FHIR Release 3 (STU)

This page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 4.0.1. For a full list of available versions, see the Directory of published versions

Claim-questionnaire.json

Financial Management Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Encounter, Patient, Practitioner, RelatedPerson

Raw JSON (canonical form)

Generated Questionnaire for Claim

{
  "resourceType": "Questionnaire",
  "id": "qs1",
  "contained": [
    {
      "resourceType": "ValueSet",
      "id": "vs2",
      "name": "Type options for Claim.prescription",
      "status": "active",
      "description": "Type options for Claim.prescription",
      "expansion": {
        "identifier": "urn:uuid:151a5d3e-3f8e-4c39-948e-119564d7f273",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "MedicationRequest",
            "display": "MedicationRequest"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "VisionPrescription",
            "display": "VisionPrescription"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs3",
      "name": "Type options for Claim.payee.party",
      "status": "active",
      "description": "Type options for Claim.payee.party",
      "expansion": {
        "identifier": "urn:uuid:24e5911d-9355-40f8-9d8e-131dab8a1dae",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Practitioner",
            "display": "Practitioner"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Organization",
            "display": "Organization"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Patient",
            "display": "Patient"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "RelatedPerson",
            "display": "RelatedPerson"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs4",
      "name": "Type options for Claim.careTeam.provider",
      "status": "active",
      "description": "Type options for Claim.careTeam.provider",
      "expansion": {
        "identifier": "urn:uuid:4d541978-b207-4501-af07-d036d37c599c",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Practitioner",
            "display": "Practitioner"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Organization",
            "display": "Organization"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs5",
      "name": "Type options for Claim.information.timing[x]",
      "status": "active",
      "description": "Type options for Claim.information.timing[x]",
      "expansion": {
        "identifier": "urn:uuid:0ef7e989-b151-42d4-bef1-06aa2409bd3b",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "date",
            "display": "date"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Period",
            "display": "Period"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs6",
      "name": "Type options for Claim.information.value[x]",
      "status": "active",
      "description": "Type options for Claim.information.value[x]",
      "expansion": {
        "identifier": "urn:uuid:1c6b4a04-e9ec-4221-a771-de6e3b0e00e3",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "string",
            "display": "string"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Quantity",
            "display": "Quantity"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Attachment",
            "display": "Attachment"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Resource",
            "display": "Resource"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs7",
      "name": "Type options for Claim.diagnosis.diagnosis[x]",
      "status": "active",
      "description": "Type options for Claim.diagnosis.diagnosis[x]",
      "expansion": {
        "identifier": "urn:uuid:e60a42eb-9851-4b83-a561-4f1fc554a295",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "CodeableConcept",
            "display": "CodeableConcept"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Condition",
            "display": "Condition"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs8",
      "name": "Type options for Claim.procedure.procedure[x]",
      "status": "active",
      "description": "Type options for Claim.procedure.procedure[x]",
      "expansion": {
        "identifier": "urn:uuid:d96f9ce2-c0a4-4d93-bf74-cf0e74991daa",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "CodeableConcept",
            "display": "CodeableConcept"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Procedure",
            "display": "Procedure"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs9",
      "name": "Type options for Claim.accident.location[x]",
      "status": "active",
      "description": "Type options for Claim.accident.location[x]",
      "expansion": {
        "identifier": "urn:uuid:04868545-197e-491c-9d8d-a3cd8cac1f93",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Address",
            "display": "Address"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Location",
            "display": "Location"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs10",
      "name": "Type options for Claim.item.serviced[x]",
      "status": "active",
      "description": "Type options for Claim.item.serviced[x]",
      "expansion": {
        "identifier": "urn:uuid:788ec4db-8352-49f6-8edd-cb8682972d2e",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "date",
            "display": "date"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Period",
            "display": "Period"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs11",
      "name": "Type options for Claim.item.location[x]",
      "status": "active",
      "description": "Type options for Claim.item.location[x]",
      "expansion": {
        "identifier": "urn:uuid:783c0f93-5803-4152-953d-c596e080d751",
        "timestamp": "2019-10-24T11:53:00+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "CodeableConcept",
            "display": "CodeableConcept"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Address",
            "display": "Address"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Location",
            "display": "Location"
          }
        ]
      }
    }
  ],
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986"
    }
  ],
  "status": "draft",
  "date": "2019-10-24T11:53:00+11:00",
  "publisher": "Health Level Seven International (Financial Management)",
  "item": [
    {
      "linkId": "Claim",
      "text": "Claim, Pre-determination or Pre-authorization",
      "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"
                  }
                ]
              }
            }
          ],
          "text": "A provider issued list of services and products provided, or to be provided, to a patient which is provided to an insurer for payment recovery.",
          "type": "display"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "string"
            }
          ],
          "linkId": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
              "type": "display"
            },
            {
              "linkId": "Claim.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": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may 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": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "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. 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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
              "type": "display"
            },
            {
              "linkId": "Claim.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": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "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": "Claim.language.value",
              "text": "language",
              "type": "choice",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "A human-readable narrative that contains a summary of the resource, and may 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 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=1 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 in formation is added later.",
              "type": "display"
            }
          ]
        },
        {
          "linkId": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. 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.",
              "type": "display"
            }
          ]
        },
        {
          "linkId": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, 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. 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": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.identifier",
          "text": "Claim number",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The business identifier for the instance: claim number, pre-determination or pre-authorization number.",
              "type": "display"
            },
            {
              "linkId": "Claim.identifier.label",
              "text": "label:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.identifier.system",
              "text": "system:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.identifier.value",
              "text": "value:",
              "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": "Claim.status",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The status of the resource instance. This element is labeled as a modifier because the status contains the code entered-in-error that marks the claim as not currently valid.",
              "type": "display"
            },
            {
              "linkId": "Claim.status.value",
