{
  "resourceType": "Questionnaire",
  "id": "qgen-CoverageEligibilityRequest1",
  "contained": [
    {
      "resourceType": "ValueSet",
      "id": "vs2",
      "name": "Type options for CoverageEligibilityRequest.event.when[x]",
      "status": "active",
      "description": "Type options for CoverageEligibilityRequest.event.when[x]",
      "expansion": {
        "identifier": "urn:uuid:22678c46-8c4c-4638-940f-4a8e7f3db90c",
        "timestamp": "2023-03-26T15:24:32+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/fhir-types",
            "code": "dateTime",
            "display": "dateTime"
          },
          {
            "system": "http://hl7.org/fhir/fhir-types",
            "code": "Period",
            "display": "Period"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs3",
      "name": "Type options for CoverageEligibilityRequest.serviced[x]",
      "status": "active",
      "description": "Type options for CoverageEligibilityRequest.serviced[x]",
      "expansion": {
        "identifier": "urn:uuid:61949caf-d6a5-4548-ba64-6bda8f9e13cb",
        "timestamp": "2023-03-26T15:24:32+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/fhir-types",
            "code": "date",
            "display": "date"
          },
          {
            "system": "http://hl7.org/fhir/fhir-types",
            "code": "Period",
            "display": "Period"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs4",
      "name": "Type options for CoverageEligibilityRequest.item.diagnosis.diagnosis[x]",
      "status": "active",
      "description": "Type options for CoverageEligibilityRequest.item.diagnosis.diagnosis[x]",
      "expansion": {
        "identifier": "urn:uuid:0a7e14d1-d044-435f-9c8e-b1a1d48bf885",
        "timestamp": "2023-03-26T15:24:32+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/fhir-types",
            "code": "CodeableConcept",
            "display": "CodeableConcept"
          },
          {
            "system": "http://hl7.org/fhir/fhir-types",
            "code": "Condition",
            "display": "Condition"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/Questionnaire/qgen-CoverageEligibilityRequest1",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986"
    }
  ],
  "version": "5.0.0",
  "status": "draft",
  "experimental": false,
  "date": "2023-03-26T15:21:02+11:00",
  "publisher": "Health Level Seven International (Financial Management)",
  "item": [
    {
      "linkId": "CoverageEligibilityRequest",
      "text": "CoverageEligibilityRequest resource",
      "type": "group",
      "required": false,
      "repeats": true,
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "flyover",
                    "display": "Fly-over"
                  }
                ]
              }
            }
          ],
          "linkId": "CoverageEligibilityRequest-flyover",
          "text": "The CoverageEligibilityRequest provides patient and insurance coverage information to an insurer for them to respond, in the form of an CoverageEligibilityResponse, with information regarding whether the stated coverage is valid and in-force and optionally to provide the insurance details of the policy.",
          "type": "display"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "string"
            }
          ],
          "linkId": "CoverageEligibilityRequest.id",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.id-flyover",
              "text": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.id.value",
              "text": "Logical id of this artifact",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "CoverageEligibilityRequest.meta",
          "text": "Metadata about the resource",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.meta-flyover",
              "text": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
              "type": "display"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "uri"
            }
          ],
          "linkId": "CoverageEligibilityRequest.implicitRules",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.implicitRules-flyover",
              "text": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.implicitRules.value",
              "text": "A set of rules under which this content was created",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "code"
            }
          ],
          "linkId": "CoverageEligibilityRequest.language",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.language-flyover",
              "text": "The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.language.value",
              "text": "language",
              "type": "coding",
              "required": false,
              "repeats": false,
              "answerConstraint": "optionsOrType"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "CoverageEligibilityRequest.text",
          "text": "Text summary of the resource, for human interpretation",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.text-flyover",
              "text": "A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs\u003d1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
              "type": "display"
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.contained",
          "text": "Contained, inline Resources",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.contained-flyover",
              "text": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.",
              "type": "display"
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.extension",
          "text": "Additional content defined by implementations",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.extension-flyover",
              "text": "May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
              "type": "display"
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.modifierExtension",
          "text": "Extensions that cannot be ignored",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.modifierExtension-flyover",
              "text": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
              "type": "display"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Identifier"
            }
          ],
          "linkId": "CoverageEligibilityRequest.identifier",
          "text": "Business Identifier for coverage eligiblity request",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.identifier-flyover",
              "text": "A unique identifier assigned to this coverage eligiblity request.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.identifier.label",
              "text": "label:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "CoverageEligibilityRequest.identifier.system",
              "text": "system:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "CoverageEligibilityRequest.identifier.value",
              "text": "value:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "code"
            }
          ],
          "linkId": "CoverageEligibilityRequest.status",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.status-flyover",
              "text": "The status of the resource instance. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.status.value",
              "text": "status",
              "type": "coding",
              "required": false,
              "repeats": false,
              "answerConstraint": "optionsOrType"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "CodeableConcept"
            }
          ],
