Common CQL Artifacts for FHIR (US-Based)
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Common CQL Artifacts for FHIR (US-Based), published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/us-cql-ig/ and changes regularly. See the Directory of published versions

Questionnaire: Example Patient and Coverage Questionnaire (Experimental)

Official URL: http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire Version: 2.0.0-cibuild
Standards status: Informative Active as of 2024-09-16 Computable Name: ExamplePatientAndCoverageQuestionnaire

For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.

LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. ExamplePatientAndCoverageQuestionnaire For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed. Questionnaire http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire#2.0.0-cibuild
... patient-info Patient Information 0..1 group Value Set:
.... patient-info|patient-name Name 0..1 string Value Set:
.... patient-info|date-of-birth Date of Birth 0..1 date Value Set:
.... patient-info|birth-sex Birth Sex 0..1 choice Value Set: Birth Sex
.... patient-info|medical-record-number Medical Record Number 0..1 string Value Set:
.... patient-info|phone-number Phone Number 0..1 string Value Set:
.... patient-info|email-address Email Address 0..1 string Value Set:
.... patient-info|address Address 0..1 string Value Set:
.... patient-info|city City 0..1 string Value Set:
.... patient-info|state State 0..1 string Value Set:
.... patient-info|postal-code Postal Code 0..1 string Value Set:
... coverage-info Coverage Information 0..1 group Value Set:
.... coverage-info|member-id Member ID 0..1 string Value Set:
.... completing-form|patient-info|policy-number Policy Number 0..1 string Value Set:
... provider-info Requesting Provider Information 0..1 group Value Set:
.... provider-info|name Requesting provider name 0..1 string Value Set:
.... provider-info|phone-number Phone 0..1 string Value Set:
.... provider-info|address Ordering provider address 0..1 string Value Set:
.... provider-info|npi Ordering provider Tax ID/NPI # 0..1 string Value Set:
.... provider-info|fax Fax 0..1 string Value Set:
.... servicing-provider|name Servicing Provider name 0..1 string Value Set:
.... servicing-provider|phone-number Phone 0..1 string Value Set:
.... servicing-provider|address Ordering provider address 0..1 string Value Set:
.... servicing-provider|npi Ordering provider Tax ID/NPI # 0..1 string Value Set:
.... servicing-provider|fax Fax 0..1 string Value Set:

doco Documentation for this format

Patient Information

  • linkId: patient-info
  • Answers:

Name

  • linkId: patient-info|patient-name
  • Answers:

Date of Birth

  • linkId: patient-info|date-of-birth
  • Answers:

Birth Sex

  • linkId: patient-info|birth-sex
  • Answers: Birth Sex

Medical Record Number

  • linkId: patient-info|medical-record-number
  • Answers:

Phone Number

  • linkId: patient-info|phone-number
  • Answers:

Email Address

  • linkId: patient-info|email-address
  • Answers:

Address

  • linkId: patient-info|address
  • Answers:

City

  • linkId: patient-info|city
  • Answers:

State

  • linkId: patient-info|state
  • Answers:

Postal Code

  • linkId: patient-info|postal-code
  • Answers:

Coverage Information

  • linkId: coverage-info
  • Answers:

Member ID

  • linkId: coverage-info|member-id
  • Answers:

Policy Number

  • linkId: completing-form|patient-info|policy-number
  • Answers:

Requesting Provider Information

  • linkId: provider-info
  • Answers:

Requesting provider name

  • linkId: provider-info|name
  • Answers:

Phone

  • linkId: provider-info|phone-number
  • Answers:

Ordering provider address

  • linkId: provider-info|address
  • Answers:

Ordering provider Tax ID/NPI #

  • linkId: provider-info|npi
  • Answers:

Fax

  • linkId: provider-info|fax
  • Answers:

Laboratory performing testing/Servicing Provider

  • linkId: servicing-provider
  • Answers:

Servicing Provider name

  • linkId: servicing-provider|name
  • Answers:

Phone

  • linkId: servicing-provider|phone-number
  • Answers:

Ordering provider address

  • linkId: servicing-provider|address
  • Answers:

Ordering provider Tax ID/NPI #

  • linkId: servicing-provider|npi
  • Answers:

Fax

  • linkId: servicing-provider|fax
  • Answers:

LinkIDDescription & Constraintsdoco
.. patient-info Value Set:
... patient-info|patient-name Value Set:
... patient-info|date-of-birth Value Set:
... patient-info|birth-sex Value Set: Birth Sex
... patient-info|phone-number Value Set:
... patient-info|email-address Value Set:
... patient-info|address Value Set:
... patient-info|city Value Set:
... patient-info|state Value Set:
... patient-info|postal-code Value Set:
.. coverage-info Value Set:
... coverage-info|member-id Value Set:
... completing-form|patient-info|policy-number Value Set:
.. provider-info Value Set:
... provider-info|name Value Set:
... provider-info|phone-number Value Set:
... provider-info|address Value Set:
... provider-info|npi Value Set:
... provider-info|fax Value Set:
.. servicing-provider Value Set:
... servicing-provider|name Value Set:
... servicing-provider|phone-number Value Set:
... servicing-provider|address Value Set:
... servicing-provider|npi Value Set:
... servicing-provider|fax Value Set:

doco Documentation for this format

Contained resources

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.