{
  "summary": "Request Form Completion Card",
  "detail": "This is a Request Form Completion Card which indicates that there are forms that need to be completed.",
  "indicator": "info",
  "source": {
    "label": "Inferno",
    "url": "https://inferno.healthit.gov/",
    "topic": {
      "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
      "code": "coverage-info",
      "display": "Coverage Information"
    }
  },
  "selectionBehavior": "any",
  "suggestions": [
    {
      "label": "Add 'completion of the ABC form' to your task list (possibly for reassignment)",
      "actions": [
        {
          "type": "create",
          "description": "Add version 2 of the XYZ form to the clinical system's repository (if it doesn't already exist)",
          "resource": {
            "resourceType": "Questionnaire",
            "id": "XYZ",
            "url": "http://example.org/Questionnaire/XYZ",
            "title": "Cancer Quality Forum Questionnaire XYZ",
            "version": 2,
            "status": "active",
            "subjectType": [
              "Patient"
            ],
            "date": "2012-01",
            "item": [
              {
                "linkId": "1",
                "code": [
                  {
                    "system": "http://example.org/system/code/sections",
                    "code": "COMORBIDITY"
                  }
                ],
                "type": "group",
                "item": [
                  {
                    "linkId": "1.1",
                    "code": [
                      {
                        "system": "http://example.org/system/code/questions",
                        "code": "COMORB"
                      }
                    ],
                    "prefix": "1",
                    "type": "choice",
                    "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow",
                    "item": [
                      {
                        "linkId": "1.1.1",
                        "code": [
                          {
                            "system": "http://example.org/system/code/sections",
                            "code": "CARDIAL"
                          }
                        ],
                        "type": "group",
                        "enableWhen": [
                          {
                            "question": "1.1",
                            "operator": "=",
                            "answerCoding": {
                              "system": "http://terminology.hl7.org/CodeSystem/v2-0136",
                              "code": "Y"
                            }
                          }
                        ],
                        "item": [
                          {
                            "linkId": "1.1.1.1",
                            "code": [
                              {
                                "system": "http://example.org/system/code/questions",
                                "code": "COMORBCAR"
                              }
                            ],
                            "prefix": "1.1",
                            "type": "choice",
                            "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow",
                            "item": [
                              {
                                "linkId": "1.1.1.1.1",
                                "code": [
                                  {
                                    "system": "http://example.org/system/code/questions",
                                    "code": "COMCAR00",
                                    "display": "Angina Pectoris"
                                  },
                                  {
                                    "system": "http://snomed.info/sct",
                                    "code": "194828000",
                                    "display": "Angina (disorder)"
                                  }
                                ],
                                "prefix": "1.1.1",
                                "type": "choice",
                                "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
                              },
                              {
                                "linkId": "1.1.1.1.2",
                                "code": [
                                  {
                                    "system": "http://snomed.info/sct",
                                    "code": "22298006",
                                    "display": "Myocardial infarction (disorder)"
                                  }
                                ],
                                "prefix": "1.1.2",
                                "type": "choice",
                                "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
                              }
                            ]
                          },
                          {
                            "linkId": "1.1.1.2",
                            "code": [
                              {
                                "system": "http://example.org/system/code/questions",
                                "code": "COMORBVAS"
                              }
                            ],
                            "prefix": "1.2",
                            "type": "choice",
                            "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
                          }
                        ]
                      }
                    ]
                  }
                ]
              },
              {
                "linkId": "2",
                "code": [
                  {
                    "system": "http://example.org/system/code/sections",
                    "code": "HISTOPATHOLOGY"
                  }
                ],
                "type": "group",
                "item": [
                  {
                    "linkId": "2.1",
                    "code": [
                      {
                        "system": "http://example.org/system/code/sections",
                        "code": "ABDOMINAL"
                      }
                    ],
                    "type": "group",
                    "item": [
                      {
                        "linkId": "2.1.2",
                        "code": [
                          {
                            "system": "http://example.org/system/code/questions",
                            "code": "STADPT",
                            "display": "pT category"
                          }
                        ],
                        "type": "choice"
                      }
                    ]
                  }
                ]
              }
            ]
          },
          "extension": {
            "davinci-crd.if-none-exist": "url=http://example.org/Questionnaire/XYZ&version=2"
          }
        },
        {
          "type": "create",
          "description": "Add 'Complete ABC form' to the task list",
          "resource": {
            "resourceType": "Task",
            "status": "ready",
            "intent": "order",
            "code": {
              "coding": [
                {
                  "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                  "code": "complete-questionnaire"
                }
              ]
            },
            "description": "Complete XYZ form for local retention",
            "for": {
              "reference": "http://example.org/fhir/Patient/123"
            },
            "authoredOn": "2018-08-09",
            "requester": {
              "reference": "http://example.org/fhir/Organization/payer"
            },
            "input": [
              {
                "type": {
                  "text": "questionnaire",
                  "coding": [
                    {
                      "system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
                      "code": "questionnaire"
                    }
                  ]
                },
                "valueCanonical": "http://example.org/Questionnaire/XYZ"
              },
              {
                "type": {
                  "text": "afterCompletion",
                  "coding": [
                    {
                      "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                      "code": "after-completion-action"
                    }
                  ]
                },
                "valueCodeableConcept": {
                  "coding": [
                    {
                      "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                      "code": "prior-auth-include",
                      "display": "Include in prior authorization"
                    }
                  ]
                }
              }
            ]
          }
        }
      ]
    }
  ]
}