              "text": "status",
              "type": "choice",
              "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": "Claim.type",
          "text": "Type or discipline",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The category of claim, eg, oral, pharmacy, vision, insitutional, professional. Affects which fields and value sets are used.",
              "type": "display"
            },
            {
              "linkId": "Claim.type.coding",
              "text": "code:",
              "type": "choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.type.text",
              "text": "text:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "CodeableConcept"
            }
          ],
          "linkId": "Claim.subType",
          "text": "Finer grained claim type 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"
                      }
                    ]
                  }
                }
              ],
              "text": "A finer grained suite of claim subtype codes which may convey Inpatient vs Outpatient and/or a specialty service. In the US the BillType. This may contain the local bill type codes such as the US UB-04 bill type code.",
              "type": "display"
            },
            {
              "linkId": "Claim.subType.coding",
              "text": "code:",
              "type": "open-choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.subType.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": "code"
            }
          ],
          "linkId": "Claim.use",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Complete (Bill or Claim), Proposed (Pre-Authorization), Exploratory (Pre-determination).",
              "type": "display"
            },
            {
              "linkId": "Claim.use.value",
              "text": "use",
              "type": "choice",
              "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": "Claim.patient",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Patient Resource.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Patient"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.patient.value",
              "text": "The subject of the Products and Services",
              "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": "Period"
            }
          ],
          "linkId": "Claim.billablePeriod",
          "text": "Period for charge submission",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The billable period for which charges are being submitted.",
              "type": "display"
            },
            {
              "linkId": "Claim.billablePeriod.low",
              "text": "start:",
              "type": "dateTime",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.billablePeriod.end",
              "text": "end:",
              "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": "datetime"
            }
          ],
          "linkId": "Claim.created",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The date when the enclosed suite of services were performed or completed.",
              "type": "display"
            },
            {
              "linkId": "Claim.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": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "Person who created the invoice/claim/pre-determination or pre-authorization.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Practitioner"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.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": "Claim.insurer",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The Insurer who is target of the request.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Organization"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.insurer.value",
              "text": "Target",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "Claim.provider",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The provider which is responsible for the bill, claim pre-determination, pre-authorization.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Practitioner"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.provider.value",
              "text": "Responsible provider",
              "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": "Claim.organization",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The organization which is responsible for the bill, claim pre-determination, pre-authorization.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Organization"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.organization.value",
              "text": "Responsible organization",
              "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": "CodeableConcept"
            }
          ],
          "linkId": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "Immediate (STAT), best effort (NORMAL), deferred (DEFER).",
              "type": "display"
            },
            {
              "linkId": "Claim.priority.coding",
              "text": "code:",
              "type": "open-choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.priority.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": "Claim.fundsReserve",
          "text": "Funds requested to be reserved",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "In the case of a Pre-Determination/Pre-Authorization the provider may request that funds in the amount of the expected Benefit be reserved ('Patient' or 'Provider') to pay for the Benefits determined on the subsequent claim(s). 'None' explicitly indicates no funds reserving is requested.",
              "type": "display"
            },
            {
              "linkId": "Claim.fundsReserve.coding",
              "text": "code:",
              "type": "open-choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.fundsReserve.text",
              "text": "text:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "Claim.related",
          "text": "Related Claims which may be revelant to processing this claimn",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Other claims which are related to this claim such as prior claim versions or for related 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": "Claim.related.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.related.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.related.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.related.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Reference"
                }
              ],
              "linkId": "Claim.related.claim",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Other claims which are related to this claim such as prior claim versions or for related services. Do we need a relationship code?",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                      "valueCode": "Claim"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                    }
                  ],
                  "linkId": "Claim.related.claim.value",
                  "text": "Reference to the related claim",
                  "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": "CodeableConcept"
                }
              ],
              "linkId": "Claim.related.relationship",
              "text": "How the reference claim is related",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "For example prior or umbrella.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.related.relationship.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.related.relationship.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": "Identifier"
                }
              ],
              "linkId": "Claim.related.reference",
              "text": "Related file or case reference",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "An alternate organizational reference to the case or file to which this particular claim pertains - eg Property/Casualy insurer claim # or Workers Compensation case # .",
                  "type": "display"
                },
                {
                  "linkId": "Claim.related.reference.label",
                  "text": "label:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.related.reference.system",
                  "text": "system:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.related.reference.value",
                  "text": "value:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "Claim.prescription",
          "text": "Prescription authorizing services or products",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Prescription to support the dispensing of Pharmacy or Vision products. Should we create a group to hold multiple prescriptions and add a sequence number and on the line items a link to the sequence.",
              "type": "display"
            },
            {
              "linkId": "Claim.prescription._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs2"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "Claim.prescription._MedicationRequest",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "MedicationRequest"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "Claim.prescription._MedicationRequest.value",
                      "text": "MedicationRequest",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "Claim.prescription._VisionPrescription",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "VisionPrescription"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "Claim.prescription._VisionPrescription.value",
