/fhir/Patient/SubscriberExample> )
      ] [
    fhir:fullUrl [ fhir:v "http://example.org/fhir/Claim/HomecareAuthorizationExample"^^xsd:anyURI ] ;
        ( fhir:resource <http://example.org/fhir/Claim/HomecareAuthorizationExample> )
      ] ) . #

    <http://example.org/fhir/Claim/HomecareAuthorizationUpdateExample> a fhir:Claim ;
      fhir:id [ fhir:v "HomecareAuthorizationUpdateExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_HomecareAuthorizationUpdateExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim HomecareAuthorizationUpdateExample</b></p><a name=\"HomecareAuthorizationUpdateExample\"> </a><a name=\"hcHomecareAuthorizationUpdateExample\"> </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-claim-update.html\">PAS Claim Update</a></p></div><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099-UPDATE</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( Member Number)</a></p><p><b>created</b>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-HomecareAuthorizationExample.html\">Claim: extension = ; identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2019-07-20 11:01:00+0500; priority = Normal</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship prior}\">Prior Claim</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets G0154}\">G0154</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 3}\">Cancel</span></p><p><b>InfoCancelledFlag</b>: true</p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4184}\">B4184</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>InfoChanged</b>: added</p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4185}\">B4185</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:identifier ( [
    fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "111099-UPDATE" ] ;
    fhir:assigner [
    fhir:identifier [
    fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "9012345678" ]       ]     ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:type [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "professional" ]     ] )
      ] ; #
      fhir:use [ fhir:v "preauthorization"] ; #
      fhir:patient [
    fhir:reference [ fhir:v "Patient/SubscriberExample" ]
      ] ; #
      fhir:created [ fhir:v "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ; #
      fhir:insurer [
    fhir:reference [ fhir:v "Organization/InsurerExample" ]
      ] ; #
      fhir:provider [
    fhir:reference [ fhir:v "Organization/UMOExample" ]
      ] ; #
      fhir:priority [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "normal" ]     ] )
      ] ; #
      fhir:related ( [
    fhir:claim [
    fhir:reference [ fhir:v "Claim/HomecareAuthorizationExample" ]     ] ;
    fhir:relationship [
          ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "prior" ]       ] )     ]
      ] ) ; #
      fhir:insurance ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:focal [ fhir:v true ] ;
    fhir:coverage [
    fhir:reference [ fhir:v "Coverage/InsuranceExample" ]     ]
      ] ) ; #
      fhir:item ( [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "HS" ] ;
    fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "I" ] ;
    fhir:display [ fhir:v "Initial" ]         ] )       ]     ] ) ;
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "42" ] ;
    fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "G0154" ]       ] )     ] ;
    fhir:location [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "11" ]       ] )     ]
      ] [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "HS" ] ;
    fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "I" ] ;
    fhir:display [ fhir:v "Initial" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:code ;
    fhir:v "added"       ]     ] ) ;
    fhir:sequence [ fhir:v "3"^^xsd:positiveInteger ] ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "42" ] ;
    fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "B4185" ]       ] )     ] ;
    fhir:location [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "11" ]       ] )     ]
      ] ) ; #
      fhir:_item ( [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "HS" ] ;
    fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "3" ] ;
    fhir:display [ fhir:v "Cancel" ]         ] )       ]     ] ) ;
        ( fhir:modifierExtension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:boolean ;
    fhir:v true       ]     ] ) ;
    fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "42" ] ;
    fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "B4184" ]       ] )     ] ;
    fhir:location [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "11" ]       ] )     ]
      ] ) . #

