Common CQL Artifacts for FHIR (US-Based)
2.0.0-cibuild - Informative 2 - CI Build
Common CQL Artifacts for FHIR (US-Based)
2.0.0-cibuild - Informative 2 - CI Build
Common CQL Artifacts for FHIR (US-Based), published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-cibuild built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/us-cql-ig/ and changes regularly. See the Directory of published versions
| Page standards status: Informative |
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- <http://hl7.org/fhir/Questionnaire/ExamplePatientAndCoverageQuestionnaire> a fhir:Questionnaire ; fhir:nodeRole fhir:treeRoot ; fhir:Resource.id [ fhir:value "ExamplePatientAndCoverageQuestionnaire"] ; fhir:Resource.language [ fhir:value "en"] ; fhir:DomainResource.text [ fhir:Narrative.status [ fhir:value "extensions" ] ; fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire ExamplePatientAndCoverageQuestionnaire</b></p><a name=\"ExamplePatientAndCoverageQuestionnaire\"> </a><a name=\"hcExamplePatientAndCoverageQuestionnaire\"> </a><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description & Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> ExamplePatientAndCoverageQuestionnaire</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire#2.0.0-cibuild</td></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.patient-info\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> patient-info</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Patient Information</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|patient-name\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|patient-name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|date-of-birth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> patient-info|date-of-birth</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Date of Birth</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|birth-sex\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> patient-info|birth-sex</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Birth Sex</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Value Set: <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1021.24/expansion\">Birth Sex</a></td></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|medical-record-number\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|medical-record-number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Medical Record Number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|phone-number\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|phone-number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Phone Number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|email-address\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|email-address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Email Address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|address\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|city\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|city</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">City</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient-info|state\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|state</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">State</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.patient-info|postal-code\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient-info|postal-code</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Postal Code</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.coverage-info\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> coverage-info</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Coverage Information</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.coverage-info|member-id\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> coverage-info|member-id</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Member ID</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.completing-form|patient-info|policy-number\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> completing-form|patient-info|policy-number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Policy Number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.provider-info\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> provider-info</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Requesting Provider Information</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.provider-info|name\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> provider-info|name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Requesting provider name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.provider-info|phone-number\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> provider-info|phone-number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Phone</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.provider-info|address\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> provider-info|address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Ordering provider address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.provider-info|npi\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> provider-info|npi</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Ordering provider Tax ID/NPI #</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.provider-info|fax\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> provider-info|fax</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Fax</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" id=\"item.servicing-provider\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> servicing-provider</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Laboratory performing testing/Servicing Provider</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.servicing-provider|name\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> servicing-provider|name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Servicing Provider name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.servicing-provider|phone-number\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> servicing-provider|phone-number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Phone</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.servicing-provider|address\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> servicing-provider|address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Ordering provider address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.servicing-provider|npi\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> servicing-provider|npi</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Ordering provider Tax ID/NPI #</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" id=\"item.servicing-provider|fax\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> servicing-provider|fax</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Fax</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>#xD;\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><h2>Contained Resources</h2><hr/>\n <table class=\"narrative-table\">\n <tbody>\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Metadata</th>\n\n\n</tr>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n\n<td class=\"content-container\">\n module-definition from <a href=\"http://terminology.hl7.org/7.2.0/CodeSystem-library-type.html\">http://terminology.hl7.org/CodeSystem/library-type</a> \n\n\n</td>\n\n\n</tr>\n\n\n\n<tr>\n \n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: USCore model information\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <a href=\"Library-USCore-ModelInfo.html\">US Core Model Information</a> version: 6.1.0-derived\n <br/>\n <em>Canonical URL</em>: <tt>http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived</tt>\n \n \n \n </td>\n</tr>\n\n<tr>\n \n \n \n \n \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n \n \n <td class=\"content-container\">\n \n <em>Description</em>: FHIR model information\n \n <br/>\n \n \n \n \n \n \n <em>Resource</em>: <a href=\"http://hl7.org/fhir/uv/cql/STU2/Library-FHIR-ModelInfo.html\">http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1</a>\n <br/>\n <em>Canonical URL</em>: <tt>http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1</tt>\n \n \n \n </td>\n</tr>\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"parameters\"> </a>Parameters</th>\n\n\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Parameter</th>\n\n\n\n<td class=\"content-container\">None</td>\n\n\n</tr>\n\n\n\n\n\n<tr>\n <th colspan=\"2\" scope=\"row\" class=\"row-header\">Generated using version 0.5.3-cibuild of the sample-content-ig Liquid templates</th>\n</tr>\n\n </tbody>\n </table>\n</div>" ] ; fhir:DomainResource.contained [ a fhir:Library ; fhir:index -1 ; fhir:Resource.id [ fhir:value "effective-data-requirements" ] ; fhir:Library.name [ fhir:value "EffectiveDataRequirements" ] ; fhir:Library.status [ fhir:value "active" ] ; fhir:Library.type [ fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/library-type" ] ; fhir:Coding.code [ fhir:value "module-definition" ] ] ] ; fhir:Library.relatedArtifact [ fhir:index -1 ; fhir:RelatedArtifact.type [ fhir:value "depends-on" ] ; fhir:RelatedArtifact.display [ fhir:value "USCore model information" ] ; fhir:RelatedArtifact.resource [ fhir:value "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived" ; fhir:link <http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived> ] ], [ fhir:index -1 ; fhir:RelatedArtifact.type [ fhir:value "depends-on" ] ; fhir:RelatedArtifact.display [ fhir:value "FHIR model information" ] ; fhir:RelatedArtifact.resource [ fhir:value "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1" ; fhir:link <http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1> ] ] ] ; fhir:DomainResource.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/cqf-library" ] ; fhir:Extension.valueCanonical [ fhir:value "http://hl7.org/fhir/us/cql/Library/ExamplePatientAndCoverageInitialExpressions" ; fhir:link <http://hl7.org/fhir/us/cql/Library/ExamplePatientAndCoverageInitialExpressions> ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueCoding [ fhir:Coding.system [ fhir:value "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext" ] ; fhir:Coding.code [ fhir:value "patient" ] ; fhir:Coding.display [ fhir:value "Patient" ] ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "type" ] ; fhir:Extension.valueCode [ fhir:value "Patient" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "The patient that is to be used to pre-populate the form" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueCoding [ fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/additionalLaunchContext" ] ; fhir:Coding.code [ fhir:value "Coverage" ] ; fhir:Coding.display [ fhir:value "Coverage" ] ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "type" ] ; fhir:Extension.valueCode [ fhir:value "Coverage" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "The coverage that is to be used to pre-populate the form" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "name" ] ; fhir:Extension.valueCoding [ fhir:Coding.system [ fhir:value "http://example.org/fhir/CodeSystem/additionalLaunchContext" ] ; fhir:Coding.code [ fhir:value "ServiceRequest" ] ; fhir:Coding.display [ fhir:value "ServiceRequest" ] ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "type" ] ; fhir:Extension.valueCode [ fhir:value "ServiceRequest" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "description" ] ; fhir:Extension.valueString [ fhir:value "The ServiceRequest that is to be used to pre-populate the form" ] ] ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ; fhir:Extension.valueCode [ fhir:value "cds" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements" ] ; fhir:Extension.valueCanonical [ fhir:value "#effective-data-requirements" ] ], [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ; fhir:Extension.valueCode [ fhir:value "informative" ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ; fhir:Extension.valueCanonical [ fhir:value "http://hl7.org/fhir/us/cql/ImplementationGuide/hl7.fhir.us.cql" ; fhir:link <http://hl7.org/fhir/us/cql/ImplementationGuide/hl7.fhir.us.cql> ] ] ] ] ; fhir:Questionnaire.url [ fhir:value "http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire"] ; fhir:Questionnaire.version [ fhir:value "2.0.0-cibuild"] ; fhir:Questionnaire.name [ fhir:value "ExamplePatientAndCoverageQuestionnaire"] ; fhir:Questionnaire.title [ fhir:value "Example Patient and Coverage Questionnaire"] ; fhir:Questionnaire.status [ fhir:value "active"] ; fhir:Questionnaire.experimental [ fhir:value "true"^^xsd:boolean] ; fhir:Questionnaire.date [ fhir:value "2024-09-16T00:00:00+00:00"^^xsd:dateTime] ; fhir:Questionnaire.publisher [ fhir:value "HL7 International / Clinical Decision Support"] ; fhir:Questionnaire.contact [ fhir:index -1 ; fhir:ContactDetail.telecom [ fhir:index -1 ; fhir:ContactPoint.system [ fhir:value "url" ] ; fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/dss" ] ] ] ; fhir:Questionnaire.description [ fhir:value "For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed."] ; fhir:Questionnaire.jurisdiction [ fhir:index -1 ; fhir:CodeableConcept.coding [ fhir:index -1 ; fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ; fhir:Coding.code [ fhir:value "US" ] ; fhir:Coding.display [ fhir:value "United States of America" ] ] ] ; fhir:Questionnaire.item [ fhir:index -1 ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info" ] ; fhir:Questionnaire.item.text [ fhir:value "Patient Information" ] ; fhir:Questionnaire.item.type [ fhir:value "group" ] ; fhir:Questionnaire.item.item [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Patient Name" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|patient-name" ] ; fhir:Questionnaire.item.text [ fhir:value "Name" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Date of Birth" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|date-of-birth" ] ; fhir:Questionnaire.item.text [ fhir:value "Date of Birth" ] ; fhir:Questionnaire.item.type [ fhir:value "date" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Birth Sex" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|birth-sex" ] ; fhir:Questionnaire.item.text [ fhir:value "Birth Sex" ] ; fhir:Questionnaire.item.type [ fhir:value "choice" ] ; fhir:Questionnaire.item.answerValueSet [ fhir:value "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24" ; fhir:link <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24> ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Medical Record Number" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|medical-record-number" ] ; fhir:Questionnaire.item.text [ fhir:value "Medical Record Number" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Phone Number" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|phone-number" ] ; fhir:Questionnaire.item.text [ fhir:value "Phone Number" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Email Address" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|email-address" ] ; fhir:Questionnaire.item.text [ fhir:value "Email Address" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Address" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|address" ] ; fhir:Questionnaire.item.text [ fhir:value "Address" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "City" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|city" ] ; fhir:Questionnaire.item.text [ fhir:value "City" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "State" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|state" ] ; fhir:Questionnaire.item.text [ fhir:value "State" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Postal Code" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "patient-info|postal-code" ] ; fhir:Questionnaire.item.text [ fhir:value "Postal Code" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ] ], [ fhir:index -1 ; fhir:Questionnaire.item.linkId [ fhir:value "coverage-info" ] ; fhir:Questionnaire.item.text [ fhir:value "Coverage Information" ] ; fhir:Questionnaire.item.type [ fhir:value "group" ] ; fhir:Questionnaire.item.item [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Member ID" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "coverage-info|member-id" ] ; fhir:Questionnaire.item.text [ fhir:value "Member ID" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Policy Number" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "completing-form|patient-info|policy-number" ] ; fhir:Questionnaire.item.text [ fhir:value "Policy Number" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ] ], [ fhir:index -1 ; fhir:Questionnaire.item.linkId [ fhir:value "provider-info" ] ; fhir:Questionnaire.item.text [ fhir:value "Requesting Provider Information" ] ; fhir:Questionnaire.item.type [ fhir:value "group" ] ; fhir:Questionnaire.item.item [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Requesting Provider Name" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "provider-info|name" ] ; fhir:Questionnaire.item.text [ fhir:value "Requesting provider name" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Requesting Provider Phone" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "provider-info|phone-number" ] ; fhir:Questionnaire.item.text [ fhir:value "Phone" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Requesting Provider Address" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "provider-info|address" ] ; fhir:Questionnaire.item.text [ fhir:value "Ordering provider address" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Requesting Provider NPI" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "provider-info|npi" ] ; fhir:Questionnaire.item.text [ fhir:value "Ordering provider Tax ID/NPI #" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Requesting Provider Fax" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "provider-info|fax" ] ; fhir:Questionnaire.item.text [ fhir:value "Fax" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ] ], [ fhir:index -1 ; fhir:Questionnaire.item.linkId [ fhir:value "servicing-provider" ] ; fhir:Questionnaire.item.text [ fhir:value "Laboratory performing testing/Servicing Provider" ] ; fhir:Questionnaire.item.type [ fhir:value "group" ] ; fhir:Questionnaire.item.item [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Servicing Provider Name" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "servicing-provider|name" ] ; fhir:Questionnaire.item.text [ fhir:value "Servicing Provider name" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Servicing Provider Phone" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "servicing-provider|phone-number" ] ; fhir:Questionnaire.item.text [ fhir:value "Phone" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Servicing Provider Address" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "servicing-provider|address" ] ; fhir:Questionnaire.item.text [ fhir:value "Ordering provider address" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Servicing Provider NPI" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "servicing-provider|npi" ] ; fhir:Questionnaire.item.text [ fhir:value "Ordering provider Tax ID/NPI #" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ], [ fhir:index -1 ; fhir:Element.extension [ fhir:index -1 ; fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression" ] ; fhir:Extension.valueExpression [ fhir:Expression.language [ fhir:value "text/cql-identifier" ] ; fhir:Expression.expression [ fhir:value "Servicing Provider Fax" ] ] ] ; fhir:Questionnaire.item.linkId [ fhir:value "servicing-provider|fax" ] ; fhir:Questionnaire.item.text [ fhir:value "Fax" ] ; fhir:Questionnaire.item.type [ fhir:value "string" ] ] ] . # - ontology header ------------------------------------------------------------ <http://hl7.org/fhir/Questionnaire/ExamplePatientAndCoverageQuestionnaire.ttl> a owl:Ontology ; owl:imports fhir:fhir.ttl ; owl:versionIRI <http://build.fhir.org/Questionnaire/ExamplePatientAndCoverageQuestionnaire.ttl> .
IG © 2019+ HL7 International / Clinical Decision Support.
Package hl7.fhir.us.cql#2.0.0-cibuild based on FHIR 4.0.1.
Generated
2026-07-12
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