          "linkId": "CoverageEligibilityRequest.priority",
          "text": "Desired processing priority",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.priority-flyover",
              "text": "When the requestor expects the processor to complete processing.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.priority.coding",
              "text": "code:",
              "type": "coding",
              "required": false,
              "repeats": false,
              "answerConstraint": "optionsOnly"
            },
            {
              "linkId": "CoverageEligibilityRequest.priority.text",
              "text": "text:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "code"
            }
          ],
          "linkId": "CoverageEligibilityRequest.purpose",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.purpose-flyover",
              "text": "Code to specify whether requesting: prior authorization requirements for some service categories or billing codes; benefits for coverages specified or discovered; discovery and return of coverages for the patient; and/or validation that the specified coverage is in-force at the date/period specified or \u0027now\u0027 if not specified.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.purpose.value",
              "text": "purpose",
              "type": "coding",
              "required": false,
              "repeats": false,
              "answerConstraint": "optionsOrType"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "CoverageEligibilityRequest.patient",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.patient-flyover",
              "text": "The party who is the beneficiary of the supplied coverage and for whom eligibility is sought. 1..1.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                  "valueCode": "Patient"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                }
              ],
              "linkId": "CoverageEligibilityRequest.patient.value",
              "text": "Intended recipient of products and services",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.event",
          "text": "Event information",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.event-flyover",
              "text": "Information code for an event with a corresponding date or period.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "CoverageEligibilityRequest.event.id",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.event.id-flyover",
                  "text": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.event.id.value",
                  "text": "Unique id for inter-element referencing",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.event.extension",
              "text": "Additional content defined by implementations",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.event.extension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.event.modifierExtension",
              "text": "Extensions that cannot be ignored even if unrecognized",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.event.modifierExtension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "CoverageEligibilityRequest.event.type",
              "text": "Specific event",
              "type": "group",
              "required": true,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.event.type-flyover",
                  "text": "A coded event such as when a service is expected or a card printed.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.event.type.coding",
                  "text": "code:",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly"
                },
                {
                  "linkId": "CoverageEligibilityRequest.event.type.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "CoverageEligibilityRequest.event.when[x]",
              "text": "Occurance date or period",
              "type": "group",
              "required": true,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.event.when[x]-flyover",
                  "text": "A date or period in the past or future indicating when the event occurred or is expectd to occur.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.event.when[x]._type",
                  "text": "type",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly",
                  "answerValueSet": "#vs2",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "datetime"
                        }
                      ],
                      "linkId": "CoverageEligibilityRequest.event.when[x]._null",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "CoverageEligibilityRequest.event.when[x]._null.value",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Period"
                        }
                      ],
                      "linkId": "CoverageEligibilityRequest.event.when[x]._null",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "CoverageEligibilityRequest.event.when[x]._null.low",
                          "text": "start:",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "CoverageEligibilityRequest.event.when[x]._null.end",
                          "text": "end:",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "CoverageEligibilityRequest.serviced[x]",
          "text": "Estimated date or dates of service",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.serviced[x]-flyover",
              "text": "The date or dates when the enclosed suite of services were performed or completed.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.serviced[x]._type",
              "text": "type",
              "type": "coding",
              "required": false,
              "repeats": false,
              "answerConstraint": "optionsOnly",
              "answerValueSet": "#vs3",
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "datetime"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.serviced[x]._null",
                  "type": "group",
                  "item": [
                    {
                      "linkId": "CoverageEligibilityRequest.serviced[x]._null.value",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Period"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.serviced[x]._null",
                  "type": "group",
                  "item": [
                    {
                      "linkId": "CoverageEligibilityRequest.serviced[x]._null.low",
                      "text": "start:",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "CoverageEligibilityRequest.serviced[x]._null.end",
                      "text": "end:",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "datetime"
            }
          ],
          "linkId": "CoverageEligibilityRequest.created",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.created-flyover",
              "text": "The date when this resource was created.",
              "type": "display"
            },
            {
              "linkId": "CoverageEligibilityRequest.created.value",
              "text": "Creation date",
              "type": "dateTime",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "CoverageEligibilityRequest.enterer",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.enterer-flyover",
              "text": "Person who created the request.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                  "valueCode": "Practitioner, PractitionerRole"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                }
              ],
              "linkId": "CoverageEligibilityRequest.enterer.value",
