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

## : PAS LOINC Attachment Codes Value Set

Page standards status: Trial-use | Maturity Level: 3

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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:ValueSet ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "pas-loinc-attachment-codes"] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet pas-loinc-attachment-codes</b></p><a name=\"pas-loinc-attachment-codes\"> </a><a name=\"hcpas-loinc-attachment-codes\"> </a><ul><li>Include these codes as defined in <a href=\"http://loinc.org\"><code>http://loinc.org</code></a><span title=\"Version is not explicitly stated. No matching Code System found\"> version Not Stated (use latest from terminology server)</span><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href=\"https://loinc.org/11526-1/\">11526-1</a></td><td>Pathology study</td></tr><tr><td><a href=\"https://loinc.org/11488-4/\">11488-4</a></td><td>Consult note</td></tr><tr><td><a href=\"https://loinc.org/80792-5/\">80792-5</a></td><td>Pulmonary Diagnostic study note</td></tr><tr><td><a href=\"https://loinc.org/47420-5/\">47420-5</a></td><td>Functional status assessment note</td></tr><tr><td><a href=\"https://loinc.org/34117-2/\">34117-2</a></td><td>History and physical note</td></tr><tr><td><a href=\"https://loinc.org/74156-1/\">74156-1</a></td><td>Oncology Plan of care and summary note</td></tr><tr><td><a href=\"https://loinc.org/18776-5/\">18776-5</a></td><td>Plan of care note</td></tr><tr><td><a href=\"https://loinc.org/80785-9/\">80785-9</a></td><td>Radiation oncology Plan of care note</td></tr><tr><td><a href=\"https://loinc.org/11506-3/\">11506-3</a></td><td>Progress note</td></tr><tr><td><a href=\"https://loinc.org/11504-8/\">11504-8</a></td><td>Surgical operation note</td></tr><tr><td><a href=\"https://loinc.org/18842-5/\">18842-5</a></td><td>Discharge summary</td></tr><tr><td><a href=\"https://loinc.org/34133-9/\">34133-9</a></td><td>Summary of episode note</td></tr><tr><td><a href=\"https://loinc.org/18761-7/\">18761-7</a></td><td>Transfer summary note</td></tr><tr><td><a href=\"https://loinc.org/80565-5/\">80565-5</a></td><td>Medication administration record</td></tr><tr><td><a href=\"https://loinc.org/28570-0/\">28570-0</a></td><td>Procedure note</td></tr><tr><td><a href=\"https://loinc.org/57133-1/\">57133-1</a></td><td>Referral note</td></tr><tr><td><a href=\"https://loinc.org/52027-0/\">52027-0</a></td><td>Abortion consent Document</td></tr><tr><td><a href=\"https://loinc.org/52028-8/\">52028-8</a></td><td>Hysterectomy consent Document</td></tr><tr><td><a href=\"https://loinc.org/52029-6/\">52029-6</a></td><td>Sterilization consent Document</td></tr><tr><td><a href=\"https://loinc.org/53245-7/\">53245-7</a></td><td>Driver license</td></tr><tr><td><a href=\"https://loinc.org/57828-6/\">57828-6</a></td><td>Prescription list</td></tr><tr><td><a href=\"https://loinc.org/18682-5/\">18682-5</a></td><td>Ambulance records</td></tr><tr><td><a href=\"https://loinc.org/52063-5/\">52063-5</a></td><td>Prescription for durable medical equipment (DME)</td></tr><tr><td><a href=\"https://loinc.org/52062-7/\">52062-7</a></td><td>Transcutaneous electrical neural stimulation (TENS) attachment</td></tr><tr><td><a href=\"https://loinc.org/52073-4/\">52073-4</a></td><td>Vision services attachment</td></tr><tr><td><a href=\"https://loinc.org/52070-0/\">52070-0</a></td><td>Workers compensation attachment</td></tr><tr><td><a