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Source1

{
  "resourceType": "Task",
  "id": "cdex-task-inline-example22",
  "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": "requested",
  "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"
    },
    {
      "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"
          }
        ]
      }
    }
  ]
}