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 Referral Request Example

Page standards status: Informative

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    <ServiceRequest xmlns="http://hl7.org/fhir">
      <id value="ReferralRequestExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest"/>
      </meta>
      <language value="en"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><p class="res-header-id"><b>Generated Narrative: ServiceRequest ReferralRequestExample</b></p><a name="ReferralRequestExample"> </a><a name="hcReferralRequestExample"> </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">Language: en</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-profile-servicerequest.html">PAS Service Request</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Order</p><p><b>code</b>: <span title="Codes:{https://codesystem.x12.org/005010/1365 3}">Consultation</span></p><p><b>quantity</b>: 1 visit<span style="background: LightGoldenRodYellow"> (Details: UCUM  code1 = '1')</span></p><p><b>subject</b>: <a href="Patient-SubscriberExample.html">JOE SMITH  Male, DoB Unknown ( Member Number)</a></p></div>
      </text>
      <status value="active"/>
      <intent value="order"/>
      <code>
        <coding>
          <system value="https://codesystem.x12.org/005010/1365"/>
          <code value="3"/>
          <display value="Consultation"/>
        </coding>
      </code>
      <quantityQuantity>
        <value value="1"/>
        <unit value="visit"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="1"/>
      </quantityQuantity>
      <subject>🔗
        <reference value="Patient/SubscriberExample"/>
      </subject>
    </ServiceRequest>