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

Explanationofbenefit-questionnaire.xml

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

Raw XML (canonical form)

Generated Questionnaire for ExplanationOfBenefit

<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="qs1"/>
  <contained>
    <ValueSet>
      <id value="vs2"/>
      <name value="Type options for ExplanationOfBenefit.prescription"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.prescription"/>
      <expansion>
        <identifier value="urn:uuid:1a902185-b921-40e8-8d15-c9a16a247af0"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="MedicationRequest"/>
          <display value="MedicationRequest"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="VisionPrescription"/>
          <display value="VisionPrescription"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs3"/>
      <name value="Type options for ExplanationOfBenefit.payee.party"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.payee.party"/>
      <expansion>
        <identifier value="urn:uuid:96a38114-16ec-4784-8c19-1c1020d711d0"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Practitioner"/>
          <display value="Practitioner"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Organization"/>
          <display value="Organization"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Patient"/>
          <display value="Patient"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="RelatedPerson"/>
          <display value="RelatedPerson"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs4"/>
      <name value="Type options for ExplanationOfBenefit.information.timing[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.information.timing[x]"/>
      <expansion>
        <identifier value="urn:uuid:6374215f-896e-4b37-8d2c-edce6e3c5115"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="date"/>
          <display value="date"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Period"/>
          <display value="Period"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs5"/>
      <name value="Type options for ExplanationOfBenefit.information.value[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.information.value[x]"/>
      <expansion>
        <identifier value="urn:uuid:6379bf78-0785-4b5f-bcee-25bde435c2b1"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="string"/>
          <display value="string"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Quantity"/>
          <display value="Quantity"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Attachment"/>
          <display value="Attachment"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Resource"/>
          <display value="Resource"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs6"/>
      <name value="Type options for ExplanationOfBenefit.careTeam.provider"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.careTeam.provider"/>
      <expansion>
        <identifier value="urn:uuid:acfff43e-9038-4477-b79c-33785909d9b9"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Practitioner"/>
          <display value="Practitioner"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Organization"/>
          <display value="Organization"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs7"/>
      <name value="Type options for ExplanationOfBenefit.diagnosis.diagnosis[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.diagnosis.diagnosis[x]"/>
      <expansion>
        <identifier value="urn:uuid:64194d37-6c6a-4b82-8712-34c1a6dc6fef"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="CodeableConcept"/>
          <display value="CodeableConcept"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Condition"/>
          <display value="Condition"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs8"/>
      <name value="Type options for ExplanationOfBenefit.procedure.procedure[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.procedure.procedure[x]"/>
      <expansion>
        <identifier value="urn:uuid:8c99c0b2-8cd6-4032-b4ac-8556e824473e"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="CodeableConcept"/>
          <display value="CodeableConcept"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Procedure"/>
          <display value="Procedure"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs9"/>
      <name value="Type options for ExplanationOfBenefit.accident.location[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.accident.location[x]"/>
      <expansion>
        <identifier value="urn:uuid:eea153e6-bdd5-46a6-b9ce-877c151bbd8b"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Address"/>
          <display value="Address"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Location"/>
          <display value="Location"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs10"/>
      <name value="Type options for ExplanationOfBenefit.item.serviced[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.item.serviced[x]"/>
      <expansion>
        <identifier value="urn:uuid:6aa3a1ca-1fdb-4ef2-ac25-e7564150f4f0"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="date"/>
          <display value="date"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Period"/>
          <display value="Period"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs11"/>
      <name value="Type options for ExplanationOfBenefit.item.location[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.item.location[x]"/>
      <expansion>
        <identifier value="urn:uuid:49a49dfc-f2ba-4335-9f3d-0ba32bf68b38"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="CodeableConcept"/>
          <display value="CodeableConcept"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Address"/>
          <display value="Address"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Location"/>
          <display value="Location"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs12"/>
      <name value="Type options for ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/>
      <expansion>
        <identifier value="urn:uuid:6a15aa7a-e4be-4bcb-a565-cbed5387e4ca"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="unsignedInt"/>
          <display value="unsignedInt"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="string"/>
          <display value="string"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Money"/>
          <display value="Money"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs13"/>
      <name value="Type options for ExplanationOfBenefit.benefitBalance.financial.used[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.benefitBalance.financial.used[x]"/>
      <expansion>
        <identifier value="urn:uuid:d4a27eab-c820-40af-bb3f-87d08c32c184"/>
        <timestamp value="2019-10-24T11:53:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="unsignedInt"/>
          <display value="unsignedInt"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Money"/>
          <display value="Money"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
  </identifier>
  <status value="draft"/>
  <date value="2019-10-24T11:53:00+11:00"/>
  <publisher value="Health Level Seven International (Financial Management)"/>
  <item>
    <linkId value="ExplanationOfBenefit"/>
    <text value="Explanation of Benefit resource"/>
    <type value="group"/>
    <required value="false"/>
    <repeats value="true"/>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="flyover"/>
            <display value="Fly-over"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <text value="This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided."/>
      <type value="display"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="string"/>
      </extension>
      <linkId value="ExplanationOfBenefit.id"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.id.value"/>
        <text value="Logical id of this artifact"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.meta"/>
      <text value="Metadata about the resource"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="uri"/>
      </extension>
      <linkId value="ExplanationOfBenefit.implicitRules"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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. &#xA;&#xA;This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it&#39;s meaning or interpretation."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.implicitRules.value"/>
        <text value="A set of rules under which this content was created"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="code"/>
      </extension>
      <linkId value="ExplanationOfBenefit.language"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.language.value"/>
        <text value="language"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.text"/>
      <text value="Text summary of the resource, for human interpretation"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 &quot;clinically safe&quot; 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 &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded in formation is added later."/>
        <type value="display"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.contained"/>
      <text value="Contained, inline Resources"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.extension"/>
      <text value="Additional Content defined by implementations"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.modifierExtension"/>
      <text value="Extensions that cannot be ignored"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="ExplanationOfBenefit.identifier"/>
      <text value="Business Identifier"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The EOB Business Identifier."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.identifier.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.identifier.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.identifier.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="code"/>
