Patient Cost Transparency Implementation Guide
2.0.1 - STU 2

Patient Cost Transparency Implementation Guide, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pct/ and changes regularly. See the Directory of published versions

## : PCT-GFE-DocumentReference-Inst-1 - JSON Representation

Page standards status: Informative

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    {
      "resourceType" : "DocumentReference",
      "id" : "PCT-GFE-DocumentReference-Inst-1",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-documentreference"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: DocumentReference PCT-GFE-DocumentReference-Inst-1</b></p><a name=\"PCT-GFE-DocumentReference-Inst-1\"> </a><a name=\"hcPCT-GFE-DocumentReference-Inst-1\"> </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-davinci-pct-gfe-documentreference.html\">PCT GFE Packet Document Reference</a></p></div><p><b>Request Initiation Time</b>: 2025-01-08 09:01:00+0500</p><p><b>Significant Procedures and/or products involved</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 70551}\">Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material</span></p><p><b>Significant condition involved</b>: <span title=\"Codes:{http://hl7.org/fhir/sid/icd-10-cm S06.30}\">Unspecified focal traumatic brain injury</span></p><p><b>status</b>: Current</p><p><b>docStatus</b>: Final</p><p><b>type</b>: <span title=\"Codes:{http://loinc.org 111480-0}\">Good faith estimate</span></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse estimate}\">Estimation Packet</span></p><p><b>subject</b>: <a href=\"Patient-patient1001.html\">Eve Betterhalf Female, DoB: 1955-07-23 ( http://example.com/identifiers/patient#1001)</a></p><p><b>date</b>: 2025-01-10 11:01:00+0500</p><p><b>author</b>: </p><ul><li><a href=\"Organization-org1001.html\">Organization Umbrella Insurance Company</a></li><li><a href=\"Organization-Submitter-Org-1.html\">Organization GFE Service Help INC.</a></li></ul><blockquote><p><b>content</b></p><h3>Attachments</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Url</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://example.org/fhir/Bundle/PCT-GFE-Packet-Inst-1\">http://example.org/fhir/Bundle/PCT-GFE-Packet-Inst-1</a></td></tr></table></blockquote></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/requestInitiationTime",
          "valueInstant" : "2025-01-08T09:01:00+05:00"
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateProcedureOrService",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://www.ama-assn.org/go/cpt",
                "code" : "70551",
                "display" : "Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateCondition",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
                "code" : "S06.30",
                "display" : "Unspecified focal traumatic brain injury"
              }
            ]
          }
        }
      ],
      "status" : "current",
      "docStatus" : "final",
      "type" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "111480-0",
            "display" : "Good faith estimate"
          }
        ]
      },
      "category" : [
        {
          "coding" : [
            {
              "system" : "http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse",
              "code" : "estimate"
            }
          ]
        }
      ],
      "subject" : {
        🔗 "reference" : "Patient/patient1001"
      },
      "date" : "2025-01-10T11:01:00+05:00",
      "author" : [
        {
          🔗 "reference" : "Organization/org1001"
        },
        {
          🔗 "reference" : "Organization/Submitter-Org-1"
        }
      ],
      "content" : [
        {
          "attachment" : {
            "url" : "http://example.org/fhir/Bundle/PCT-GFE-Packet-Inst-1"
          }
        }
      ]
    }