              "text": "Author",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "CoverageEligibilityRequest.provider",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.provider-flyover",
              "text": "The provider which is responsible for the request. Typically this field would be 1..1 where this party is accountable for the data content within the claim but is not necessarily the facility, provider group or practitioner who provided the products and services listed within this claim resource. This field is the Billing Provider, for example, a facility, provider group, lab or practitioner.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                  "valueCode": "Practitioner, PractitionerRole, Organization"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                }
              ],
              "linkId": "CoverageEligibilityRequest.provider.value",
              "text": "Party responsible for the request",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "CoverageEligibilityRequest.insurer",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurer-flyover",
              "text": "The Insurer who issued the coverage in question and is the recipient of the request.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                  "valueCode": "Organization"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurer.value",
              "text": "Coverage issuer",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "CoverageEligibilityRequest.facility",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.facility-flyover",
              "text": "Facility where the services are intended to be provided.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                  "valueCode": "Location"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                }
              ],
              "linkId": "CoverageEligibilityRequest.facility.value",
              "text": "Servicing facility",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.supportingInfo",
          "text": "Supporting information",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "linkId": "CoverageEligibilityRequest.supportingInfo-display",
              "text": "Often there are multiple jurisdiction specific valuesets which are required.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.supportingInfo-flyover",
              "text": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "CoverageEligibilityRequest.supportingInfo.id",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.id-flyover",
                  "text": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.supportingInfo.id.value",
                  "text": "Unique id for inter-element referencing",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.supportingInfo.extension",
              "text": "Additional content defined by implementations",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.extension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.supportingInfo.modifierExtension",
              "text": "Extensions that cannot be ignored even if unrecognized",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.modifierExtension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "integer"
                }
              ],
              "linkId": "CoverageEligibilityRequest.supportingInfo.sequence",
              "type": "group",
              "required": true,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.sequence-flyover",
                  "text": "A number to uniquely identify supporting information entries.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.supportingInfo.sequence.value",
                  "text": "Information instance identifier",
                  "type": "integer",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "CoverageEligibilityRequest.supportingInfo.information",
              "type": "group",
              "required": true,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.information-flyover",
                  "text": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data. Could be used to provide references to other resources, document. For example could contain a PDF in an Attachment of the Police Report for an Accident.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                      "valueCode": "Resource"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.information.value",
                  "text": "Data to be provided",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "boolean"
                }
              ],
              "linkId": "CoverageEligibilityRequest.supportingInfo.appliesToAll",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.supportingInfo.appliesToAll-flyover",
                  "text": "The supporting materials are applicable for all detail items, product/servce categories and specific billing codes.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.supportingInfo.appliesToAll.value",
                  "text": "Applies to all items",
                  "type": "boolean",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.insurance",
          "text": "Patient insurance information",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "linkId": "CoverageEligibilityRequest.insurance-display",
              "text": "All insurance coverages for the patient which may be applicable for reimbursement, of the products and services listed in the claim, are typically provided in the claim to allow insurers to confirm the ordering of the insurance coverages relative to local \u0027coordination of benefit\u0027 rules. One coverage (and only one) with \u0027focal\u003dtrue\u0027 is to be used in the adjudication of this claim. Coverages appearing before the focal Coverage in the list, and where \u0027subrogation\u003dfalse\u0027, should provide a reference to the ClaimResponse containing the adjudication results of the prior claim.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurance-flyover",
              "text": "Financial instruments for reimbursement for the health care products and services.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurance.id",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.id-flyover",
                  "text": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.insurance.id.value",
                  "text": "Unique id for inter-element referencing",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.insurance.extension",
              "text": "Additional content defined by implementations",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.extension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.insurance.modifierExtension",
              "text": "Extensions that cannot be ignored even if unrecognized",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.modifierExtension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "boolean"
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurance.focal",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.focal-flyover",
                  "text": "A flag to indicate that this Coverage is to be used for evaluation of this request when set to true. A patient may (will) have multiple insurance policies which provide reimburement for healthcare services and products. For example a person may also be covered by their spouse\u0027s policy and both appear in the list (and may be from the same insurer). This flag will be set to true for only one of the listed policies and that policy will be used for evaluating this request. Other requests would be created to request evaluation against the other listed policies.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.insurance.focal.value",
