Da Vinci Risk Adjustment Implementation Guide
2.1.0 - STU 2.1

Da Vinci Risk Adjustment Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ra/ and changes regularly. See the Directory of published versions

## : RA Coding Gap MeasureReport Example04 with RA Model CMS-HCC V21 for Patient03 Nelda Nuclear - XML Representation

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    <MeasureReport xmlns="http://hl7.org/fhir">
      <id value="ra-measurereport04"/>
      <meta>
        <extension url="http://hl7.org/fhir/StructureDefinition/instance-name">
          <valueString
                       value="RA Coding Gap MeasureReport Example04 with RA Model CMS-HCC V21 for Patient03 Nelda Nuclear"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/instance-description">
          <valueMarkdown
                         value="This is an example for the Risk Adjustment Coding Gap MeasureReport profile. This example report uses the CMS-HCC version 21 as the Risk Adjustment Model and the example patient used is Eve Everywoman."/>
        </extension>
        <profile
                 value="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: MeasureReport ra-measurereport04</b></p><a name="ra-measurereport04"> </a><a name="hcra-measurereport04"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ra-measurereport.html">Risk Adjustment Coding Gap MeasureReport</a></p></div><p><b>Measure Report Category</b>: <span title="Codes:{http://hl7.org/fhir/CodeSystem/measurereport-category ra}">Risk Adjustment</span></p><p><b>Clinical Data Collection Deadline Extension</b>: 2022-03-31</p><p><b>status</b>: Complete</p><p><b>type</b>: Individual</p><p><b>measure</b>: <a href="Measure-RAModelExample02.html">Risk Adjustment Model Version 21 - CMS Hierarchical Category Condition (CMS-HCC)</a></p><p><b>subject</b>: <a href="Patient-ra-patient03.html">Nelda Nuclear (official) Female, DoB: 1965-07-26 ( Medical record number: 34567 (use: usual, ))</a></p><p><b>date</b>: 2021-10-18</p><p><b>reporter</b>: <a href="Organization-ra-payer01.html">Organization ABC Payer</a></p><p><b>period</b>: 2021-01-01 --&gt; 2021-09-30</p><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-001</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}">Historic Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}">Closed Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 188}">CMS-HCC 188: Artificial Openings for Feeding or Elimination</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-002</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}">Historic Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}">Open Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 111}">CMS-HCC 111: Chronic Obstructive Pulmonary Disease</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-003</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}">Historic Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}">Open Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 21}">CMS-HCC 21: Protein-Calorie Malnutrition</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-004</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}">Historic Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}">Open Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 35}">CMS-HCC 35: Inflammatory Bowel Disease</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-005</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type historic}">Historic Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}">Open Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 96}">CMS-HCC 96: Specified Heart Arrhythmia</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-006</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}">Suspected Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}">Closed Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 18}">CMS-HCC 18: Diabetes with Chronic Complications</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-007</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}">Suspected Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}">Closed Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 134}">CMS-HCC 134: Dialysis Status</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-008</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}">Suspected Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}">Open Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 58}">CMS-HCC 58: Major Depressive, Bipolar, and Paranoid Disorders</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-009</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}">Suspected Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}">Closed Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-superseded}">Hierarchies applied and Condition Category is superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 19}">CMS-HCC 19: Diabetes without Complication</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-010</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}">Suspected Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status pending}">Pending Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-superseded}">Hierarchies applied and Condition Category is superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 135}">CMS-HCC 135: Acute Renal Failure</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-011</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type suspected}">Suspected Condition Category Gap</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status open-gap}">Open Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-superseded}">Hierarchies applied and Condition Category is superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 136}">CMS-HCC 136: Chronic Kidney Disease, Stage 5</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-012</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type net-new}">Net-New Condition Category</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status pending}">Pending Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-not-superseded}">Hierarchies applied and Condition Category is not superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 107}">CMS-HCC 107: Vascular Disease with Complications</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-013</blockquote><p><b>Condition Category Type Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type net-new}">Net-New Condition Category</span></p><p><b>Evidence Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status closed-gap}">Closed Condition Category Gap</span></p><p><b>Hierarchical Status Extension</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status applied-superseded}">Hierarchies applied and Condition Category is superseded</span></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/cmshcc 