href=\"https://loinc.org/80405-4/\">80405-4</a></td><td>Provider Certification [Type]</td></tr><tr><td><a href=\"https://loinc.org/53242-4/\">53242-4</a></td><td>Charge ticket or encounter form</td></tr><tr><td><a href=\"https://loinc.org/52042-9/\">52042-9</a></td><td>Continuous positive airway pressure (CPAP) attachment</td></tr><tr><td><a href=\"https://loinc.org/52040-3/\">52040-3</a></td><td>Dental X-rays and other images (not DICOM)</td></tr><tr><td><a href=\"https://loinc.org/18748-4/\">18748-4</a></td><td>Diagnostic imaging study</td></tr><tr><td><a href=\"https://loinc.org/53243-2/\">53243-2</a></td><td>Advanced beneficiary notice</td></tr><tr><td><a href=\"https://loinc.org/53247-3/\">53247-3</a></td><td>Eligibility acknowledgement</td></tr><tr><td><a href=\"https://loinc.org/52071-8/\">52071-8</a></td><td>Employee assistance program attachment</td></tr><tr><td><a href=\"https://loinc.org/67796-3/\">67796-3</a></td><td>EMS patient care report - version 3 Document NEMSIS</td></tr><tr><td><a href=\"https://loinc.org/77601-3/\">77601-3</a></td><td>Enhanced note</td></tr><tr><td><a href=\"https://loinc.org/52043-7/\">52043-7</a></td><td>Enteral nutrition attachment</td></tr><tr><td><a href=\"https://loinc.org/11514-7/\">11514-7</a></td><td>Chiropractic Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11521-2/\">11521-2</a></td><td>Occupational therapy Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11515-4/\">11515-4</a></td><td>Physical therapy Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11516-2/\">11516-2</a></td><td>Physician Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11517-0/\">11517-0</a></td><td>Podiatry Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11518-8/\">11518-8</a></td><td>Psychology Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11519-6/\">11519-6</a></td><td>Social service Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/11520-4/\">11520-4</a></td><td>Speech therapy Episode of care medical records</td></tr><tr><td><a href=\"https://loinc.org/52030-4/\">52030-4</a></td><td>Explanation of benefits</td></tr><tr><td><a href=\"https://loinc.org/52031-2/\">52031-2</a></td><td>Explanation of benefits to subscriber</td></tr><tr><td><a href=\"https://loinc.org/52044-5/\">52044-5</a></td><td>External infusion pump attachment</td></tr><tr><td><a href=\"https://loinc.org/103567-4/\">103567-4</a></td><td>Path report IG</td></tr><tr><td><a href=\"https://loinc.org/52064-3/\">52064-3</a></td><td>Worker's compensation first report of injury attachment</td></tr><tr><td><a href=\"https://loinc.org/52045-2/\">52045-2</a></td><td>Gait trainers attachment</td></tr><tr><td><a href=\"https://loinc.org/52033-8/\">52033-8</a></td><td>General correspondence attachment</td></tr><tr><td><a href=\"https://loinc.org/11485-0/\">11485-0</a></td><td>Anesthesia records</td></tr><tr><td><a href=\"https://loinc.org/52035-3/\">52035-3</a></td><td>Home health claims</td></tr><tr><td><a href=\"https://loinc.org/52036-1/\">52036-1</a></td><td>Home health prior authorization</td></tr><tr><td><a href=\"https://loinc.org/52046-0/\">52046-0</a></td><td>Hospital beds attachment</td></tr><tr><td><a href=\"https://loinc.org/52032-0/\">52032-0</a></td><td>Appeal denial letter</td></tr><tr><td><a href=\"https://loinc.org/52047-8/\">52047-8</a></td><td>Immunosuppressive drug attachment</td></tr><tr><td><a href=\"https://loinc.org/77600-5/\">77600-5</a></td><td>Interval note</td></tr><tr><td><a