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

Eligibilityresponse-questionnaire.xml

Financial Management Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Practitioner

Raw XML (canonical form)

Generated Questionnaire for EligibilityResponse

<?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 EligibilityResponse.insurance.benefitBalance.financial.allowed[x]"/>
      <status value="active"/>
      <description value="Type options for EligibilityResponse.insurance.benefitBalance.financial.allowed[x]"/>
      <expansion>
        <identifier value="urn:uuid:6642e4cf-9603-4230-bdc4-98390f5275b3"/>
        <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="vs3"/>
      <name value="Type options for EligibilityResponse.insurance.benefitBalance.financial.used[x]"/>
      <status value="active"/>
      <description value="Type options for EligibilityResponse.insurance.benefitBalance.financial.used[x]"/>
      <expansion>
        <identifier value="urn:uuid:10ff2fb4-eccf-4d02-8e47-9f0a82d2ac19"/>
        <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="EligibilityResponse"/>
    <text value="EligibilityResponse 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 eligibility and plan details from the processing of an Eligibility resource."/>
      <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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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 Response business identifier."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.identifier.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.identifier.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.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="EligibilityResponse.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 response as not currently valid."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.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="datetime"/>
      </extension>
      <linkId value="EligibilityResponse.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 enclosed suite of services were performed or completed."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.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="EligibilityResponse.requestProvider"/>
      <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 responsible for the services rendered to the patient."/>
        <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=$encounter"/>
        </extension>
        <linkId value="EligibilityResponse.requestProvider.value"/>
        <text value="Responsible practitioner"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="EligibilityResponse.requestOrganization"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The organization which is responsible for the services rendered to the patient."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Organization"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="EligibilityResponse.requestOrganization.value"/>
        <text value="Responsible organization"/>
        <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="EligibilityResponse.request"/>
      <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 request resource reference."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="EligibilityRequest"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="EligibilityResponse.request.value"/>
        <text value="Eligibility 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="EligibilityResponse.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="Transaction status: error, complete."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.outcome.coding"/>
        <text value="code:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.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="EligibilityResponse.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."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.disposition.value"/>
        <text value="Disposition Message"/>
        <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="EligibilityResponse.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 who produced this adjudicated response."/>
        <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="EligibilityResponse.insurer.value"/>
        <text value="Insurer issuing the coverage"/>
        <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="boolean"/>
      </extension>
      <linkId value="EligibilityResponse.inforce"/>
      <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="Flag indicating if the coverage provided is inforce currently  if no service date(s) specified or for the whole duration of the service dates."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.inforce.value"/>
        <text value="Coverage inforce indicator"/>
        <type value="boolean"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="EligibilityResponse.insurance"/>
      <text value="Details by 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="The insurer may provide both the details for the requested coverage as well as details for additional coverages known to the insurer."/>
        <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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="EligibilityResponse.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="A suite of updated or additional Coverages from the Insurer."/>
          <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=$encounter"/>
          </extension>
          <linkId value="EligibilityResponse.insurance.coverage.value"/>
          <text value="Updated Coverage details"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="EligibilityResponse.insurance.contract"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The contract resource which may provide more detailed information."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Contract"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="EligibilityResponse.insurance.contract.value"/>
          <text value="Contract details"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="EligibilityResponse.insurance.benefitBalance"/>
        <text value="Benefits by 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="Benefits and optionally current balances by 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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.category.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.subCategory.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.network.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.unit.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.term.coding"/>
            <text value="code:"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="EligibilityResponse.insurance.benefitBalance.term.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.financial.type.coding"/>
              <text value="code:"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._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="integer"/>
                </extension>
                <linkId value="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._unsignedInt"/>
                <type value="group"/>
                <item>
                  <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._string"/>
                <type value="group"/>
                <item>
                  <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._Money"/>
                <text value="Money"/>
                <type value="group"/>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._Money.comparator"/>
                  <text value="comp:"/>
                  <type value="choice"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._Money.value"/>
                  <text value="value:"/>
                  <type value="decimal"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._Money.units"/>
                  <text value="units:"/>
                  <type value="string"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.allowed[x]._Money.code"/>
                  <text value="coded units:"/>
                  <type value="string"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.financial.used[x]._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="integer"/>
                </extension>
                <linkId value="EligibilityResponse.insurance.benefitBalance.financial.used[x]._unsignedInt"/>
                <type value="group"/>
                <item>
                  <linkId value="EligibilityResponse.insurance.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="EligibilityResponse.insurance.benefitBalance.financial.used[x]._Money"/>
                <text value="Money"/>
                <type value="group"/>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.used[x]._Money.comparator"/>
                  <text value="comp:"/>
                  <type value="choice"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.used[x]._Money.value"/>
                  <text value="value:"/>
                  <type value="decimal"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.used[x]._Money.units"/>
                  <text value="units:"/>
                  <type value="string"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.benefitBalance.financial.used[x]._Money.code"/>
                  <text value="coded units:"/>
                  <type value="string"/>
                  <required value="false"/>
                  <repeats value="false"/>
                </item>
                <item>
                  <linkId value="EligibilityResponse.insurance.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>
    <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="EligibilityResponse.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="EligibilityResponse.form.coding"/>
        <text value="code:"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="EligibilityResponse.form.text"/>
        <text value="text:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="EligibilityResponse.error"/>
      <text value="Processing errors"/>
      <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="Mutually exclusive with Services Provided (Item)."/>
        <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="EligibilityResponse.error.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="EligibilityResponse.error.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="EligibilityResponse.error.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="EligibilityResponse.error.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="EligibilityResponse.error.code"/>
        <text value="Error code detailing processing issues"/>
        <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="An error code,from a specified code system, which details why the eligibility check could not be performed."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="EligibilityResponse.error.code.coding"/>
          <text value="code:"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="EligibilityResponse.error.code.text"/>
          <text value="text:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </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.