      </extension>
      <linkId value="ExplanationOfBenefit.status"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The status of the resource instance. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.status.value"/>
        <text value="status"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="CodeableConcept"/>
      </extension>
      <linkId value="ExplanationOfBenefit.type"/>
      <text value="Type or discipline"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The category of claim, eg, oral, pharmacy, vision, insitutional, professional. Affects which fields and value sets are used."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.type.coding"/>
        <text value="code:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.type.text"/>
        <text value="text:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="CodeableConcept"/>
      </extension>
      <linkId value="ExplanationOfBenefit.subType"/>
      <text value="Finer grained claim type information"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.subType.coding"/>
        <text value="code:"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.subType.text"/>
        <text value="text:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.patient"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Patient Resource."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Patient"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.patient.value"/>
        <text value="The subject of the Products and Services"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Period"/>
      </extension>
      <linkId value="ExplanationOfBenefit.billablePeriod"/>
      <text value="Period for charge submission"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The billable period for which charges are being submitted."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.billablePeriod.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.billablePeriod.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="datetime"/>
      </extension>
      <linkId value="ExplanationOfBenefit.created"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The date when the EOB was created."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.created.value"/>
        <text value="Creation date"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.enterer"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The person who created the explanation of benefit."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Practitioner"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.enterer.value"/>
        <text value="Author"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.insurer"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The insurer which is responsible for the explanation of benefit."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Organization"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.insurer.value"/>
        <text value="Insurer responsible for the EOB"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.provider"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The provider which is responsible for the claim."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Practitioner"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.provider.value"/>
        <text value="Responsible provider for the claim"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.organization"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The provider which is responsible for the claim."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Organization"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.organization.value"/>
        <text value="Responsible organization for the claim"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.referral"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The referral resource which lists the date, practitioner, reason and other supporting information."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="ReferralRequest"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.referral.value"/>
        <text value="Treatment Referral"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.facility"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Facility where the services were provided."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Location"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.facility.value"/>
        <text value="Servicing Facility"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.claim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Claim"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.claim.value"/>
        <text value="Claim reference"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.claimResponse"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="ClaimResponse"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.claimResponse.value"/>
        <text value="Claim response reference"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="CodeableConcept"/>
      </extension>
      <linkId value="ExplanationOfBenefit.outcome"/>
      <text value="complete | error | partial"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Processing outcome errror, partial or complete processing."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.outcome.coding"/>
        <text value="code:"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.outcome.text"/>
        <text value="text:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="string"/>
      </extension>
      <linkId value="ExplanationOfBenefit.disposition"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="A description of the status of the adjudication. Do we need a disposition code?"/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.disposition.value"/>
        <text value="Disposition Message"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.related"/>
      <text value="Related Claims which may be revelant to processing this claim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Other claims which are related to this claim such as prior claim versions or for related services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.related.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.related.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.related.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.related.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.related.claim"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Other claims which are related to this claim such as prior claim versions or for related services. Do we need a relationship code?"/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Claim"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.related.claim.value"/>
          <text value="Reference to the related claim"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.related.relationship"/>
        <text value="How the reference claim is related"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="For example prior or umbrella."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.related.relationship.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.related.relationship.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Identifier"/>
        </extension>
        <linkId value="ExplanationOfBenefit.related.reference"/>
        <text value="Related file or case reference"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.related.reference.label"/>
          <text value="label:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.related.reference.system"/>
          <text value="system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.related.reference.value"/>
          <text value="value:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.prescription"/>
      <text value="Prescription authorizing services or products"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Prescription to support the dispensing of Pharmacy or Vision products."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.prescription._type"/>
        <text value="type"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
        <options>
          <reference value="#vs2"/>
        </options>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Reference"/>
          </extension>
          <linkId value="ExplanationOfBenefit.prescription._MedicationRequest"/>
          <type value="group"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
              <valueCode value="MedicationRequest"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
              <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
            </extension>
            <linkId value="ExplanationOfBenefit.prescription._MedicationRequest.value"/>
            <text value="MedicationRequest"/>
            <type value="reference"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Reference"/>
          </extension>
          <linkId value="ExplanationOfBenefit.prescription._VisionPrescription"/>
          <type value="group"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
              <valueCode value="VisionPrescription"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
              <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
            </extension>
            <linkId value="ExplanationOfBenefit.prescription._VisionPrescription.value"/>
            <text value="VisionPrescription"/>
            <type value="reference"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.originalPrescription"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 &#39;prescription&#39; and that from the physician becomes the &#39;original prescription&#39;."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="MedicationRequest"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.originalPrescription.value"/>