                      "text": "VisionPrescription",
                      "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": "Claim.originalPrescription",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products. For example, a physician may prescribe a medication which the pharmacy determines is contraindicated, or for which the patient has an intolerance, and therefor issues a new precription for an alternate medication which has the same theraputic intent. The prescription from the pharmacy becomes the 'prescription' and that from the physician becomes the 'original prescription'. as above.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "MedicationRequest"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.originalPrescription.value",
              "text": "Original prescription if superceded by fulfiller",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "Claim.payee",
          "text": "Party to be paid any benefits payable",
          "type": "group",
          "required": false,
          "repeats": false,
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The party to be reimbursed for the 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": "Claim.payee.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.payee.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.payee.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.payee.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.payee.type",
              "text": "Type of party: Subscriber, Provider, other",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Type of Party to be reimbursed: Subscriber, provider, other.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.payee.type.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.payee.type.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": "Coding"
                }
              ],
              "linkId": "Claim.payee.resourceType",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "organization | patient | practitioner | relatedperson.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.payee.resourceType.value",
                  "text": "organization | patient | practitioner | relatedperson",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "Claim.payee.party",
              "text": "Party to receive the payable",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Party to be reimbursed: Subscriber, provider, other.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.payee.party._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs3"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.payee.party._Practitioner",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Practitioner"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.payee.party._Practitioner.value",
                          "text": "Practitioner",
                          "type": "reference",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.payee.party._Organization",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Organization"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.payee.party._Organization.value",
                          "text": "Organization",
                          "type": "reference",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.payee.party._Patient",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Patient"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.payee.party._Patient.value",
                          "text": "Patient",
                          "type": "reference",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.payee.party._RelatedPerson",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "RelatedPerson"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.payee.party._RelatedPerson.value",
                          "text": "RelatedPerson",
                          "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": "Claim.referral",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The referral resource which lists the date, practitioner, reason and other supporting information.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "ReferralRequest"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.referral.value",
              "text": "Treatment Referral",
              "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": "Claim.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"
                      }
                    ]
                  }
                }
              ],
              "text": "Facility where the services were provided.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Location"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "Claim.facility.value",
              "text": "Servicing Facility",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "Claim.careTeam",
          "text": "Members of the care team",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The members of the team who provided the overall service as well as their role and whether responsible and qualifications.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "Claim.careTeam.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.careTeam.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.careTeam.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.careTeam.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.careTeam.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Sequence of the careTeam which serves to order and provide a link.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.careTeam.sequence.value",
                  "text": "Number to covey order of careTeam",
                  "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
                }
              ],
              "linkId": "Claim.careTeam.provider",
              "text": "Provider individual or organization",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Member of the team who provided the overall service.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.careTeam.provider._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs4"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.careTeam.provider._Practitioner",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Practitioner"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.careTeam.provider._Practitioner.value",
                          "text": "Practitioner",
                          "type": "reference",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.careTeam.provider._Organization",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Organization"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.careTeam.provider._Organization.value",
                          "text": "Organization",
                          "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": "Claim.careTeam.responsible",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The party who is billing and responsible for the claimed good or service rendered to the patient.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.careTeam.responsible.value",
                  "text": "Billing provider",
                  "type": "boolean",
                  "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": "Claim.careTeam.role",
              "text": "Role on the team",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.careTeam.role.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.careTeam.role.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": "Claim.careTeam.qualification",
              "text": "Type, classification or Specialization",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The qualification which is applicable for this service.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.careTeam.qualification.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.careTeam.qualification.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "Claim.information",
          "text": "Exceptions, special considerations, the condition, situation, prior or concurrent issues",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Additional information codes regarding exceptions, special considerations, the condition, situation, prior or concurrent issues. Often there are mutiple jurisdiction specific valuesets which are required.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "Claim.information.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.information.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.information.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.information.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.information.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Sequence of the information element which serves to provide a link.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.information.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": "CodeableConcept"
                }
              ],
              "linkId": "Claim.information.category",
              "text": "General class of 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The general class of the information supplied: information; exception; accident, employment; onset, etc. This may contain the local bill type codes such as the US UB-04 bill type code.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.information.category.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.information.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": "Claim.information.code",