                  "text": "Applicable coverage",
                  "type": "boolean",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurance.coverage",
              "type": "group",
              "required": true,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.coverage-flyover",
                  "text": "Reference to the insurance card level information contained in the Coverage resource. The coverage issuing insurer will use these details to locate the patient\u0027s actual coverage within the insurer\u0027s information system.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                      "valueCode": "Coverage"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.coverage.value",
                  "text": "Insurance information",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "CoverageEligibilityRequest.insurance.businessArrangement",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.insurance.businessArrangement-flyover",
                  "text": "A business agreement number established between the provider and the insurer for special business processing purposes.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.insurance.businessArrangement.value",
                  "text": "Additional provider contract number",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "CoverageEligibilityRequest.item",
          "text": "Item to be evaluated for eligibiity",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "linkId": "CoverageEligibilityRequest.item-flyover",
              "text": "Service categories or billable services for which benefit details and/or an authorization prior to service delivery may be required by the payor.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.id",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.id-flyover",
                  "text": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.id.value",
                  "text": "Unique id for inter-element referencing",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.item.extension",
              "text": "Additional content defined by implementations",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.extension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.item.modifierExtension",
              "text": "Extensions that cannot be ignored even if unrecognized",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.modifierExtension-flyover",
                  "text": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                  "type": "display"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "integer"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.supportingInfoSequence",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.supportingInfoSequence-flyover",
                  "text": "Exceptions, special conditions and supporting information applicable for this service or product line.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.supportingInfoSequence.value",
                  "text": "Applicable exception or supporting information",
                  "type": "integer",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.category",
              "text": "Benefit classification",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.category-flyover",
                  "text": "Code to identify the general type of benefits under which products and services are provided. Examples include Medical Care, Periodontics, Renal Dialysis, Vision Coverage.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.category.coding",
                  "text": "code:",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.category.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.productOrService",
              "text": "Billing, service, product, or drug code",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.productOrService-flyover",
                  "text": "This contains the product, service, drug or other billing code for the item. Code to indicate the Professional Service or Product supplied (e.g. CTP, HCPCS, USCLS, ICD10, NCPDP, DIN, RxNorm, ACHI, CCI).",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.productOrService.coding",
                  "text": "code:",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.productOrService.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.modifier",
              "text": "Product or service billing modifiers",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.modifier-flyover",
                  "text": "Item typification or modifiers codes to convey additional context for the product or service. For example in Oral whether the treatment is cosmetic or associated with TMJ, or for Medical whether the treatment was outside the clinic or out of office hours.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.modifier.coding",
                  "text": "code:",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.modifier.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.provider",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.provider-flyover",
                  "text": "The practitioner who is responsible for the product or service to be rendered to the patient.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                      "valueCode": "Practitioner, PractitionerRole"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.provider.value",
                  "text": "Perfoming practitioner",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Quantity"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.quantity",
              "text": "Count of products or services",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.quantity-flyover",
                  "text": "The number of repetitions of a service or product.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.quantity.comparator",
                  "text": "comp:",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.quantity.value",
                  "text": "value:",
                  "type": "decimal",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.quantity.units",
                  "text": "units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.quantity.code",
                  "text": "coded units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.quantity.system",
                  "text": "units system:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Quantity"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.unitPrice",
              "text": "Fee, charge or cost per item",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.unitPrice-flyover",
                  "text": "The amount charged to the patient by the provider for a single unit.",
                  "type": "display"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.unitPrice.comparator",
                  "text": "comp:",
                  "type": "coding",
                  "required": false,
                  "repeats": false,
                  "answerConstraint": "optionsOnly"
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.unitPrice.value",
                  "text": "value:",
                  "type": "decimal",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.unitPrice.units",