href=\"https://loinc.org/94093-2/\">94093-2</a></td><td>Itemized bill</td></tr><tr><td><a href=\"https://loinc.org/15508-5/\">15508-5</a></td><td>Labor and delivery records</td></tr><tr><td><a href=\"https://loinc.org/11502-2/\">11502-2</a></td><td>Laboratory report</td></tr><tr><td><a href=\"https://loinc.org/52048-6/\">52048-6</a></td><td>Lymphedema pump attachment</td></tr><tr><td><a href=\"https://loinc.org/52049-4/\">52049-4</a></td><td>Manual wheelchair attachment</td></tr><tr><td><a href=\"https://loinc.org/11503-0/\">11503-0</a></td><td>Medical records</td></tr><tr><td><a href=\"https://loinc.org/28011-5/\">28011-5</a></td><td>Emergency department Medical records</td></tr><tr><td><a href=\"https://loinc.org/94118-7/\">94118-7</a></td><td>Medical records in response to authorization denial</td></tr><tr><td><a href=\"https://loinc.org/52037-9/\">52037-9</a></td><td>Member ID card copy</td></tr><tr><td><a href=\"https://loinc.org/52065-0/\">52065-0</a></td><td>Automobile liability attachment</td></tr><tr><td><a href=\"https://loinc.org/52050-2/\">52050-2</a></td><td>Motorized wheelchair attachment</td></tr><tr><td><a href=\"https://loinc.org/76641-0/\">76641-0</a></td><td>Neurology study</td></tr><tr><td><a href=\"https://loinc.org/52072-6/\">52072-6</a></td><td>Non-emergency transportation attachment</td></tr><tr><td><a href=\"https://loinc.org/53246-5/\">53246-5</a></td><td>Non-medical services attachment</td></tr><tr><td><a href=\"https://loinc.org/52066-8/\">52066-8</a></td><td>Notice of Discharge Medicare Appeal Rights (NODMAR) form</td></tr><tr><td><a href=\"https://loinc.org/53244-0/\">53244-0</a></td><td>Notice of privacy practices receipt</td></tr><tr><td><a href=\"https://loinc.org/52051-0/\">52051-0</a></td><td>Orthotic/Prosthetic attachment</td></tr><tr><td><a href=\"https://loinc.org/52052-8/\">52052-8</a></td><td>Osteogenesis stimulator attachment</td></tr><tr><td><a href=\"https://loinc.org/52053-6/\">52053-6</a></td><td>Oxygen attachment</td></tr><tr><td><a href=\"https://loinc.org/52054-4/\">52054-4</a></td><td>Parenteral nutrition attachment</td></tr><tr><td><a href=\"https://loinc.org/52067-6/\">52067-6</a></td><td>Past filing limit justification</td></tr><tr><td><a href=\"https://loinc.org/52034-6/\">52034-6</a></td><td>Payer letter</td></tr><tr><td><a href=\"https://loinc.org/28629-4/\">28629-4</a></td><td>Perimetry study</td></tr><tr><td><a href=\"https://loinc.org/74030-8/\">74030-8</a></td><td>Periodontal service attachment</td></tr><tr><td><a href=\"https://loinc.org/28633-6/\">28633-6</a></td><td>Polysomnography (sleep) study</td></tr><tr><td><a href=\"https://loinc.org/52055-1/\">52055-1</a></td><td>Power operated vehicle attachment</td></tr><tr><td><a href=\"https://loinc.org/57073-9/\">57073-9</a></td><td>Prenatal records</td></tr><tr><td><a href=\"https://loinc.org/52041-1/\">52041-1</a></td><td>Blood glucose monitor attachment</td></tr><tr><td><a href=\"https://loinc.org/52068-4/\">52068-4</a></td><td>Property and casualty state mandated forms</td></tr><tr><td><a href=\"https://loinc.org/52075-9/\">52075-9</a></td><td>Purchase invoice</td></tr><tr><td><a href=\"https://loinc.org/18823-5/\">18823-5</a></td><td>Alcohol and/or substance abuse service attachment</td></tr><tr><td><a href=\"https://loinc.org/18824-3/\">18824-3</a></td><td>Cardiac service attachment</td></tr><tr><td><a href=\"https://loinc.org/18825-0/\">18825-0</a></td><td>Medical social services attachment</td></tr><tr><td><a