108}">CMS-HCC 108: Vascular Disease</span></p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href="Condition-ra-condition01pat03.html">Condition Other artificial openings of gastrointestinal tract status</a></li><li><a href="Condition-ra-condition04pat03.html">Condition Chronic obstructive pulmonary disease with (acute) exacerbation</a></li><li><a href="Condition-ra-condition05pat03.html">Condition Unspecified protein-calorie malnutrition</a></li><li><a href="Condition-ra-condition06pat03.html">Condition Crohn's disease of large intestine with unspecified complications</a></li><li><a href="Condition-ra-condition07pat03.html">Condition Other persistent atrial fibrillation</a></li><li><a href="Condition-ra-condition15pat03.html">Condition Diabetes mellitus due to underlying condition with diabetic chronic kidney disease</a></li><li><a href="Condition-ra-condition16pat03.html">Condition Dependence on renal dialysis</a></li><li><a href="Condition-ra-condition21pat03.html">Condition Type 2 diabetes mellitus without complications</a></li><li><a href="Condition-ra-condition22pat03.html">Condition Other acute kidney failure</a></li><li><a href="Condition-ra-condition32pat03.html">Condition Chronic pulmonary embolism</a></li><li><a href="Condition-ra-condition35pat03.html">Condition Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene</a></li><li><a href="Condition-ra-condition42pat03.html">Condition Other artificial openings of gastrointestinal tract status</a></li><li><a href="Encounter-ra-encounter01pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-07-14 --&gt; 2021-07-14</a></li><li><a href="Encounter-ra-encounter04pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2020-12-18 --&gt; 2020-12-18</a></li><li><a href="Encounter-ra-encounter05pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2020-03-03 --&gt; 2020-03-03</a></li><li><a href="Encounter-ra-encounter06pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2020-09-17 --&gt; 2020-09-17</a></li><li><a href="Encounter-ra-encounter07pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2019-02-07 --&gt; 2019-02-07</a></li><li><a href="Encounter-ra-encounter15pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-08-08 --&gt; 2021-08-08</a></li><li><a href="Encounter-ra-encounter16pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-07-27 --&gt; 2021-07-27</a></li><li><a href="Encounter-ra-encounter19pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2019-08-23 --&gt; 2019-08-23</a></li><li><a href="Encounter-ra-encounter21pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-01-30 --&gt; 2021-01-30</a></li><li><a href="Encounter-ra-encounter22pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-07-01 --&gt; 2021-07-01</a></li><li><a href="Encounter-ra-encounter01pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-07-14 --&gt; 2021-07-14</a></li><li><a href="Encounter-ra-encounter35pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2021-02-12 --&gt; 2021-02-12</a></li><li><a href="Encounter-ra-encounter42pat03.html">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.; period = 2020-02-10 --&gt; 2020-02-10</a></li><li><a href="Observation-ra-obs01pat03.html">Observation Creat SerPl-mCnc</a></li><li><a href="Observation-ra-obs02pat03.html">Observation Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]</a></li></ul></div>
      </text>
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                 url="http://hl7.org/fhir/StructureDefinition/measurereport-category">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://hl7.org/fhir/CodeSystem/measurereport-category"/>
            <code value="ra"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline">
        <valueDate value="2022-03-31"/>
      </extension>
      <status value="complete"/>
      <type value="individual"/>
      <measure
               value="http://hl7.org/fhir/us/davinci-ra/Measure/RAModelExample02"/>
      <subject>🔗
        <reference value="Patient/ra-patient03"/>
      </subject>
      <date value="2021-10-18"/>
      <reporter>🔗
        <reference value="Organization/ra-payer01"/>
      </reporter>
      <period>
        <start value="2021-01-01"/>
        <end value="2021-09-30"/>
      </period>
      <group id="group-001">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="historic"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="closed-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="188"/>
            <display value="Artificial Openings for Feeding or Elimination"/>
          </coding>
          <text
                value="CMS-HCC 188: Artificial Openings for Feeding or Elimination"/>
        </code>
      </group>
      <group id="group-002">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="historic"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="open-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="111"/>
            <display value="Chronic Obstructive Pulmonary Disease"/>
          </coding>
          <text value="CMS-HCC 111: Chronic Obstructive Pulmonary Disease"/>
        </code>
      </group>
      <group id="group-003">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="historic"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="open-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="21"/>
            <display value="Protein-Calorie Malnutrition"/>
          </coding>
          <text value="CMS-HCC 21: Protein-Calorie Malnutrition"/>
        </code>
      </group>
      <group id="group-004">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="historic"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="open-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="35"/>
            <display value="Inflammatory Bowel Disease"/>
          </coding>
          <text value="CMS-HCC 35: Inflammatory Bowel Disease"/>
        </code>
      </group>
      <group id="group-005">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="historic"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="open-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="96"/>
            <display value="Specified Heart Arrhythmias"/>
          </coding>
          <text value="CMS-HCC 96: Specified Heart Arrhythmia"/>
        </code>
      </group>
      <group id="group-006">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="suspected"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="closed-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="18"/>
            <display value="Diabetes with Chronic Complications"/>
          </coding>
          <text value="CMS-HCC 18: Diabetes with Chronic Complications"/>
        </code>
      </group>
      <group id="group-007">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="suspected"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="closed-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="134"/>