        <text value="Original prescription if superceded by fulfiller"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.payee"/>
      <text value="Party to be paid any benefits payable"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="false"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The party to be reimbursed for the services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.payee.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.payee.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.type"/>
        <text value="Type of party: Subscriber, Provider, other"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Type of Party to be reimbursed: Subscriber, provider, other."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.type.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.type.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.resourceType"/>
        <text value="organization | patient | practitioner | relatedperson"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="organization | patient | practitioner | relatedperson."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.resourceType.coding"/>
          <text value="code:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.resourceType.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.party"/>
        <text value="Party to receive the payable"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Party to be reimbursed: Subscriber, provider, other."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.party._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs3"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.payee.party._Practitioner"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Practitioner"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.payee.party._Practitioner.value"/>
              <text value="Practitioner"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.payee.party._Organization"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Organization"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.payee.party._Organization.value"/>
              <text value="Organization"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.payee.party._Patient"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Patient"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.payee.party._Patient.value"/>
              <text value="Patient"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.payee.party._RelatedPerson"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="RelatedPerson"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.payee.party._RelatedPerson.value"/>
              <text value="RelatedPerson"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.information"/>
      <text value="Exceptions, special considerations, the condition, situation, prior or concurrent issues"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="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 value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.information.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.information.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Sequence of the information element which serves to provide a link."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.sequence.value"/>
          <text value="Information instance identifier"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.category"/>
        <text value="General class of information"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.category.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.category.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.code"/>
        <text value="Type of information"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.code.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.code.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.timing[x]"/>
        <text value="When it occurred"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The date when or period to which this information refers."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.timing[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs4"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="datetime"/>
            </extension>
            <linkId value="ExplanationOfBenefit.information.timing[x]._date"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.information.timing[x]._date.value"/>
              <text value="date"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Period"/>
            </extension>
            <linkId value="ExplanationOfBenefit.information.timing[x]._Period"/>
            <text value="Period"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.information.timing[x]._Period.low"/>
              <text value="start:"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.information.timing[x]._Period.end"/>
              <text value="end:"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.value[x]"/>
        <text value="Additional Data or supporting information"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Additional data or information such as resources, documents, images etc. including references to the data or the actual inclusion of the data."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.value[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs5"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="string"/>
            </extension>
            <linkId value="ExplanationOfBenefit.information.value[x]._string"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.information.value[x]._string.value"/>
              <text value="string"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.information.value[x]._Quantity"/>
            <text value="Quantity"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.information.value[x]._Quantity.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.information.value[x]._Quantity.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.information.value[x]._Quantity.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.information.value[x]._Quantity.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.information.value[x]._Quantity.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Attachment"/>
            </extension>
            <linkId value="ExplanationOfBenefit.information.value[x]._Attachment"/>
            <text value="Attachment"/>
            <type value="group"/>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.information.value[x]._Resource"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Resource"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.information.value[x]._Resource.value"/>
              <text value="Resource"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.information.reason"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.information.reason.value"/>
          <text value="Reason associated with the information"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.careTeam"/>
      <text value="Care Team members"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The members of the team who provided the overall service as well as their role and whether responsible and qualifications."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.careTeam.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.careTeam.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.careTeam.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.careTeam.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Sequence of careteam which serves to order and provide a link."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.sequence.value"/>
          <text value="Number to covey order of careteam"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.careTeam.provider"/>
        <text value="Member of the Care Team"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The members of the team who provided the overall service."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.provider._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs6"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.careTeam.provider._Practitioner"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Practitioner"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.careTeam.provider._Practitioner.value"/>
              <text value="Practitioner"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.careTeam.provider._Organization"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Organization"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.careTeam.provider._Organization.value"/>
              <text value="Organization"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="boolean"/>
        </extension>
        <linkId value="ExplanationOfBenefit.careTeam.responsible"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The practitioner who is billing and responsible for the claimed services rendered to the patient."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.responsible.value"/>
          <text value="Billing practitioner"/>
          <type value="boolean"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.careTeam.role"/>
        <text value="Role on the team"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The lead, assisting or supervising practitioner and their discipline if a multidisiplinary team."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.role.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.role.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.careTeam.qualification"/>