href=\"https://loinc.org/18826-8/\">18826-8</a></td><td>Occupational therapy service attachment</td></tr><tr><td><a href=\"https://loinc.org/19002-5/\">19002-5</a></td><td>Physical therapy service attachment</td></tr><tr><td><a href=\"https://loinc.org/18594-2/\">18594-2</a></td><td>Psychiatric service attachment</td></tr><tr><td><a href=\"https://loinc.org/52184-9/\">52184-9</a></td><td>Pulmonary therapy service attachment</td></tr><tr><td><a href=\"https://loinc.org/19003-3/\">19003-3</a></td><td>Respiratory therapy service attachment</td></tr><tr><td><a href=\"https://loinc.org/29206-0/\">29206-0</a></td><td>Speech therapy service attachment</td></tr><tr><td><a href=\"https://loinc.org/52056-9/\">52056-9</a></td><td>Repair of durable medical equipment attachment</td></tr><tr><td><a href=\"https://loinc.org/52057-7/\">52057-7</a></td><td>Seat lift mechanism attachment</td></tr><tr><td><a href=\"https://loinc.org/52058-5/\">52058-5</a></td><td>Seating system attachment</td></tr><tr><td><a href=\"https://loinc.org/52039-5/\">52039-5</a></td><td>Skilled Nursing Facility (SNF) record</td></tr><tr><td><a href=\"https://loinc.org/101657-5/\">101657-5</a></td><td>Special investigation unit (SIU) medical record request Document</td></tr><tr><td><a href=\"https://loinc.org/52059-3/\">52059-3</a></td><td>Speech generating device attachment</td></tr><tr><td><a href=\"https://loinc.org/52060-1/\">52060-1</a></td><td>Standers/standing frame attachment</td></tr><tr><td><a href=\"https://loinc.org/52038-7/\">52038-7</a></td><td>Subscriber Information including retroactive and presumptive eligibility</td></tr><tr><td><a href=\"https://loinc.org/52061-9/\">52061-9</a></td><td>Support surface attachment</td></tr><tr><td><a href=\"https://loinc.org/52069-2/\">52069-2</a></td><td>Tax ID number - IRS form W9</td></tr><tr><td><a href=\"https://loinc.org/103595-5/\">103595-5</a></td><td>Certificate of Medical Necessity</td></tr><tr><td><a href=\"https://loinc.org/103596-3/\">103596-3</a></td><td>Durable medical equipment proof of delivery receipt</td></tr><tr><td><a href=\"https://loinc.org/103597-1/\">103597-1</a></td><td>Pain management form or template</td></tr><tr><td><a href=\"https://loinc.org/46212-7/\">46212-7</a></td><td>Pre operative photo</td></tr><tr><td><a href=\"https://loinc.org/52459-5/\">52459-5</a></td><td>CMS certification number (CCN) Provider</td></tr></table></li></ul></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "fm"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm>     ] ;
    fhir:value [
    a fhir:Integer ;
    fhir:v 3 ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas>         ]       ] )     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "trial-use" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/ImplementationGuide/hl7.fhir.us.davinci-pas>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pas/ValueSet/pas-loinc-attachment-codes"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pas/ValueSet/pas-loinc-attachment-codes>
      ] ; #
      fhir:identifier ( [
    fhir:system [
    fhir:v "http://loinc.org"^^xsd:anyURI ;
    fhir:l <http://loinc.org>     ] ;
    fhir:value [ fhir:v "valid-hl7-attachment-requests" ]
      ] [
    fhir:system [
    fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ;
    fhir:l <urn:ietf:rfc:3986>     ] ;
    fhir:value [ fhir:v "urn:oid:1.3.6.1.4.1.12009.10.2.6" ]
      ] ) ; #
      fhir:version [ fhir:v "2.2.0-ballot"] ; #