              "text": "Type of 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "System and code pertaining to the specific information regarding special conditions relating to the setting, treatment or patient  for which care is sought which may influence the adjudication. This may contain the local bill type codes such as the US UB-04 bill type code.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.information.code.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.information.code.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "Claim.information.timing[x]",
              "text": "When it occurred",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The date when or period to which this information refers.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.information.timing[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs5"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "datetime"
                        }
                      ],
                      "linkId": "Claim.information.timing[x]._date",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.information.timing[x]._date.value",
                          "text": "date",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Period"
                        }
                      ],
                      "linkId": "Claim.information.timing[x]._Period",
                      "text": "Period",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.information.timing[x]._Period.low",
                          "text": "start:",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.information.timing[x]._Period.end",
                          "text": "end:",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    }
                  ]
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "Claim.information.value[x]",
              "text": "Additional Data or supporting 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.information.value[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs6"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "string"
                        }
                      ],
                      "linkId": "Claim.information.value[x]._string",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.information.value[x]._string.value",
                          "text": "string",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Quantity"
                        }
                      ],
                      "linkId": "Claim.information.value[x]._Quantity",
                      "text": "Quantity",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.information.value[x]._Quantity.comparator",
                          "text": "comp:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.information.value[x]._Quantity.value",
                          "text": "value:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.information.value[x]._Quantity.units",
                          "text": "units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.information.value[x]._Quantity.code",
                          "text": "coded units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.information.value[x]._Quantity.system",
                          "text": "units system:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Attachment"
                        }
                      ],
                      "linkId": "Claim.information.value[x]._Attachment",
                      "text": "Attachment",
                      "type": "group"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.information.value[x]._Resource",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Resource"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.information.value[x]._Resource.value",
                          "text": "Resource",
                          "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": "CodeableConcept"
                }
              ],
              "linkId": "Claim.information.reason",
              "text": "Reason associated with the 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "For example, provides the reason for: the additional stay, or missing tooth or any other situation where a reason code is required in addition to the content.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.information.reason.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.information.reason.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "Claim.diagnosis",
          "text": "List of 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"
                      }
                    ]
                  }
                }
              ],
              "text": "List of 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": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.diagnosis.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.diagnosis.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.diagnosis.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Sequence of diagnosis which serves to provide a link.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.diagnosis.sequence.value",
                  "text": "Number to covey order of diagnosis",
                  "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
                }
              ],
              "linkId": "Claim.diagnosis.diagnosis[x]",
              "text": "Patient's diagnosis",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The diagnosis.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.diagnosis.diagnosis[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs7"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "CodeableConcept"
                        }
                      ],
                      "linkId": "Claim.diagnosis.diagnosis[x]._CodeableConcept",
                      "text": "CodeableConcept",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.diagnosis.diagnosis[x]._CodeableConcept.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.diagnosis.diagnosis[x]._CodeableConcept.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.diagnosis.diagnosis[x]._Condition",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Condition"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.diagnosis.diagnosis[x]._Condition.value",
                          "text": "Condition",
                          "type": "reference",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    }
                  ]
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "Claim.diagnosis.type",
              "text": "Timing or nature of the 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The type of the Diagnosis, for example: admitting, primary, secondary, discharge. Diagnosis are presented in list order to their expected importance: primary, secondary, etc.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.diagnosis.type.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.diagnosis.type.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": "Claim.diagnosis.packageCode",
              "text": "Package billing 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The package billing code, for example DRG, based on the assigned grouping code system.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.diagnosis.packageCode.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.diagnosis.packageCode.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "Claim.procedure",
          "text": "Procedures performed",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Ordered list of patient procedures performed to support the adjudication.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "Claim.procedure.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.procedure.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.procedure.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.procedure.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.procedure.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Sequence of procedures which serves to order and provide a link.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.procedure.sequence.value",
                  "text": "Procedure sequence for reference",
                  "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": "datetime"
                }
              ],
              "linkId": "Claim.procedure.date",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Date and optionally time the procedure was performed . SB DateTime??",
                  "type": "display"
                },
                {
                  "linkId": "Claim.procedure.date.value",
                  "text": "When the procedure was performed",
                  "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
                }
              ],
              "linkId": "Claim.procedure.procedure[x]",
              "text": "Patient's list of procedures performed",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The procedure code.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.procedure.procedure[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs8"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "CodeableConcept"
                        }
                      ],
                      "linkId": "Claim.procedure.procedure[x]._CodeableConcept",
                      "text": "CodeableConcept",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.procedure.procedure[x]._CodeableConcept.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.procedure.procedure[x]._CodeableConcept.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.procedure.procedure[x]._Procedure",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Procedure"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.procedure.procedure[x]._Procedure.value",
