# Submit Claim Referral Request Example - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Example ServiceRequest: Submit Claim Referral Request Example

Language: en

Profile: [PAS Service Request](StructureDefinition-profile-servicerequest.md)

**status**: Active

**intent**: Order

**code**: Consultation

**quantity**: 1 visit (Details: UCUM code1 = '1')

**subject**: [JOE SMITH Male, DoB Unknown ( Member Number)](Patient-SubscriberExample.md)



## Resource Content

```json
{
  "resourceType" : "ServiceRequest",
  "id" : "ReferralRequestExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest"
    ]
  },
  "language" : "en",
  "status" : "active",
  "intent" : "order",
  "code" : {
    "coding" : [
      {
        "system" : "https://codesystem.x12.org/005010/1365",
        "code" : "3",
        "display" : "Consultation"
      }
    ]
  },
  "quantityQuantity" : {
    "value" : 1,
    "unit" : "visit",
    "system" : "http://unitsofmeasure.org",
    "code" : "1"
  },
  "subject" : {
    "reference" : "Patient/SubscriberExample"
  }
}

```