    <http://example.org/fhir/Organization/UMOExample> a fhir:Organization ;
      fhir:id [ fhir:v "UMOExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_UMOExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization UMOExample</b></p><a name=\"UMOExample\"> </a><a name=\"hcUMOExample\"> </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-requestor.html\">PAS Requestor Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/8189991234</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 X3}\">X3</span></p><p><b>name</b>: DR. JOE SMITH CORPORATION</p><p><b>address</b>: 111 1ST STREET SAN DIEGO CA 92101 US </p></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:identifier ( [
    fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "8189991234" ]
      ] ) ; #
      fhir:active [ fhir:v true] ; #
      fhir:type ( [
        ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "X3" ]     ] )
      ] ) ; #
      fhir:name [ fhir:v "DR. JOE SMITH CORPORATION"] ; #
      fhir:address ( [
        ( fhir:line [ fhir:v "111 1ST STREET" ] ) ;
    fhir:city [ fhir:v "SAN DIEGO" ] ;
    fhir:state [ fhir:v "CA" ] ;
    fhir:postalCode [ fhir:v "92101" ] ;
    fhir:country [ fhir:v "US" ]
      ] ) . #

    <http://example.org/fhir/Organization/InsurerExample> a fhir:Organization ;
      fhir:id [ fhir:v "InsurerExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_InsurerExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization InsurerExample</b></p><a name=\"InsurerExample\"> </a><a name=\"hcInsurerExample\"> </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-insurer.html\">PAS Insurer Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.2.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/98 PR}\">PR</span></p><p><b>name</b>: MARYLAND CAPITAL INSURANCE COMPANY</p></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:identifier ( [
    fhir:system [ fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "1234567893" ]
      ] ) ; #
      fhir:active [ fhir:v true] ; #
      fhir:type ( [
        ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/98"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "PR" ]     ] )
      ] ) ; #
      fhir:name [ fhir:v "MARYLAND CAPITAL INSURANCE COMPANY"] . #

    <http://example.org/fhir/Coverage/InsuranceExample> a fhir:Coverage ;
      fhir:id [ fhir:v "InsuranceExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_InsuranceExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage InsuranceExample</b></p><a name=\"InsuranceExample\"> </a><a name=\"hcInsuranceExample\"> </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-coverage.html\">PAS Coverage</a></p></div><p><b>status</b>: Active</p><p><b>subscriberId</b>: 1122334455</p><p><b>beneficiary</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( Member Number)</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}, {https://codesystem.x12.org/005010/1069 18}\">Self</span></p><p><b>payor</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:subscriberId [ fhir:v "1122334455"] ; #
      fhir:beneficiary [
    fhir:reference [ fhir:v "Patient/SubscriberExample" ]
      ] ; #
      fhir:relationship [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "self" ]     ] [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1069"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "18" ]     ] )
      ] ; #
      fhir:payor ( [
    fhir:reference [ fhir:v "Organization/InsurerExample" ]
      ] ) . #

    <http://example.org/fhir/Patient/SubscriberExample> a fhir:Patient ;
      fhir:id [ fhir:v "SubscriberExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_SubscriberExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient SubscriberExample</b></p><a name=\"SubscriberExample\"> </a><a name=\"hcSubscriberExample\"> </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-subscriber.html\">PAS Subscriber Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">JOE SMITH  Male, DoB Unknown ( Member Number)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"A patient's military status.\"><a href=\"StructureDefinition-extension-militaryStatus.html\"/></td><td colspan=\"3\"><span title=\"Codes:{https://codesystem.x12.org/005010/584 RU}\">RU</span></td></tr></table></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:extension ( [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/584"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "RU" ]       ] )     ]
      ] ) ; #
      fhir:identifier ( [
    fhir:type [
          ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "MB" ]       ] )     ] ;
    fhir:system [ fhir:v "http://example.org/MIN"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "12345678901" ]
      ] ) ; #
      fhir:name ( [
    fhir:family [ fhir:v "SMITH" ] ;
        ( fhir:given [ fhir:v "JOE" ] )
      ] ) ; #
      fhir:gender [ fhir:v "male"] . #