        <text value="Type, classification or Specialization"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The qualification which is applicable for this service."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.qualification.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.careTeam.qualification.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.diagnosis"/>
      <text value="List of Diagnosis"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Ordered list of patient diagnosis for which care is sought."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.diagnosis.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.diagnosis.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Sequence of diagnosis which serves to provide a link."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.sequence.value"/>
          <text value="Number to covey order of diagnosis"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]"/>
        <text value="Patient&#39;s diagnosis"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The diagnosis."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs7"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]._CodeableConcept"/>
            <text value="CodeableConcept"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]._CodeableConcept.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]._CodeableConcept.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]._Condition"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Condition"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.diagnosis.diagnosis[x]._Condition.value"/>
              <text value="Condition"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.type"/>
        <text value="Timing or nature of the diagnosis"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.type.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.type.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.packageCode"/>
        <text value="Package billing code"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The package billing code, for example DRG, based on the assigned grouping code system."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.packageCode.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.packageCode.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.procedure"/>
      <text value="Procedures performed"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Ordered list of patient procedures performed to support the adjudication."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.procedure.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.procedure.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.procedure.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.procedure.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.procedure.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Sequence of procedures which serves to order and provide a link."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.procedure.sequence.value"/>
          <text value="Procedure sequence for reference"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="datetime"/>
        </extension>
        <linkId value="ExplanationOfBenefit.procedure.date"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Date and optionally time the procedure was performed . SB DateTime??"/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.procedure.date.value"/>
          <text value="When the procedure was performed"/>
          <type value="dateTime"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.procedure.procedure[x]"/>
        <text value="Patient&#39;s list of procedures performed"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The procedure code."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.procedure.procedure[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs8"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.procedure.procedure[x]._CodeableConcept"/>
            <text value="CodeableConcept"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.procedure.procedure[x]._CodeableConcept.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.procedure.procedure[x]._CodeableConcept.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.procedure.procedure[x]._Procedure"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Procedure"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.procedure.procedure[x]._Procedure.value"/>
              <text value="Procedure"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="integer"/>
      </extension>
      <linkId value="ExplanationOfBenefit.precedence"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Precedence (primary, secondary, etc.)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.precedence.value"/>
        <text value="Precedence (primary, secondary, etc.)"/>
        <type value="integer"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.insurance"/>
      <text value="Insurance or medical plan"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="false"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Financial instrument by which payment information for health care."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.insurance.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.insurance.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.insurance.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.insurance.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.insurance.coverage"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Reference to the program or plan identification, underwriter or payor."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Coverage"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.insurance.coverage.value"/>
          <text value="Insurance information"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.insurance.preAuthRef"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A list of references from the Insurer to which these services pertain."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.insurance.preAuthRef.value"/>
          <text value="Pre-Authorization/Determination Reference"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.accident"/>
      <text value="Details of an accident"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="false"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="An accident which resulted in the need for healthcare services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.accident.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.accident.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.accident.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.accident.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="datetime"/>
        </extension>
        <linkId value="ExplanationOfBenefit.accident.date"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Date of an accident which these services are addressing."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.accident.date.value"/>
          <text value="When the accident occurred"/>
          <type value="dateTime"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.accident.type"/>
        <text value="The nature of the accident"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Type of accident: work, auto, etc."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.accident.type.coding"/>
          <text value="code:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.accident.type.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.accident.location[x]"/>
        <text value="Accident Place"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Where the accident occurred."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.accident.location[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs9"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Address"/>
            </extension>
            <linkId value="ExplanationOfBenefit.accident.location[x]._Address"/>
            <text value="Address"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.line"/>
              <text value="line:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="true"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.city"/>
              <text value="city:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.state"/>
              <text value="state:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.postalCode"/>
              <text value="post code:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.country"/>
              <text value="country:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Address.use"/>
              <text value="use:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.accident.location[x]._Location"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Location"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.accident.location[x]._Location.value"/>
              <text value="Location"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Period"/>
      </extension>
      <linkId value="ExplanationOfBenefit.employmentImpacted"/>
      <text value="Period unable to work"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The start and optional end dates of when the patient was precluded from working due to the treatable condition(s)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.employmentImpacted.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.employmentImpacted.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Period"/>
      </extension>
      <linkId value="ExplanationOfBenefit.hospitalization"/>
      <text value="Period in hospital"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The start and optional end dates of when the patient was confined to a treatment center."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.hospitalization.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.hospitalization.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.item"/>
