# GFEConsentForBalanceBilling - Patient Cost Transparency Implementation Guide v2.0.1

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **GFEConsentForBalanceBilling**

## Extension: GFEConsentForBalanceBilling 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling | *Version*:2.0.1 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](http://hl7.org/fhir/versions.html#maturity): 2 | *Computable Name*:GFEConsentForBalanceBilling |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.4.42.26 | | |

If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form.

**Context of Use**

**Usage info**

**Usages:**

* Use this Extension: [PCT Good Faith Estimate Institutional](StructureDefinition-davinci-pct-gfe-institutional.md) and [PCT Good Faith Estimate Professional](StructureDefinition-davinci-pct-gfe-professional.md)
* Examples for this Extension: [Bundle/PCT-AEOB-Packet-1](Bundle-PCT-AEOB-Packet-1.md), [Bundle/PCT-GFE-Bundle-Inst-1](Bundle-PCT-GFE-Bundle-Inst-1.md), [Bundle/PCT-GFE-Packet-Inst-1](Bundle-PCT-GFE-Packet-Inst-1.md) and [Claim/PCT-GFE-Institutional-1](Claim-PCT-GFE-Institutional-1.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.davinci-pct|current/StructureDefinition/gfeConsentForBalanceBilling)

**Changes since version 1.1.0:**

* No changes

### Formal Views of Extension Content

 [Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-gfeConsentForBalanceBilling.csv), [Excel](StructureDefinition-gfeConsentForBalanceBilling.xlsx), [Schematron](StructureDefinition-gfeConsentForBalanceBilling.sch) 

#### Constraints



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "gfeConsentForBalanceBilling",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fm"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 2,
    "_valueInteger" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/davinci-pct/ImplementationGuide/hl7.fhir.us.davinci-pct"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.4.42.26"
  }],
  "version" : "2.0.1",
  "name" : "GFEConsentForBalanceBilling",
  "status" : "active",
  "date" : "2026-03-26T13:47:00+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [{
    "name" : "HL7 International / Financial Management",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/fm"
    },
    {
      "system" : "email",
      "value" : "fmlists@lists.hl7.org"
    }]
  }],
  "description" : "If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "complex-type",
  "abstract" : false,
  "context" : [{
    "type" : "element",
    "expression" : "Claim.provider"
  }],
  "type" : "Extension",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/Extension",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Extension",
      "path" : "Extension",
      "definition" : "If the provider has received a written consent form indicating a patient has agreed to waive their protections and pay up to the full cost for the out-of-network item or service, this will be “true”. If the provider has not received written consent, this will be “false”. This is an attestation only. The billing provider is legally required to maintain the written notice and consent form."
    },
    {
      "id" : "Extension.extension",
      "path" : "Extension.extension",
      "max" : "0"
    },
    {
      "id" : "Extension.url",
      "path" : "Extension.url",
      "fixedUri" : "http://hl7.org/fhir/us/davinci-pct/StructureDefinition/gfeConsentForBalanceBilling"
    },
    {
      "id" : "Extension.value[x]",
      "path" : "Extension.value[x]",
      "min" : 1,
      "type" : [{
        "code" : "boolean"
      }]
    }]
  }
}

```
