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

<Parameters xmlns="http://hl7.org/fhir">
  <meta>
    <extension url="http://hl7.org/fhir/StructureDefinition/instance-name">
      <valueString value="CDex Parameters Example 5"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/instance-description">
      <valueMarkdown value="**Completed QuestionnaireResponse Attachment Example:** Parameters Resource example showing how it is used to submit a solicited attachment using the `$submit-attachment` operation for a prior authorization. The attachment parameter payload is a QuestionnaireResponse completed using DTR in response to a Questionnaire sent in the Attachments request."/>
    </extension>
    <profile value="http://hl7.org/fhir/us/davinci-cdex/StructureDefinition/cdex-parameters-submit-attachment"/>
  </meta>
  <language value="en"/>
  <parameter>
    <name value="TrackingId"/>
    <valueIdentifier>
      <system value="http://example.org/payer-acns"/>
      <value value="trackingid1012"/>
    </valueIdentifier>
  </parameter>
  <parameter>
    <name value="AdminRefNumber"/>
    <valueIdentifier>
      <system value="http://example.org/payer-refnos"/>
      <value value="adminrefnumber4657"/>
    </valueIdentifier>
  </parameter>
  <parameter>
    <name value="AttachTo"/>
    <valueCode value="preauthorization"/>
  </parameter>
  <parameter>
    <name value="PayerId"/>
    <valueIdentifier>
      <system value="http://example.org/cdex/payer/payer-ids"/>
      <value value="payer123"/>
    </valueIdentifier>
  </parameter>
  <parameter>
    <name value="OrganizationId"/>
    <valueIdentifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="1234567893"/>
    </valueIdentifier>
  </parameter>
  <parameter>
    <name value="ProviderId"/>
    <valueIdentifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="9941339100"/>
    </valueIdentifier>
  </parameter>
  <parameter>
    <name value="MemberId"/>
    <valueIdentifier>
      <system value="http://example.org/cdex/payer/member-ids"/>
      <value value="Member123"/>
    </valueIdentifier>
  </parameter>
  <parameter>
    <name value="Attachment"/>
    <part>
      <name value="LineItem"/>
      <valueString value="1"/>
    </part>
    <part>
      <name value="Content"/>
      <resource>
        <QuestionnaireResponse>
          <id value="cdex-questionnaireresponse-example1"/>
          <language value="en"/>
          <questionnaire value="http://example.org/cdex-questionnaire-example1"/>
          <status value="completed"/>
          <subject>
            <identifier>
              <use value="usual"/>
              <type>
                <coding>
                  <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
                  <code value="MB"/>
                  <display value="Member Number"/>
                </coding>
                <text value="Member Number"/>
              </type>
              <system value="http://example.org/cdex/payer/member-ids"/>
              <value value="Member123"/>
            </identifier>
            <display value="Amy Shaw"/>
          </subject>
          <authored value="2022-06-17"/>
          <author>
            <identifier>
              <system value="http://hl7.org/fhir/sid/us-npi"/>
              <value value="9941339100"/>
            </identifier>
          </author>
          <item>
            <linkId value="1"/>
            <text value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
            <answer>
              <valueString value="Examplitis"/>
            </answer>
          </item>
          <item>
            <linkId value="2"/>
            <text value="Order Reason"/>
            <answer>
              <valueCoding>
                <system value="http://example.org"/>
                <code value="4"/>
                <display value="Replacement"/>
              </valueCoding>
            </answer>
          </item>
        </QuestionnaireResponse>
      </resource>
    </part>
  </parameter>
</Parameters>