      <text value="Goods and Services"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="First tier of goods and services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A service line number."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.sequence.value"/>
          <text value="Service instance"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.careTeamLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Careteam applicable for this service or product line."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.careTeamLinkId.value"/>
          <text value="Applicable careteam members"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.diagnosisLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Diagnosis applicable for this service or product line."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.diagnosisLinkId.value"/>
          <text value="Applicable diagnoses"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.procedureLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Procedures applicable for this service or product line."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.procedureLinkId.value"/>
          <text value="Applicable procedures"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.informationLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Exceptions, special conditions and supporting information pplicable for this service or product line."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.informationLinkId.value"/>
          <text value="Applicable exception and supporting information"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.revenue"/>
        <text value="Revenue or cost center code"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The type of reveneu or cost center providing the product and/or service."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.revenue.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.revenue.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.category"/>
        <text value="Type of service or product"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Health Care Service Type Codes  to identify the classification of service or benefits."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.category.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.category.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.service"/>
        <text value="Billing Code"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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. &#39;glasses&#39; or &#39;compound&#39;."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.service.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.service.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.modifier"/>
        <text value="Service/Product billing modifiers"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.modifier.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.modifier.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.programCode"/>
        <text value="Program specific reason for item inclusion"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.programCode.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.programCode.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.serviced[x]"/>
        <text value="Date or dates of Service"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The date or dates when the enclosed suite of services were performed or completed."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.serviced[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs10"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="datetime"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.serviced[x]._date"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.item.serviced[x]._date.value"/>
              <text value="date"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Period"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.serviced[x]._Period"/>
            <text value="Period"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.item.serviced[x]._Period.low"/>
              <text value="start:"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.serviced[x]._Period.end"/>
              <text value="end:"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.location[x]"/>
        <text value="Place of service"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Where the service was provided."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.location[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs11"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.location[x]._CodeableConcept"/>
            <text value="CodeableConcept"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._CodeableConcept.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._CodeableConcept.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Address"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.location[x]._Address"/>
            <text value="Address"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.line"/>
              <text value="line:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="true"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.city"/>
              <text value="city:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.state"/>
              <text value="state:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.postalCode"/>
              <text value="post code:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.country"/>
              <text value="country:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.location[x]._Address.use"/>
              <text value="use:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.location[x]._Location"/>
            <type value="group"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Location"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.location[x]._Location.value"/>
              <text value="Location"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.quantity"/>
        <text value="Count of Products or Services"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The number of repetitions of a service or product."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.unitPrice"/>
        <text value="Fee, charge or cost per point"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="decimal"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.factor"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.factor.value"/>
          <text value="Price scaling factor"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.net"/>
        <text value="Total item cost"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.udi"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="List of Unique Device Identifiers associated with this line item."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Device"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.udi.value"/>
          <text value="Unique Device Identifier"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.bodySite"/>
        <text value="Service Location"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Physical service site on the patient (limb, tooth, etc)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.bodySite.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.bodySite.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.subSite"/>
        <text value="Service Sub-location"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A region or surface of the site, eg. limb region or tooth surface(s)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.subSite.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.subSite.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.encounter"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A billed item may include goods or services provided in multiple encounters."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Encounter"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.encounter.value"/>
          <text value="Encounters related to this billed item"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.noteNumber"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A list of note references to the notes provided below."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.noteNumber.value"/>
          <text value="List of note numbers which apply"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.adjudication"/>
        <text value="Adjudication details"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The adjudications results."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.adjudication.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.adjudication.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.category"/>
          <text value="Adjudication category such as co-pay, eligible, benefit, etc."/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.category.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.category.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.reason"/>
          <text value="Explanation of Adjudication outcome"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Adjudication reason such as limit reached."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.reason.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.reason.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.amount"/>
          <text value="Monetary amount"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Monitory amount associated with the code."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="decimal"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.value"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.value.value"/>
            <text value="Non-monitory value"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.detail"/>
