{
  "resourceType" : "Task",
  "id" : "cdex-task-example22",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Task cdex-task-example22</b></p><a name=\"cdex-task-example22\"> </a><a name=\"hccdex-task-example22\"> </a><a name=\"cdex-task-example22-en-US\"> </a><p><b>identifier</b>: Re-Association Tracking Control Number/trackingid1012</p><p><b>status</b>: In Progress</p><p><b>intent</b>: order</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes attachment-request-questionnaire}\">Attachment Request Questionnaire</span></p><p><b>for</b>: <a href=\"#hccdex-task-example22/patient\">Amy Shaw  (no stated gender), DoB: 1987-02-20 ( Patient Account Number:\u00a0PA-123\u00a0(use:\u00a0usual,\u00a0))</a></p><p><b>authoredOn</b>: 2022-06-17 16:16:06+0000</p><p><b>lastModified</b>: 2022-06-17 16:16:06+0000</p><p><b>requester</b>: Identifier: <code>http://example.org/cdex/payer/payer-ids</code>/Payer123</p><p><b>owner</b>: <a href=\"#hccdex-task-example22/practitionerrole\">PractitionerRole</a></p><p><b>reasonCode</b>: <span title=\"Codes:{http://hl7.org/fhir/claim-use preauthorization}\">preauthorization</span></p><p><b>reasonReference</b>: Identifier: <code>http://example.org/cdex/payer/claim-ids</code>/Preauth123</p><h3>Restrictions</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Period</b></td></tr><tr><td style=\"display: none\">*</td><td>?? --&gt; 2022-06-21</td></tr></table><blockquote><p><b>input</b></p><p><b>PALineNumber</b>: 1</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes questionnaire-context}\">Questionnaire Context</span></p><p><b>value</b>: <a href=\"Questionnaire-cdex-questionnaire-example1.html\">Home Oxygen Therapy Questionnaire</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes payer-url}\">Payer URL</span></p><p><b>value</b>: <a href=\"http://example.org/cdex/payer/$submit-attachment\">http://example.org/cdex/payer/$submit-attachment</a></p></blockquote><blockquote><p><b>input</b></p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp purpose-of-use}\">Purpose Of Use</span></p><p><b>value</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActReason COVAUTH}\">coverage authorization</span></p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Patient #patient</b></p><a name=\"cdex-task-example22/patient\"> </a><a name=\"hccdex-task-example22/patient\"> </a><a name=\"cdex-task-example22/patient-en-US\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Amy Shaw  (no stated gender), DoB: 1987-02-20 ( Patient Account Number:\u00a0PA-123\u00a0(use:\u00a0usual,\u00a0))</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Other Id (see the one above)\">Other Id:</td><td colspan=\"3\">Member Number/Member123\u00a0(use:\u00a0usual,\u00a0)</td></tr></table></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: PractitionerRole #practitionerrole</b></p><a name=\"cdex-task-example22/practitionerrole\"> </a><a name=\"hccdex-task-example22/practitionerrole\"> </a><a name=\"cdex-task-example22/practitionerrole-en-US\"> </a><p><b>practitioner</b>: Identifier: <a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/9941339100</p><p><b>organization</b>: Identifier: <a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p></blockquote></div>"
  },
  "contained" : [{
    "resourceType" : "Patient",
    "id" : "patient",
    "identifier" : [{
      "use" : "usual",
      "type" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
          "code" : "MB",
          "display" : "Member Number"
        }],
        "text" : "Member Number"
      },
      "system" : "http://example.org/cdex/payer/member-ids",
      "value" : "Member123"
    },
    {
      "use" : "usual",
      "type" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
          "code" : "pat",
          "display" : "Patient Account Number"
        }],
        "text" : "Patient Account Number"
      },
      "system" : "http://example.org/cdex/provider/patient-ids",
      "value" : "PA-123"
    }],
    "name" : [{
      "family" : "Shaw",
      "given" : ["Amy"]
    }],
    "birthDate" : "1987-02-20"
  },
  {
    "resourceType" : "PractitionerRole",
    "id" : "practitionerrole",
    "practitioner" : {
      "identifier" : {
        "system" : "http://hl7.org/fhir/sid/us-npi",
        "value" : "9941339100"
      }
    },
    "organization" : {
      "identifier" : {
        "system" : "http://hl7.org/fhir/sid/us-npi",
        "value" : "1234567893"
      }
    }
  }],
  "identifier" : [{
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
        "code" : "tracking-id",
        "display" : "Tracking Id"
      }],
      "text" : "Re-Association Tracking Control Number"
    },
    "system" : "http://example.org/payer",
    "value" : "trackingid1012"
  }],
  "status" : "in-progress",
  "intent" : "order",
  "code" : {
    "coding" : [{
      "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
      "code" : "attachment-request-questionnaire"
    }],
    "text" : "Attachment Request Questionnaire"
  },
  "for" : {
    "reference" : "#patient"
  },
  "authoredOn" : "2022-06-17T16:16:06Z",
  "lastModified" : "2022-06-17T16:16:06Z",
  "requester" : {
    "identifier" : {
      "system" : "http://example.org/cdex/payer/payer-ids",
      "value" : "Payer123"
    }
  },
  "owner" : {
    "reference" : "#practitionerrole"
  },
  "reasonCode" : {
    "coding" : [{
      "system" : "http://hl7.org/fhir/claim-use",
      "code" : "preauthorization",
      "display" : "Preauthorization"
    }],
    "text" : "preauthorization"
  },
  "reasonReference" : {
    "identifier" : {
      "system" : "http://example.org/cdex/payer/claim-ids",
      "value" : "Preauth123"
    }
  },
  "restriction" : {
    "period" : {
      "end" : "2022-06-21"
    }
  },
  "input" : [{
    "extension" : [{
      "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-paLineNumber",
      "valueInteger" : 1
    }],
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "questionnaire-context"
      }]
    },
    "valueCanonical" : "http://example.org/cdex-questionnaire-example1",
    "_valueCanonical" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/display",
        "valueString" : "Home Oxygen Therapy Questionnaire"
      }]
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes",
        "code" : "payer-url"
      }]
    },
    "valueUrl" : "http://example.org/cdex/payer/$submit-attachment"
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/davinci-cdex/CodeSystem/cdex-temp",
        "code" : "purpose-of-use"
      }]
    },
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "COVAUTH",
        "display" : "coverage authorization"
      }]
    }
  }]
}