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

Raw json | Download

    {
      "resourceType" : "ServiceRequest",
      "id" : "ReferralRequestExample",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest"
        ]
      },
      "language" : "en",
      "text" : {
        "status" : "generated",
        "div" : "<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>"
      },
      "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"
      }
    }