        <text value="Additional items"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Second tier of goods and services."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="integer"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.sequence"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A service line number."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.sequence.value"/>
            <text value="Service instance"/>
            <type value="integer"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.type"/>
          <text value="Group or type of product or service"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The type of product or service. ItemType."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.type.coding"/>
            <text value="code:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.type.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.revenue"/>
          <text value="Revenue or cost center code"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The type of reveneu or cost center providing the product and/or service."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.revenue.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.revenue.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.category"/>
          <text value="Type of service or product"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Health Care Service Type Codes  to identify the classification of service or benefits."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.category.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.category.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.service"/>
          <text value="Billing Code"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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. &#39;glasses&#39; or &#39;compound&#39;."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.service.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.service.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.modifier"/>
          <text value="Service/Product billing modifiers"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.modifier.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.modifier.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.programCode"/>
          <text value="Program specific reason for item inclusion"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.programCode.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.programCode.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.quantity"/>
          <text value="Count of Products or Services"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The number of repetitions of a service or product."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.unitPrice"/>
          <text value="Fee, charge or cost per point"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="decimal"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.factor"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.factor.value"/>
            <text value="Price scaling factor"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.net"/>
          <text value="Total additional item cost"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Reference"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.udi"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="List of Unique Device Identifiers associated with this line item."/>
            <type value="display"/>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
              <valueCode value="Device"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
              <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.udi.value"/>
            <text value="Unique Device Identifier"/>
            <type value="reference"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="integer"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.noteNumber"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A list of note references to the notes provided below."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.noteNumber.value"/>
            <text value="List of note numbers which apply"/>
            <type value="integer"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.adjudication"/>
          <text value="Detail level adjudication details"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The adjudications results."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.subDetail"/>
          <text value="Additional items"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Third tier of goods and services."/>
            <type value="display"/>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="string"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.id"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.id.value"/>
              <text value="xml:id (or equivalent in JSON)"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.extension"/>
            <text value="Additional Content defined by implementations"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="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 value="display"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.modifierExtension"/>
            <text value="Extensions that cannot be ignored"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="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 value="display"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="integer"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.sequence"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A service line number."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.sequence.value"/>
              <text value="Service instance"/>
              <type value="integer"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.type"/>
            <text value="Type of product or service"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The type of product or service."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.type.coding"/>
              <text value="code:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.type.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.revenue"/>
            <text value="Revenue or cost center code"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The type of reveneu or cost center providing the product and/or service."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.revenue.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.revenue.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.category"/>
            <text value="Type of service or product"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="Health Care Service Type Codes  to identify the classification of service or benefits."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.category.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.category.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.service"/>
            <text value="Billing Code"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI)."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.service.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.service.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.modifier"/>
            <text value="Service/Product billing modifiers"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="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 value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.modifier.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.modifier.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="CodeableConcept"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.programCode"/>
            <text value="Program specific reason for item inclusion"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="For programs which require reson codes for the inclusion, covering, of this billed item under the program or sub-program."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.programCode.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.programCode.text"/>
              <text value="text:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity"/>
            <text value="Count of Products or Services"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The number of repetitions of a service or product."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice"/>
            <text value="Fee, charge or cost per point"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The fee for an addittional service or product or charge."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="decimal"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.factor"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="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 value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.factor.value"/>
              <text value="Price scaling factor"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.net"/>
            <text value="Net additional item cost"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="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 value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Reference"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.udi"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="List of Unique Device Identifiers associated with this line item."/>
              <type value="display"/>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
                <valueCode value="Device"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
                <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.udi.value"/>
              <text value="Unique Device Identifier"/>