      fhir:name [ fhir:v "PASLOINCAttachmentCodesValueSet"] ; #
      fhir:title [ fhir:v "PAS LOINC Attachment Codes Value Set"] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:experimental [ fhir:v false] ; #
      fhir:date [ fhir:v "2022-06-29"^^xsd:date] ; #
      fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; #
      fhir:contact ( [
    fhir:name [ fhir:v "HL7 International / Financial Management" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://hl7.org/Special/committees/fm" ]     ] [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "fmlists@lists.hl7.org" ]     ] )
      ] [
    fhir:name [ fhir:v "Jean Duteau" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "mailto:jean@duteaudesign.com" ]     ] )
      ] [
    fhir:name [ fhir:v "HL7 International / Financial Management" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] )
      ] ) ; #
      fhir:description [ fhir:v "This value set includes LOINC terms that can be sent by a payer as part of an HL7 attachment request for additional information. It has been curated by the HL7 Payer/Provider Information Exchange (PIE) Work Group.  More information about using LOINC in HIPAA attachments and the source of this value set can be found at [LOINC Attahments](https://loinc.org/attachments/)."] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ] ;
    fhir:display [ fhir:v "United States of America" ]     ] )
      ] ) ; #
      fhir:copyright [ fhir:v "This material contains content from LOINC (http://loinc.org). LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc."] ; #
      fhir:compose [
        ( fhir:include [
    fhir:system [
    fhir:v "http://loinc.org"^^xsd:anyURI ;
    fhir:l <http://loinc.org>       ] ;
          ( fhir:concept [
    fhir:code [ fhir:v "11526-1" ] ;
    fhir:display [ fhir:v "Pathology study" ]       ] [
    fhir:code [ fhir:v "11488-4" ] ;
    fhir:display [ fhir:v "Consult note" ]       ] [
    fhir:code [ fhir:v "80792-5" ] ;
    fhir:display [ fhir:v "Pulmonary Diagnostic study note" ]       ] [
    fhir:code [ fhir:v "47420-5" ] ;
    fhir:display [ fhir:v "Functional status assessment note" ]       ] [
    fhir:code [ fhir:v "34117-2" ] ;
    fhir:display [ fhir:v "History and physical note" ]       ] [
    fhir:code [ fhir:v "74156-1" ] ;
    fhir:display [ fhir:v "Oncology Plan of care and summary note" ]       ] [
    fhir:code [ fhir:v "18776-5" ] ;
    fhir:display [ fhir:v "Plan of care note" ]       ] [
    fhir:code [ fhir:v "80785-9" ] ;
    fhir:display [ fhir:v "Radiation oncology Plan of care note" ]       ] [
    fhir:code [ fhir:v "11506-3" ] ;
    fhir:display [ fhir:v "Progress note" ]       ] [
    fhir:code [ fhir:v "11504-8" ] ;
    fhir:display [ fhir:v "Surgical operation note" ]       ] [
    fhir:code [ fhir:v "18842-5" ] ;
    fhir:display [ fhir:v "Discharge summary" ]       ] [
    fhir:code [ fhir:v "34133-9" ] ;
    fhir:display [ fhir:v "Summary of episode note" ]       ] [
    fhir:code [ fhir:v "18761-7" ] ;
    fhir:display [ fhir:v "Transfer summary note" ]       ] [
    fhir:code [ fhir:v "80565-5" ] ;
    fhir:display [ fhir:v "Medication administration record" ]       ] [
    fhir:code [ fhir:v "28570-0" ] ;
    fhir:display [ fhir:v "Procedure note" ]       ] [
    fhir:code [ fhir:v "57133-1" ] ;
    fhir:display [ fhir:v "Referral note" ]       ] [
    fhir:code [ fhir:v "52027-0" ] ;
    fhir:display [ fhir:v "Abortion consent Document" ]       ] [
    fhir:code [ fhir:v "52028-8" ] ;