                          "text": "Procedure",
                          "type": "reference",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "linkId": "Claim.insurance",
          "text": "Insurance or medical plan",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "Financial instrument by which payment information for health care.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.insurance.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.insurance.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.insurance.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Sequence of coverage which serves to provide a link and convey coordination of benefit order.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.insurance.sequence.value",
                  "text": "Service 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": "boolean"
                }
              ],
              "linkId": "Claim.insurance.focal",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A flag to indicate that this Coverage is the focus for adjudication. The Coverage against which the claim is to be adjudicated.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.insurance.focal.value",
                  "text": "Is the focal 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": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Reference to the program or plan identification, underwriter or payor.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                      "valueCode": "Coverage"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                    }
                  ],
                  "linkId": "Claim.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": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The contract number of a business agreement which describes the terms and conditions.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.insurance.businessArrangement.value",
                  "text": "Business agreement",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "Claim.insurance.preAuthRef",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A list of references from the Insurer to which these services pertain.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.insurance.preAuthRef.value",
                  "text": "Pre-Authorization/Determination Reference",
                  "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": "Claim.insurance.claimResponse",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The Coverages adjudication details.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                      "valueCode": "ClaimResponse"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                    }
                  ],
                  "linkId": "Claim.insurance.claimResponse.value",
                  "text": "Adjudication results",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "Claim.accident",
          "text": "Details about an accident",
          "type": "group",
          "required": false,
          "repeats": false,
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "An accident which resulted in the need for healthcare 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": "Claim.accident.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.accident.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.accident.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.accident.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "datetime"
                }
              ],
              "linkId": "Claim.accident.date",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Date of an accident which these services are addressing.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.accident.date.value",
                  "text": "When the accident occurred\nsee information codes\nsee information codes",
                  "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": "CodeableConcept"
                }
              ],
              "linkId": "Claim.accident.type",
              "text": "The nature of the accident",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Type of accident: work, auto, etc.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.accident.type.coding",
                  "text": "code:",
                  "type": "choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.accident.type.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "Claim.accident.location[x]",
              "text": "Accident Place",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Accident Place.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.accident.location[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs9"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Address"
                        }
                      ],
                      "linkId": "Claim.accident.location[x]._Address",
                      "text": "Address",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.accident.location[x]._Address.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.accident.location[x]._Address.line",
                          "text": "line:",
                          "type": "string",
                          "required": false,
                          "repeats": true
                        },
                        {
                          "linkId": "Claim.accident.location[x]._Address.city",
                          "text": "city:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.accident.location[x]._Address.state",
                          "text": "state:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.accident.location[x]._Address.postalCode",
                          "text": "post code:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.accident.location[x]._Address.country",
                          "text": "country:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.accident.location[x]._Address.use",
                          "text": "use:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.accident.location[x]._Location",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Location"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.accident.location[x]._Location.value",
                          "text": "Location",
                          "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": "Period"
            }
          ],
          "linkId": "Claim.employmentImpacted",
          "text": "Period unable to work",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The start and optional end dates of when the patient was precluded from working due to the treatable condition(s).",
              "type": "display"
            },
            {
              "linkId": "Claim.employmentImpacted.low",
              "text": "start:",
              "type": "dateTime",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.employmentImpacted.end",
              "text": "end:",
              "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": "Period"
            }
          ],
          "linkId": "Claim.hospitalization",
          "text": "Period in hospital",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The start and optional end dates of when the patient was confined to a treatment center.",
              "type": "display"
            },
            {
              "linkId": "Claim.hospitalization.low",
              "text": "start:",
              "type": "dateTime",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.hospitalization.end",
              "text": "end:",
              "type": "dateTime",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "Claim.item",
          "text": "Goods and 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"
                      }
                    ]
                  }
                }
              ],
              "text": "First tier of goods 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": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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": "Claim.item.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.item.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"
                          }
                        ]
                      }
                    }
                  ],
                  "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.item.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A service line number.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.sequence.value",
                  "text": "Service instance",
                  "type": "integer",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "integer"
                }
              ],
              "linkId": "Claim.item.careTeamLinkId",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "CareTeam applicable for this service or product line.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.careTeamLinkId.value",
                  "text": "Applicable careTeam members",
                  "type": "integer",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "integer"
                }
              ],
              "linkId": "Claim.item.diagnosisLinkId",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Diagnosis applicable for this service or product line.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.diagnosisLinkId.value",
