| # | Name | Source | Ver | Description | |
| 1 | AuthorizationNumber | hl7.fhir.us.davinci-pas#current | R4 | A string assigned by the UMO to an authorized review outcome associated with this service item. | |
| 2 | CalendarPattern | hl7.fhir.us.davinci-pas#current | R4 | A code representing the specific days when a service is being requested | |
| 3 | CareTeamClaimScope | hl7.fhir.us.davinci-pas#current | R4 | A flag that indicates whether the care team applies to the entire claim or a single item. | |
| 4 | CertificationType | hl7.fhir.us.davinci-pas#current | R4 | A code representing the type of certification being requested (UM02) | |
| 5 | CommunicatedDiagnosis | hl7.fhir.us.davinci-pas#current | R4 | A code representing the diagnosis that is the subject of the communication | |
| 6 | ContentModifier | hl7.fhir.us.davinci-pas#current | R4 | A code representing a modifier of the content being requested | |
| 7 | DeliveryPattern | hl7.fhir.us.davinci-pas#current | R4 | A code representing the specific delivery of a service being requested | |
| 8 | ErrorElement | hl7.fhir.us.davinci-pas#current | R4 | The specific loop, segment, or element that this error information is about. | |
| 9 | ErrorPath | hl7.fhir.us.davinci-pas#current | R4 | The FHIRPath expression that indicates which FHIR element that this error information is about. | |
| 10 | InfoCancelledFlag | hl7.fhir.us.davinci-pas#current | R4 | A flag indicating whether the piece of information was cancelled. | |
| 11 | InfoChanged | hl7.fhir.us.davinci-pas#current | R4 | A code indicating how the piece of information has changed. | |
| 12 | ItemTraceNumber | hl7.fhir.us.davinci-pas#current | R4 | Uniquely identifies this claim item. (2000F-TRN) | |
| 13 | MilitaryStatus | hl7.fhir.us.davinci-pas#current | R4 | A patient's military status. | |
| 14 | PatientStatus | hl7.fhir.us.davinci-pas#current | R4 | A code representing the status of the patient when being admitted | |
| 15 | ReviewAction | hl7.fhir.us.davinci-pas#current | R4 | The details of the review action that is necessary for the authorization. | |
| 16 | ReviewActionCode | hl7.fhir.us.davinci-pas#current | R4 | The code describing the result of the review. | |
| 17 | ServiceLineNumber | hl7.fhir.us.davinci-pas#current | R4 | A number that links the content being requested with the claim item number. |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | |
| Extension | D | D | D | D | D | D | D | D | D | D | D | D | D | D | D | D | D |
| Extension.extension | C | C | C | C | C | C | C | C | C | C | C | C | C | C | S C (4) | C | C |
| Extension.extension.value[x] | B M (3) | ||||||||||||||||
| Extension.extension.url | F (3) | ||||||||||||||||
| Extension.extension.extension | C (3) | ||||||||||||||||
| Extension.url | F | F | F | F | F | F | F | F | F | F | F | F | F | F | F | F | F |
| Extension.value[x] | B M | B M | B M | B M | B M | B M | B M | B M | C | B M |
Produced 08 Sep 2023