    fhir:display [ fhir:v "Hysterectomy consent Document" ]       ] [
    fhir:code [ fhir:v "52029-6" ] ;
    fhir:display [ fhir:v "Sterilization consent Document" ]       ] [
    fhir:code [ fhir:v "53245-7" ] ;
    fhir:display [ fhir:v "Driver license" ]       ] [
    fhir:code [ fhir:v "57828-6" ] ;
    fhir:display [ fhir:v "Prescription list" ]       ] [
    fhir:code [ fhir:v "18682-5" ] ;
    fhir:display [ fhir:v "Ambulance records" ]       ] [
    fhir:code [ fhir:v "52063-5" ] ;
    fhir:display [ fhir:v "Prescription for durable medical equipment (DME)" ]       ] [
    fhir:code [ fhir:v "52062-7" ] ;
    fhir:display [ fhir:v "Transcutaneous electrical neural stimulation (TENS) attachment" ]       ] [
    fhir:code [ fhir:v "52073-4" ] ;
    fhir:display [ fhir:v "Vision services attachment" ]       ] [
    fhir:code [ fhir:v "52070-0" ] ;
    fhir:display [ fhir:v "Workers compensation attachment" ]       ] [
    fhir:code [ fhir:v "80405-4" ] ;
    fhir:display [ fhir:v "Provider Certification [Type]" ]       ] [
    fhir:code [ fhir:v "53242-4" ] ;
    fhir:display [ fhir:v "Charge ticket or encounter form" ]       ] [
    fhir:code [ fhir:v "52042-9" ] ;
    fhir:display [ fhir:v "Continuous positive airway pressure (CPAP) attachment" ]       ] [
    fhir:code [ fhir:v "52040-3" ] ;
    fhir:display [ fhir:v "Dental X-rays and other images (not DICOM)" ]       ] [
    fhir:code [ fhir:v "18748-4" ] ;
    fhir:display [ fhir:v "Diagnostic imaging study" ]       ] [
    fhir:code [ fhir:v "53243-2" ] ;
    fhir:display [ fhir:v "Advanced beneficiary notice" ]       ] [
    fhir:code [ fhir:v "53247-3" ] ;
    fhir:display [ fhir:v "Eligibility acknowledgement" ]       ] [
    fhir:code [ fhir:v "52071-8" ] ;
    fhir:display [ fhir:v "Employee assistance program attachment" ]       ] [
    fhir:code [ fhir:v "67796-3" ] ;
    fhir:display [ fhir:v "EMS patient care report - version 3 Document NEMSIS" ]       ] [
    fhir:code [ fhir:v "77601-3" ] ;
    fhir:display [ fhir:v "Enhanced note" ]       ] [
    fhir:code [ fhir:v "52043-7" ] ;
    fhir:display [ fhir:v "Enteral nutrition attachment" ]       ] [
    fhir:code [ fhir:v "11514-7" ] ;
    fhir:display [ fhir:v "Chiropractic Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11521-2" ] ;
    fhir:display [ fhir:v "Occupational therapy Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11515-4" ] ;
    fhir:display [ fhir:v "Physical therapy Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11516-2" ] ;
    fhir:display [ fhir:v "Physician Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11517-0" ] ;
    fhir:display [ fhir:v "Podiatry Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11518-8" ] ;
    fhir:display [ fhir:v "Psychology Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11519-6" ] ;
    fhir:display [ fhir:v "Social service Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "11520-4" ] ;
    fhir:display [ fhir:v "Speech therapy Episode of care medical records" ]       ] [
    fhir:code [ fhir:v "52030-4" ] ;
    fhir:display [ fhir:v "Explanation of benefits" ]       ] [
    fhir:code [ fhir:v "52031-2" ] ;
    fhir:display [ fhir:v "Explanation of benefits to subscriber" ]       ] [
    fhir:code [ fhir:v "52044-5" ] ;
    fhir:display [ fhir:v "External infusion pump attachment" ]       ] [
    fhir:code [ fhir:v "103567-4" ] ;
    fhir:display [ fhir:v "Path report IG" ]       ] [
    fhir:code [ fhir:v "52064-3" ] ;