                  "text": "Applicable diagnoses",
                  "type": "integer",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "integer"
                }
              ],
              "linkId": "Claim.item.procedureLinkId",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Procedures applicable for this service or product line.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.procedureLinkId.value",
                  "text": "Applicable procedures",
                  "type": "integer",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "integer"
                }
              ],
              "linkId": "Claim.item.informationLinkId",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Exceptions, special conditions and supporting information pplicable for this service or product line.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.informationLinkId.value",
                  "text": "Applicable exception and 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": "Claim.item.revenue",
              "text": "Revenue or cost center 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The type of reveneu or cost center providing the product and/or service.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.revenue.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.revenue.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": "Claim.item.category",
              "text": "Type of service or product",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Health Care Service Type Codes  to identify the classification of service or benefits.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.category.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.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": "Claim.item.service",
              "text": "Billing 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,RXNorm,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.service.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.service.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "Claim.item.modifier",
              "text": "Service/Product 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Item typification or modifiers codes, eg for 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": "Claim.item.modifier.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.modifier.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "Claim.item.programCode",
              "text": "Program specific reason for item inclusion",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "For programs which require reason codes for the inclusion or covering of this billed item under the program or sub-program.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.programCode.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.programCode.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "Claim.item.serviced[x]",
              "text": "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The date or dates when the enclosed suite of services were performed or completed.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.serviced[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs10"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "datetime"
                        }
                      ],
                      "linkId": "Claim.item.serviced[x]._date",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.item.serviced[x]._date.value",
                          "text": "date",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Period"
                        }
                      ],
                      "linkId": "Claim.item.serviced[x]._Period",
                      "text": "Period",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.item.serviced[x]._Period.low",
                          "text": "start:",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.serviced[x]._Period.end",
                          "text": "end:",
                          "type": "dateTime",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    }
                  ]
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "Claim.item.location[x]",
              "text": "Place 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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Where the service was provided.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.location[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs11"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "CodeableConcept"
                        }
                      ],
                      "linkId": "Claim.item.location[x]._CodeableConcept",
                      "text": "CodeableConcept",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.item.location[x]._CodeableConcept.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.location[x]._CodeableConcept.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Address"
                        }
                      ],
                      "linkId": "Claim.item.location[x]._Address",
                      "text": "Address",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "Claim.item.location[x]._Address.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.location[x]._Address.line",
                          "text": "line:",
                          "type": "string",
                          "required": false,
                          "repeats": true
                        },
                        {
                          "linkId": "Claim.item.location[x]._Address.city",
                          "text": "city:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.location[x]._Address.state",
                          "text": "state:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.location[x]._Address.postalCode",
                          "text": "post code:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.location[x]._Address.country",
                          "text": "country:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.location[x]._Address.use",
                          "text": "use:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.item.location[x]._Location",
                      "type": "group",
                      "item": [
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Location"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.item.location[x]._Location.value",
                          "text": "Location",
                          "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": "Claim.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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The number of repetitions of a service or product.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.quantity.comparator",
                  "text": "comp:",
                  "type": "choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.quantity.value",
                  "text": "value:",
                  "type": "decimal",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.quantity.units",
                  "text": "units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.quantity.code",
                  "text": "coded units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.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": "Claim.item.unitPrice",
              "text": "Fee, charge or cost per point",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.unitPrice.comparator",
                  "text": "comp:",
                  "type": "choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.unitPrice.value",
                  "text": "value:",
                  "type": "decimal",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.unitPrice.units",
                  "text": "units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.unitPrice.code",
                  "text": "coded units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.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": "decimal"
                }
              ],
              "linkId": "Claim.item.factor",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.factor.value",
                  "text": "Price scaling factor",
                  "type": "decimal",
                  "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": "Claim.item.net",
              "text": "Total item cost",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number  * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.net.comparator",
                  "text": "comp:",
                  "type": "choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.net.value",
                  "text": "value:",
                  "type": "decimal",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.net.units",
                  "text": "units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.net.code",
                  "text": "coded units:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.net.system",
                  "text": "units system:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "Claim.item.udi",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "List of Unique Device Identifiers associated with this line item.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                      "valueCode": "Device"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                    }
                  ],
                  "linkId": "Claim.item.udi.value",
                  "text": "Unique Device Identifier",
                  "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": "CodeableConcept"
