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Source1

{
  "resourceType": "MedicationRequest",
  "id": "annotated-example",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "extension": [
        {
          "url": "coverage",
          "valueReference": {
            "reference": "Coverage/example"
          }
        },
        {
          "url": "covered",
          "valueCode": "conditional"
        },
        {
          "url": "pa-needed",
          "valueCode": "satisfied"
        },
        {
          "url": "doc-needed",
          "valueCode": "admin"
        },
        {
          "url": "doc-purpose",
          "valueCode": "withclaim"
        },
        {
          "url": "info-needed",
          "valueCode": "performer"
        },
        {
          "url": "billingCode",
          "valueCoding": {
            "system": "http://www.ama-assn.org/go/cpt",
            "code": "77067"
          }
        },
        {
          "url": "reason",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                "code": "gold-card"
              }
            ],
            "text": "Prior auth waved due to gold-card status"
          }
        },
        {
          "extension": [
            {
              "url": "category",
              "valueCode": "cat-other"
            },
            {
              "url": "code",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                    "code": "policy-link"
                  }
                ]
              }
            },
            {
              "url": "value",
              "valueUrl": "http://example.org/somepayer/policy123.pdf#abc"
            },
            {
              "url": "qualification",
              "valueString": "Additional policy details can be found here"
            }
          ],
          "url": "detail"
        },
        {
          "url": "questionnaire",
          "valueCanonical": "http://example.org/some-payer/Questionnaire/123|1.3.0"
        },
        {
          "url": "date",
          "valueDate": "2019-02-15"
        },
        {
          "url": "coverage-assertion-id",
          "valueString": "12345ABC"
        },
        {
          "url": "satisfied-pa-id",
          "valueString": "XXYYZ"
        },
        {
          "url": "contact",
          "valueContactPoint": {
            "system": "url",
            "value": "http://some-payer.org/xyz-sub-org/get-help-here.html"
          }
        },
        {
          "url": "expiry-date",
          "valueDate": "2019-08-01"
        }
      ],
      "url": "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
    }
  ],
  "status": "draft",
  "intent": "original-order",
  "medicationCodeableConcept": {
    "coding": [
      {
        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "616447",
        "display": "mycophenolate mofetil 250 MG Oral Capsule [Cellcept]"
      }
    ]
  },
  "subject": {
    "reference": "http://example.org/Patient/123",
    "display": "Jane Smith"
  },
  "encounter": {
    "reference": "http://example.org/Encounter/ABC"
  },
  "authoredOn": "2019-02-15",
  "requester": {
    "reference": "http://example.org/PractitionerRole/987",
    "display": "Dr. Jones"
  },
  "note": [
    {
      "authorString": "XYZ Insurance",
      "time": "2019-02-15T15:07:18-05:00",
      "text": "Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission."
    }
  ],
  "dosageInstruction": [
    {
      "text": "6 tablets every 12 hours.",
      "timing": {
        "repeat": {
          "frequency": 1,
          "period": 12,
          "periodUnit": "h"
        }
      },
      "doseAndRate": [
        {
          "doseQuantity": {
            "value": 6,
            "unit": "tablet"
          }
        }
      ]
    }
  ]
}