              <type value="reference"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="integer"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.noteNumber"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A list of note references to the notes provided below."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.noteNumber.value"/>
              <text value="List of note numbers which apply"/>
              <type value="integer"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication"/>
            <text value="Language if different from the resource"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The adjudications results."/>
              <type value="display"/>
            </item>
          </item>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.addItem"/>
      <text value="Insurer added line items"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The first tier service adjudications for payor added services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.sequenceLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="List of input service items which this service line is intended to replace."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.sequenceLinkId.value"/>
          <text value="Service instances"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.revenue"/>
        <text value="Revenue or cost center code"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The type of reveneu or cost center providing the product and/or service."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.revenue.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.revenue.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.category"/>
        <text value="Type of service or product"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Health Care Service Type Codes  to identify the classification of service or benefits."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.category.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.category.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.service"/>
        <text value="Billing Code"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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. &#39;glasses&#39; or &#39;compound&#39;."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.service.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.service.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.modifier"/>
        <text value="Service/Product billing modifiers"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.modifier.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.modifier.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.fee"/>
        <text value="Professional fee or Product charge"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The fee charged for the professional service or product."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.noteNumber"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A list of note references to the notes provided below."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.noteNumber.value"/>
          <text value="List of note numbers which apply"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.adjudication"/>
        <text value="Added items adjudication"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The adjudications results."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.detail"/>
        <text value="Added items details"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The second tier service adjudications for payor added services."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.detail.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.detail.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.revenue"/>
          <text value="Revenue or cost center code"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The type of reveneu or cost center providing the product and/or service."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.revenue.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.revenue.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.category"/>
          <text value="Type of service or product"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Health Care Service Type Codes  to identify the classification of service or benefits."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.category.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.category.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.service"/>
          <text value="Billing Code"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A code to indicate the Professional Service or Product supplied (eg. CTP, HCPCS,USCLS,ICD10, NCPDP,DIN,ACHI,CCI)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.service.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.service.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.modifier"/>
          <text value="Service/Product billing modifiers"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.modifier.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.modifier.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.fee"/>
          <text value="Professional fee or Product charge"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The fee charged for the professional service or product."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="integer"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.noteNumber"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A list of note references to the notes provided below."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.noteNumber.value"/>
            <text value="List of note numbers which apply"/>
            <type value="integer"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.detail.adjudication"/>
          <text value="Added items detail adjudication"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The adjudications results."/>
            <type value="display"/>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.totalCost"/>
      <text value="Total Cost of service from the Claim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The total cost of the services reported."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalCost.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalCost.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalCost.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalCost.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalCost.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.unallocDeductable"/>
      <text value="Unallocated deductable"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The amount of deductable applied which was not allocated to any particular service line."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.totalBenefit"/>
      <text value="Total benefit payable for the Claim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.payment"/>
      <text value="Payment (if paid)"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="false"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Payment details for the claim if the claim has been paid."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.payment.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.payment.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.type"/>
        <text value="Partial or Complete"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Whether this represents partial or complete payment of the claim."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.type.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.type.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.adjustment"/>
        <text value="Payment adjustment for non-Claim issues"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Adjustment to the payment of this transaction which is not related to adjudication of this transaction."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustment.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustment.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustment.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustment.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustment.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.adjustmentReason"/>
        <text value="Explanation for the non-claim adjustment"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Reason for the payment adjustment."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustmentReason.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.adjustmentReason.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="datetime"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.date"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Estimated payment date."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.date.value"/>
          <text value="Expected date of Payment"/>
          <type value="dateTime"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.amount"/>
        <text value="Payable amount after adjustment"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Payable less any payment adjustment."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.amount.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.amount.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.amount.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.amount.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.amount.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Identifier"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payment.identifier"/>
        <text value="Identifier of the payment instrument"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Payment identifer."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.identifier.label"/>
          <text value="label:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.identifier.system"/>
          <text value="system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payment.identifier.value"/>