                }
              ],
              "linkId": "Claim.item.bodySite",
              "text": "Service Location",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Physical service site on the patient (limb, tooth, etc).",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.bodySite.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.bodySite.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "Claim.item.subSite",
              "text": "Service Sub-location",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A region or surface of the site, eg. limb region or tooth surface(s).",
                  "type": "display"
                },
                {
                  "linkId": "Claim.item.subSite.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "Claim.item.subSite.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "Reference"
                }
              ],
              "linkId": "Claim.item.encounter",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A billed item may include goods or services provided in multiple encounters.",
                  "type": "display"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                      "valueCode": "Encounter"
                    },
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                      "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                    }
                  ],
                  "linkId": "Claim.item.encounter.value",
                  "text": "Encounters related to this billed item",
                  "type": "reference",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "Claim.item.detail",
              "text": "Additional items",
              "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"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "Second tier of goods 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": "Claim.item.detail.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"
                              }
                            ]
                          }
                        }
                      ],
                      "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": "Claim.item.detail.id.value",
                      "text": "xml:id (or equivalent in JSON)",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "linkId": "Claim.item.detail.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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.item.detail.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"
                              }
                            ]
                          }
                        }
                      ],
                      "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.item.detail.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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "A service line number.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.sequence.value",
                      "text": "Service instance",
                      "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": "Claim.item.detail.revenue",
                  "text": "Revenue or cost center 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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "The type of reveneu or cost center providing the product and/or service.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.revenue.coding",
                      "text": "code:",
                      "type": "open-choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.revenue.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": "Claim.item.detail.category",
                  "text": "Type of service or product",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "Health Care Service Type Codes  to identify the classification of service or benefits.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.category.coding",
                      "text": "code:",
                      "type": "open-choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.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": "Claim.item.detail.service",
                  "text": "Billing 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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "If this is an actual service or product line, ie. not a Group, then use code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI). If a grouping item then use a group code to indicate the type of thing being grouped eg. 'glasses' or 'compound'.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.service.coding",
                      "text": "code:",
                      "type": "open-choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.service.text",
                      "text": "text:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "CodeableConcept"
                    }
                  ],
                  "linkId": "Claim.item.detail.modifier",
                  "text": "Service/Product 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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "Item typification or modifiers codes, eg for 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": "Claim.item.detail.modifier.coding",
                      "text": "code:",
                      "type": "open-choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.modifier.text",
                      "text": "text:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "CodeableConcept"
                    }
                  ],
                  "linkId": "Claim.item.detail.programCode",
                  "text": "Program specific reason for item inclusion",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.programCode.coding",
                      "text": "code:",
                      "type": "open-choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.programCode.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": "Quantity"
                    }
                  ],
                  "linkId": "Claim.item.detail.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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "The number of repetitions of a service or product.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.quantity.comparator",
                      "text": "comp:",
                      "type": "choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.quantity.value",
                      "text": "value:",
                      "type": "decimal",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.quantity.units",
                      "text": "units:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.quantity.code",
                      "text": "coded units:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.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": "Claim.item.detail.unitPrice",
                  "text": "Fee, charge or cost per point",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.unitPrice.comparator",
                      "text": "comp:",
                      "type": "choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.unitPrice.value",
                      "text": "value:",
                      "type": "decimal",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.unitPrice.units",
                      "text": "units:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.unitPrice.code",
                      "text": "coded units:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.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": "decimal"
                    }
                  ],
                  "linkId": "Claim.item.detail.factor",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.factor.value",
                      "text": "Price scaling factor",
                      "type": "decimal",
                      "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": "Claim.item.detail.net",
                  "text": "Total additional item cost",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number  * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
                      "type": "display"
                    },
                    {
                      "linkId": "Claim.item.detail.net.comparator",
                      "text": "comp:",
                      "type": "choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.net.value",
                      "text": "value:",
                      "type": "decimal",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.net.units",
                      "text": "units:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.net.code",
                      "text": "coded units:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "Claim.item.detail.net.system",
                      "text": "units system:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "Claim.item.detail.udi",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "List of Unique Device Identifiers associated with this line item.",
                      "type": "display"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Device"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "Claim.item.detail.udi.value",
                      "text": "Unique Device Identifier",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "linkId": "Claim.item.detail.subDetail",
                  "text": "Additional items",
                  "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"
                              }
