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 - XML Representation

Page standards status: Informative

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    <DocumentReference xmlns="http://hl7.org/fhir">
      <id value="PCT-GFE-DocumentReference-Inst-1"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/davinci-pct-gfe-documentreference"/>
      </meta>
      <text>
        <status value="extensions"/>
        <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>
      </text>
      <extension
                 url="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/requestInitiationTime">
        <valueInstant value="2025-01-08T09:01:00+05:00"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateProcedureOrService">
        <valueCodeableConcept>
          <coding>
            <system value="http://www.ama-assn.org/go/cpt"/>
            <code value="70551"/>
            <display
                     value="Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-pct/StructureDefinition/estimateCondition">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/sid/icd-10-cm"/>
            <code value="S06.30"/>
            <display value="Unspecified focal traumatic brain injury"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <status value="current"/>
      <docStatus value="final"/>
      <type>
        <coding>
          <system value="http://loinc.org"/>
          <code value="111480-0"/>
          <display value="Good faith estimate"/>
        </coding>
      </type>
      <category>
        <coding>
          <system
                  value="http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTDocumentTypeTemporaryTrialUse"/>
          <code value="estimate"/>
        </coding>
      </category>
      <subject>🔗
        <reference value="Patient/patient1001"/>
      </subject>
      <date value="2025-01-10T11:01:00+05:00"/>
      <author>🔗
        <reference value="Organization/org1001"/>
      </author>
      <author>🔗
        <reference value="Organization/Submitter-Org-1"/>
      </author>
      <content>
        <attachment>
          <url value="http://example.org/fhir/Bundle/PCT-GFE-Packet-Inst-1"/>
        </attachment>
      </content>
    </DocumentReference>