          <text value="value:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="CodeableConcept"/>
      </extension>
      <linkId value="ExplanationOfBenefit.form"/>
      <text value="Printed Form Identifier"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The form to be used for printing the content."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.form.coding"/>
        <text value="code:"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.form.text"/>
        <text value="text:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.processNote"/>
      <text value="Processing notes"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Note text."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.processNote.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.processNote.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.processNote.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.processNote.number"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="An integer associated with each note which may be referred to from each service line item."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.number.value"/>
          <text value="Sequence number for this note"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.processNote.type"/>
        <text value="display | print | printoper"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The note purpose: Print/Display."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.type.coding"/>
          <text value="code:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.type.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.processNote.text"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The note text."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.text.value"/>
          <text value="Note explanitory text"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.processNote.language"/>
        <text value="Language if different from the resource"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. &quot;en&quot; for English, or &quot;en-US&quot; for American English versus &quot;en-EN&quot; for England English."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.language.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.processNote.language.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.benefitBalance"/>
      <text value="Balance by Benefit Category"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Balance by Benefit Category."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.benefitBalance.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.benefitBalance.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="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 value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.category"/>
        <text value="Type of services covered"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Dental, Vision, Medical, Pharmacy, Rehab etc."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.category.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.category.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.subCategory"/>
        <text value="Detailed services covered within the type"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Dental: basic, major, ortho; Vision exam, glasses, contacts; etc."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.subCategory.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.subCategory.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="boolean"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.excluded"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="True if the indicated class of service is excluded from the plan, missing or False indicated the service is included in the coverage."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.excluded.value"/>
          <text value="Excluded from the plan"/>
          <type value="boolean"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.name"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A short name or tag for the benefit, for example MED01, or DENT2."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.name.value"/>
          <text value="Short name for the benefit"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.description"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A richer description of the benefit, for example &#39;DENT2 covers 100% of basic, 50% of major but exclused Ortho, Implants and Costmetic services&#39;."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.description.value"/>
          <text value="Description of the benefit or services covered"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.network"/>
        <text value="In or out of network"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Network designation."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.network.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.network.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.unit"/>
        <text value="Individual or family"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Unit designation: individual or family."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.unit.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.unit.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="CodeableConcept"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.term"/>
        <text value="Annual or lifetime"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The term or period of the values such as &#39;maximum lifetime benefit&#39; or &#39;maximum annual vistis&#39;."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.term.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.term.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.benefitBalance.financial"/>
        <text value="Benefit Summary"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Benefits Used to date."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="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 value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="CodeableConcept"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.type"/>
          <text value="Deductable, visits, benefit amount"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Deductable, visits, benefit amount."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.type.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.type.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]"/>
          <text value="Benefits allowed"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Benefits allowed."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._type"/>
            <text value="type"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
            <options>
              <reference value="#vs12"/>
            </options>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="integer"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._unsignedInt"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._unsignedInt.value"/>
                <text value="unsignedInt"/>
                <type value="integer"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="string"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._string"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._string.value"/>
                <text value="string"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Quantity"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._Money"/>
              <text value="Money"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._Money.comparator"/>
                <text value="comp:"/>
                <type value="choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._Money.value"/>
                <text value="value:"/>
                <type value="decimal"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._Money.units"/>
                <text value="units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._Money.code"/>
                <text value="coded units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.allowed[x]._Money.system"/>
                <text value="units system:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]"/>
          <text value="Benefits used"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Benefits used."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._type"/>
            <text value="type"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
            <options>
              <reference value="#vs13"/>
            </options>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="integer"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._unsignedInt"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._unsignedInt.value"/>
                <text value="unsignedInt"/>
                <type value="integer"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Quantity"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._Money"/>
              <text value="Money"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._Money.comparator"/>
                <text value="comp:"/>
                <type value="choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._Money.value"/>
                <text value="value:"/>
                <type value="decimal"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._Money.units"/>
                <text value="units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._Money.code"/>
                <text value="coded units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.used[x]._Money.system"/>
                <text value="units system:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
          </item>
        </item>
      </item>
    </item>
  </item>
</Questionnaire>

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.