    fhir:display [ fhir:v "Worker's compensation first report of injury attachment" ]       ] [
    fhir:code [ fhir:v "52045-2" ] ;
    fhir:display [ fhir:v "Gait trainers attachment" ]       ] [
    fhir:code [ fhir:v "52033-8" ] ;
    fhir:display [ fhir:v "General correspondence attachment" ]       ] [
    fhir:code [ fhir:v "11485-0" ] ;
    fhir:display [ fhir:v "Anesthesia records" ]       ] [
    fhir:code [ fhir:v "52035-3" ] ;
    fhir:display [ fhir:v "Home health claims" ]       ] [
    fhir:code [ fhir:v "52036-1" ] ;
    fhir:display [ fhir:v "Home health prior authorization" ]       ] [
    fhir:code [ fhir:v "52046-0" ] ;
    fhir:display [ fhir:v "Hospital beds attachment" ]       ] [
    fhir:code [ fhir:v "52032-0" ] ;
    fhir:display [ fhir:v "Appeal denial letter" ]       ] [
    fhir:code [ fhir:v "52047-8" ] ;
    fhir:display [ fhir:v "Immunosuppressive drug attachment" ]       ] [
    fhir:code [ fhir:v "77600-5" ] ;
    fhir:display [ fhir:v "Interval note" ]       ] [
    fhir:code [ fhir:v "94093-2" ] ;
    fhir:display [ fhir:v "Itemized bill" ]       ] [
    fhir:code [ fhir:v "15508-5" ] ;
    fhir:display [ fhir:v "Labor and delivery records" ]       ] [
    fhir:code [ fhir:v "11502-2" ] ;
    fhir:display [ fhir:v "Laboratory report" ]       ] [
    fhir:code [ fhir:v "52048-6" ] ;
    fhir:display [ fhir:v "Lymphedema pump attachment" ]       ] [
    fhir:code [ fhir:v "52049-4" ] ;
    fhir:display [ fhir:v "Manual wheelchair attachment" ]       ] [
    fhir:code [ fhir:v "11503-0" ] ;
    fhir:display [ fhir:v "Medical records" ]       ] [
    fhir:code [ fhir:v "28011-5" ] ;
    fhir:display [ fhir:v "Emergency department Medical records" ]       ] [
    fhir:code [ fhir:v "94118-7" ] ;
    fhir:display [ fhir:v "Medical records in response to authorization denial" ]       ] [
    fhir:code [ fhir:v "52037-9" ] ;
    fhir:display [ fhir:v "Member ID card copy" ]       ] [
    fhir:code [ fhir:v "52065-0" ] ;
    fhir:display [ fhir:v "Automobile liability attachment" ]       ] [
    fhir:code [ fhir:v "52050-2" ] ;
    fhir:display [ fhir:v "Motorized wheelchair attachment" ]       ] [
    fhir:code [ fhir:v "76641-0" ] ;
    fhir:display [ fhir:v "Neurology study" ]       ] [
    fhir:code [ fhir:v "52072-6" ] ;
    fhir:display [ fhir:v "Non-emergency transportation attachment" ]       ] [
    fhir:code [ fhir:v "53246-5" ] ;
    fhir:display [ fhir:v "Non-medical services attachment" ]       ] [
    fhir:code [ fhir:v "52066-8" ] ;
    fhir:display [ fhir:v "Notice of Discharge Medicare Appeal Rights (NODMAR) form" ]       ] [
    fhir:code [ fhir:v "53244-0" ] ;
    fhir:display [ fhir:v "Notice of privacy practices receipt" ]       ] [
    fhir:code [ fhir:v "52051-0" ] ;
    fhir:display [ fhir:v "Orthotic/Prosthetic attachment" ]       ] [
    fhir:code [ fhir:v "52052-8" ] ;
    fhir:display [ fhir:v "Osteogenesis stimulator attachment" ]       ] [
    fhir:code [ fhir:v "52053-6" ] ;
    fhir:display [ fhir:v "Oxygen attachment" ]       ] [
    fhir:code [ fhir:v "52054-4" ] ;
    fhir:display [ fhir:v "Parenteral nutrition attachment" ]       ] [
    fhir:code [ fhir:v "52067-6" ] ;
    fhir:display [ fhir:v "Past filing limit justification" ]       ] [
    fhir:code [ fhir:v "52034-6" ] ;
    fhir:display [ fhir:v "Payer letter" ]       ] [
    fhir:code [ fhir:v "28629-4" ] ;
    fhir:display [ fhir:v "Perimetry study" ]       ] [
    fhir:code [ fhir:v "74030-8" ] ;
