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 - JSON Representation

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    {
      "resourceType" : "MeasureReport",
      "id" : "ra-measurereport04",
      "meta" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/instance-name",
            "valueString" : "RA Coding Gap MeasureReport Example04 with RA Model CMS-HCC V21 for Patient03 Nelda Nuclear"
          },
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/instance-description",
            "valueMarkdown" : "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."
          }
        ],
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<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\u00a0(use:\u00a0usual,\u00a0))</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>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/measurereport-category",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/CodeSystem/measurereport-category",
                "code" : "ra"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline",
          "valueDate" : "2022-03-31"
        }
      ],
      "status" : "complete",
      "type" : "individual",
      "measure" : "http://hl7.org/fhir/us/davinci-ra/Measure/RAModelExample02",
      "subject" : {
        🔗 "reference" : "Patient/ra-patient03"
      },
      "date" : "2021-10-18",
      "reporter" : {
        🔗 "reference" : "Organization/ra-payer01"
      },
      "period" : {
        "start" : "2021-01-01",
        "end" : "2021-09-30"
      },
      "group" : [
        {
          "id" : "group-001",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "closed-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "21",
                "code" : "188",
                "display" : "Artificial Openings for Feeding or Elimination"
              }
            ],
            "text" : "CMS-HCC 188: Artificial Openings for Feeding or Elimination"
          }
        },
        {
          "id" : "group-002",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "open-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "21",
                "code" : "111",
                "display" : "Chronic Obstructive Pulmonary Disease"
              }
            ],
            "text" : "CMS-HCC 111: Chronic Obstructive Pulmonary Disease"
          }
        },
        {
          "id" : "group-003",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-ccType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/cc-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "open-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
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