                            ]
                          }
                        }
                      ],
                      "text": "Third tier of goods 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": "Claim.item.detail.subDetail.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"
                                  }
                                ]
                              }
                            }
                          ],
                          "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": "Claim.item.detail.subDetail.id.value",
                          "text": "xml:id (or equivalent in JSON)",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "linkId": "Claim.item.detail.subDetail.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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, 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. 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": "Claim.item.detail.subDetail.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"
                                  }
                                ]
                              }
                            }
                          ],
                          "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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, 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. 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": "Claim.item.detail.subDetail.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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "A service line number.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.sequence.value",
                          "text": "Service instance",
                          "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": "Claim.item.detail.subDetail.revenue",
                      "text": "Revenue or cost center 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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "The type of reveneu or cost center providing the product and/or service.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.revenue.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.revenue.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": "Claim.item.detail.subDetail.category",
                      "text": "Type of service or product",
                      "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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "Health Care Service Type Codes  to identify the classification of service or benefits.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.category.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.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": "Claim.item.detail.subDetail.service",
                      "text": "Billing 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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI).",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.service.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.service.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "CodeableConcept"
                        }
                      ],
                      "linkId": "Claim.item.detail.subDetail.modifier",
                      "text": "Service/Product 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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "Item typification or modifiers codes, eg for 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": "Claim.item.detail.subDetail.modifier.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.modifier.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "CodeableConcept"
                        }
                      ],
                      "linkId": "Claim.item.detail.subDetail.programCode",
                      "text": "Program specific reason for item inclusion",
                      "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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.programCode.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.programCode.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": "Quantity"
                        }
                      ],
                      "linkId": "Claim.item.detail.subDetail.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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "The number of repetitions of a service or product.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.quantity.comparator",
                          "text": "comp:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.quantity.value",
                          "text": "value:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.quantity.units",
                          "text": "units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.quantity.code",
                          "text": "coded units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.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": "Claim.item.detail.subDetail.unitPrice",
                      "text": "Fee, charge or cost per point",
                      "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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "The fee for an addittional service or product or charge.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.unitPrice.comparator",
                          "text": "comp:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.unitPrice.value",
                          "text": "value:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.unitPrice.units",
                          "text": "units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.unitPrice.code",
                          "text": "coded units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.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": "decimal"
                        }
                      ],
                      "linkId": "Claim.item.detail.subDetail.factor",
                      "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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.factor.value",
                          "text": "Price scaling factor",
                          "type": "decimal",
                          "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": "Claim.item.detail.subDetail.net",
                      "text": "Net additional item cost",
                      "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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number  * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied.",
                          "type": "display"
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.net.comparator",
                          "text": "comp:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.net.value",
                          "text": "value:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.net.units",
                          "text": "units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.net.code",
                          "text": "coded units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "Claim.item.detail.subDetail.net.system",
                          "text": "units system:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Reference"
                        }
                      ],
                      "linkId": "Claim.item.detail.subDetail.udi",
                      "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"
                                  }
                                ]
                              }
                            }
                          ],
                          "text": "List of Unique Device Identifiers associated with this line item.",
                          "type": "display"
                        },
                        {
                          "extension": [
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                              "valueCode": "Device"
                            },
                            {
                              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                              "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                            }
                          ],
                          "linkId": "Claim.item.detail.subDetail.udi.value",
                          "text": "Unique Device Identifier",
                          "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": "Claim.total",
          "text": "Total claim cost",
          "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"
                      }
                    ]
                  }
                }
              ],
              "text": "The total value of the claim.",
              "type": "display"
            },
            {
              "linkId": "Claim.total.comparator",
              "text": "comp:",
              "type": "choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.total.value",
              "text": "value:",
              "type": "decimal",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.total.units",
              "text": "units:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.total.code",
              "text": "coded units:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "Claim.total.system",
              "text": "units system:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        }
      ]
    }
  ]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.