    fhir:display [ fhir:v "Periodontal service attachment" ]       ] [
    fhir:code [ fhir:v "28633-6" ] ;
    fhir:display [ fhir:v "Polysomnography (sleep) study" ]       ] [
    fhir:code [ fhir:v "52055-1" ] ;
    fhir:display [ fhir:v "Power operated vehicle attachment" ]       ] [
    fhir:code [ fhir:v "57073-9" ] ;
    fhir:display [ fhir:v "Prenatal records" ]       ] [
    fhir:code [ fhir:v "52041-1" ] ;
    fhir:display [ fhir:v "Blood glucose monitor attachment" ]       ] [
    fhir:code [ fhir:v "52068-4" ] ;
    fhir:display [ fhir:v "Property and casualty state mandated forms" ]       ] [
    fhir:code [ fhir:v "52075-9" ] ;
    fhir:display [ fhir:v "Purchase invoice" ]       ] [
    fhir:code [ fhir:v "18823-5" ] ;
    fhir:display [ fhir:v "Alcohol and/or substance abuse service attachment" ]       ] [
    fhir:code [ fhir:v "18824-3" ] ;
    fhir:display [ fhir:v "Cardiac service attachment" ]       ] [
    fhir:code [ fhir:v "18825-0" ] ;
    fhir:display [ fhir:v "Medical social services attachment" ]       ] [
    fhir:code [ fhir:v "18826-8" ] ;
    fhir:display [ fhir:v "Occupational therapy service attachment" ]       ] [
    fhir:code [ fhir:v "19002-5" ] ;
    fhir:display [ fhir:v "Physical therapy service attachment" ]       ] [
    fhir:code [ fhir:v "18594-2" ] ;
    fhir:display [ fhir:v "Psychiatric service attachment" ]       ] [
    fhir:code [ fhir:v "52184-9" ] ;
    fhir:display [ fhir:v "Pulmonary therapy service attachment" ]       ] [
    fhir:code [ fhir:v "19003-3" ] ;
    fhir:display [ fhir:v "Respiratory therapy service attachment" ]       ] [
    fhir:code [ fhir:v "29206-0" ] ;
    fhir:display [ fhir:v "Speech therapy service attachment" ]       ] [
    fhir:code [ fhir:v "52056-9" ] ;
    fhir:display [ fhir:v "Repair of durable medical equipment attachment" ]       ] [
    fhir:code [ fhir:v "52057-7" ] ;
    fhir:display [ fhir:v "Seat lift mechanism attachment" ]       ] [
    fhir:code [ fhir:v "52058-5" ] ;
    fhir:display [ fhir:v "Seating system attachment" ]       ] [
    fhir:code [ fhir:v "52039-5" ] ;
    fhir:display [ fhir:v "Skilled Nursing Facility (SNF) record" ]       ] [
    fhir:code [ fhir:v "101657-5" ] ;
    fhir:display [ fhir:v "Special investigation unit (SIU) medical record request Document" ]       ] [
    fhir:code [ fhir:v "52059-3" ] ;
    fhir:display [ fhir:v "Speech generating device attachment" ]       ] [
    fhir:code [ fhir:v "52060-1" ] ;
    fhir:display [ fhir:v "Standers/standing frame attachment" ]       ] [
    fhir:code [ fhir:v "52038-7" ] ;
    fhir:display [ fhir:v "Subscriber Information including retroactive and presumptive eligibility" ]       ] [
    fhir:code [ fhir:v "52061-9" ] ;
    fhir:display [ fhir:v "Support surface attachment" ]       ] [
    fhir:code [ fhir:v "52069-2" ] ;
    fhir:display [ fhir:v "Tax ID number - IRS form W9" ]       ] [
    fhir:code [ fhir:v "103595-5" ] ;
    fhir:display [ fhir:v "Certificate of Medical Necessity" ]       ] [
    fhir:code [ fhir:v "103596-3" ] ;
    fhir:display [ fhir:v "Durable medical equipment proof of delivery receipt" ]       ] [
    fhir:code [ fhir:v "103597-1" ] ;
    fhir:display [ fhir:v "Pain management form or template" ]       ] [
    fhir:code [ fhir:v "46212-7" ] ;
    fhir:display [ fhir:v "Pre operative photo" ]       ] [
    fhir:code [ fhir:v "52459-5" ] ;
    fhir:display [ fhir:v "CMS certification number (CCN) Provider" ]       ] )     ] )
      ] . #