            <display value="Dialysis Status"/>
          </coding>
          <text value="CMS-HCC 134: Dialysis Status"/>
        </code>
      </group>
      <group id="group-008">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="suspected"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="open-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="58"/>
            <display value="Major Depressive, Bipolar, and Paranoid Disorders"/>
          </coding>
          <text
                value="CMS-HCC 58: Major Depressive, Bipolar, and Paranoid Disorders"/>
        </code>
      </group>
      <group id="group-009">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="suspected"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="closed-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="19"/>
            <display value="Diabetes without Complication"/>
          </coding>
          <text value="CMS-HCC 19: Diabetes without Complication"/>
        </code>
      </group>
      <group id="group-010">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="suspected"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="pending"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="135"/>
            <display value="Acute Renal Failure"/>
          </coding>
          <text value="CMS-HCC 135: Acute Renal Failure"/>
        </code>
      </group>
      <group id="group-011">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="suspected"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="open-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="136"/>
            <display value="Chronic Kidney Disease, Stage 5"/>
          </coding>
          <text value="CMS-HCC 136: Chronic Kidney Disease, Stage 5"/>
        </code>
      </group>
      <group id="group-012">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="net-new"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="pending"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-not-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="107"/>
            <display value="Vascular Disease with Complications"/>
          </coding>
          <text value="CMS-HCC 107: Vascular Disease with Complications"/>
        </code>
      </group>
      <group id="group-013">
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type"/>
              <code value="net-new"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status"/>
              <code value="closed-gap"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus">
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status"/>
              <code value="applied-superseded"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/cmshcc"/>
            <version value="21"/>
            <code value="108"/>
            <display value="Vascular Disease"/>
          </coding>
          <text value="CMS-HCC 108: Vascular Disease"/>
        </code>
      </group>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-001"/>
        </extension>
        <reference value="Condition/ra-condition01pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-002"/>
        </extension>
        <reference value="Condition/ra-condition04pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-003"/>
        </extension>
        <reference value="Condition/ra-condition05pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-004"/>
        </extension>
        <reference value="Condition/ra-condition06pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-005"/>
        </extension>
        <reference value="Condition/ra-condition07pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-006"/>
        </extension>
        <reference value="Condition/ra-condition15pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-007"/>
        </extension>
        <reference value="Condition/ra-condition16pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-009"/>
        </extension>
        <reference value="Condition/ra-condition21pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-010"/>
        </extension>
        <reference value="Condition/ra-condition22pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-012"/>
        </extension>
        <reference value="Condition/ra-condition32pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-013"/>
        </extension>
        <reference value="Condition/ra-condition35pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-001"/>
        </extension>
        <reference value="Condition/ra-condition42pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-001"/>
        </extension>
        <reference value="Encounter/ra-encounter01pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-002"/>
        </extension>
        <reference value="Encounter/ra-encounter04pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-003"/>
        </extension>
        <reference value="Encounter/ra-encounter05pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-004"/>
        </extension>
        <reference value="Encounter/ra-encounter06pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-005"/>
        </extension>
        <reference value="Encounter/ra-encounter07pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-006"/>
        </extension>
        <reference value="Encounter/ra-encounter15pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-007"/>
        </extension>
        <reference value="Encounter/ra-encounter16pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-008"/>
        </extension>
        <reference value="Encounter/ra-encounter19pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-009"/>
        </extension>
        <reference value="Encounter/ra-encounter21pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-010"/>
        </extension>
        <reference value="Encounter/ra-encounter22pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-012"/>
        </extension>
        <reference value="Encounter/ra-encounter01pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-013"/>
        </extension>
        <reference value="Encounter/ra-encounter35pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-001"/>
        </extension>
        <reference value="Encounter/ra-encounter42pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-011"/>
        </extension>
        <reference value="Observation/ra-obs01pat03"/>
      </evaluatedResource>
      <evaluatedResource>🔗
        <extension
                   url="http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference">
          <valueString value="group-008"/>
        </extension>
        <reference value="Observation/ra-obs02pat03"/>
      </evaluatedResource>
    </MeasureReport>