                  "text": "units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.unitPrice.code",
                  "text": "coded units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.unitPrice.system",
                  "text": "units system:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.facility",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.facility-flyover",
                  "text": "Facility where the services will be provided.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                      "valueCode": "Location, Organization"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.facility.value",
                  "text": "Servicing facility",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "CoverageEligibilityRequest.item.diagnosis",
              "text": "Applicable diagnosis",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.diagnosis-flyover",
                  "text": "Patient diagnosis for which care is sought.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                      "valueInteger": 1
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "string"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.diagnosis.id",
                  "type": "group",
                  "required": false,
                  "repeats": true,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "flyover",
                                "display": "Fly-over"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId": "CoverageEligibilityRequest.item.diagnosis.id-flyover",
                      "text": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
                      "type": "display"
                    },
                    {
                      "linkId": "CoverageEligibilityRequest.item.diagnosis.id.value",
                      "text": "Unique id for inter-element referencing",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.diagnosis.extension",
                  "text": "Additional content defined by implementations",
                  "type": "group",
                  "required": false,
                  "repeats": true,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "flyover",
                                "display": "Fly-over"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId": "CoverageEligibilityRequest.item.diagnosis.extension-flyover",
                      "text": "May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                      "type": "display"
                    }
                  ]
                },
                {
                  "linkId": "CoverageEligibilityRequest.item.diagnosis.modifierExtension",
                  "text": "Extensions that cannot be ignored even if unrecognized",
                  "type": "group",
                  "required": false,
                  "repeats": true,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "flyover",
                                "display": "Fly-over"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId": "CoverageEligibilityRequest.item.diagnosis.modifierExtension-flyover",
                      "text": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element\u0027s descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
                      "type": "display"
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                      "valueInteger": 1
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]",
                  "text": "Nature of illness or problem",
                  "type": "group",
                  "required": false,
                  "repeats": true,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "flyover",
                                "display": "Fly-over"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]-flyover",
                      "text": "The nature of illness or problem in a coded form or as a reference to an external defined Condition.",
                      "type": "display"
                    },
                    {
                      "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]._type",
                      "text": "type",
                      "type": "coding",
                      "required": false,
                      "repeats": false,
                      "answerConstraint": "optionsOnly",
                      "answerValueSet": "#vs4",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                              "valueString": "CodeableConcept"
                            }
                          ],
                          "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]._null",
                          "type": "group",
                          "item": [
                            {
                              "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]._null.coding",
                              "text": "code:",
                              "type": "coding",
                              "required": false,
                              "repeats": false,
                              "answerConstraint": "optionsOnly"
                            },
                            {
                              "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]._null.text",
                              "text": "text:",
                              "type": "string",
                              "required": false,
                              "repeats": false
                            }
                          ]
                        },
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                              "valueString": "Reference"
                            }
                          ],
                          "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]._null",
                          "type": "group",
                          "item": [
                            {
                              "extension": [
                                {
                                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                                  "valueCode": "Condition"
                                },
                                {
                                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                                  "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                                }
                              ],
                              "linkId": "CoverageEligibilityRequest.item.diagnosis.diagnosis[x]._null.value",
                              "type": "reference",
                              "required": false,
                              "repeats": false
                            }
                          ]
                        }
                      ]
                    }
                  ]
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "CoverageEligibilityRequest.item.detail",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.detail-flyover",
                  "text": "The plan/proposal/order describing the proposed service in detail.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
                      "valueCode": "Resource"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject\u003d$subj\u0026patient\u003d$subj\u0026encounter\u003d$encounter"
                    }
                  ],
                  "linkId": "CoverageEligibilityRequest.item.detail.value",
                  "text": "Product or service details",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}