    <http://example.org/fhir/Claim/HomecareAuthorizationExample> a fhir:Claim ;
      fhir:id [ fhir:v "HomecareAuthorizationExample"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim>     ] )
      ] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_HomecareAuthorizationExample\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim HomecareAuthorizationExample</b></p><a name=\"HomecareAuthorizationExample\"> </a><a name=\"hcHomecareAuthorizationExample\"> </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-claim.html\">PAS Claim</a></p></div><blockquote><p><b>HomeHealthCareInformation</b></p><ul><li>prognosis: <span title=\"Codes:{https://codesystem.x12.org/005010/923 1}\">1</span></li><li>date: 2005-05-02</li></ul></blockquote><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( Member Number)</a></p><p><b>created</b>: 2019-07-20 11:01:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>provider</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-InsuranceExample.html\">Coverage: status = active; subscriberId = 1122334455; relationship = Self</a></td></tr></table><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets G0154}\">G0154</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote><blockquote><p><b>item</b></p><p><b>ServiceItemRequestType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1525 HS}\">Health Services Review</span></p><p><b>CertificationType</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1322 I}\">Initial</span></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/1365 42}\">Home Health Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets B4184}\">B4184</span></p><p><b>location</b>: <span title=\"Codes:{https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set 11}\">Office</span></p></blockquote></div>"^^rdf:XMLLiteral
      ] ; #
      fhir:extension ( [
        ( fhir:extension [
    fhir:url [ fhir:v "prognosis"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/923"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "1" ]         ] )       ]     ] [
    fhir:url [ fhir:v "date"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:date ;
    fhir:v "2005-05-02"^^xsd:date       ]     ] ) ;
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation"^^xsd:anyURI ]
      ] ) ; #
      fhir:identifier ( [
    fhir:system [ fhir:v "http://example.org/PATIENT_EVENT_TRACE_NUMBER"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "111099" ] ;
    fhir:assigner [
    fhir:identifier [
    fhir:system [ fhir:v "http://example.org/USER_ASSIGNED"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "9012345678" ]       ]     ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:type [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "professional" ]     ] )
      ] ; #
      fhir:use [ fhir:v "preauthorization"] ; #
      fhir:patient [
    fhir:reference [ fhir:v "Patient/SubscriberExample" ]
      ] ; #
      fhir:created [ fhir:v "2019-07-20T11:01:00+05:00"^^xsd:dateTime] ; #
      fhir:insurer [
    fhir:reference [ fhir:v "Organization/InsurerExample" ]
      ] ; #
      fhir:provider [
    fhir:reference [ fhir:v "Organization/UMOExample" ]
      ] ; #
      fhir:priority [
        ( fhir:coding [
    fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "normal" ]     ] )
      ] ; #
      fhir:insurance ( [
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:focal [ fhir:v true ] ;
    fhir:coverage [
    fhir:reference [ fhir:v "Coverage/InsuranceExample" ]     ]
      ] ) ; #
      fhir:item ( [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "HS" ] ;
    fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "I" ] ;
    fhir:display [ fhir:v "Initial" ]         ] )       ]     ] ) ;
    fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "42" ] ;
    fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "G0154" ]       ] )     ] ;
    fhir:location [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "11" ]       ] )     ]
      ] [
        ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1525"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "HS" ] ;
    fhir:display [ fhir:v "Health Services Review" ]         ] )       ]     ] [
    fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType"^^xsd:anyURI ] ;
    fhir:value [
    a fhir:CodeableConcept ;
            ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1322"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "I" ] ;
    fhir:display [ fhir:v "Initial" ]         ] )       ]     ] ) ;
    fhir:sequence [ fhir:v "2"^^xsd:positiveInteger ] ;
    fhir:category [
          ( fhir:coding [
    fhir:system [ fhir:v "https://codesystem.x12.org/005010/1365"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "42" ] ;
    fhir:display [ fhir:v "Home Health Care" ]       ] )     ] ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [ fhir:v "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "B4184" ]       ] )     ] ;
    fhir:location [
    a fhir:CodeableConcept ;
          ( fhir:coding [
    fhir:system [ fhir:v "https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "11" ]       ] )     ]
      ] ) . #