2nd DSTU Draft For Comment
This page is part of the FHIR Specification (v0.4.0: DSTU 2 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
Generated Questionnaire for Reversal
<?xml version="1.0" encoding="UTF-8"?>
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="qs1"/>
<contained>
<ValueSet>
<id value="vs2"/>
<url value="urn:uuid:0fdbdb17-96ec-42d0-96ad-7b4e6c85ac71"/>
<name value="Type options for Reversal.request"/>
<description value="Type options for Reversal.request"/>
<status value="active"/>
<expansion>
<timestamp value="2015-02-23T09:23:46+11:00"/>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="OralHealthClaim"/>
<display value="OralHealthClaim"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="PharmacyClaim"/>
<display value="PharmacyClaim"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="VisionClaim"/>
<display value="VisionClaim"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="ProfessionalClaim"/>
<display value="ProfessionalClaim"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="InstitutionalClaim"/>
<display value="InstitutionalClaim"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="SupportingDocumentation"/>
<display value="SupportingDocumentation"/>
</contains>
</expansion>
</ValueSet>
</contained>
<contained>
<ValueSet>
<id value="vs3"/>
<url value="urn:uuid:16979842-de0a-41fc-b1f9-7316904e7cb8"/>
<name value="Type options for Reversal.response"/>
<description value="Type options for Reversal.response"/>
<status value="active"/>
<expansion>
<timestamp value="2015-02-23T09:23:46+11:00"/>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="ClaimResponse"/>
<display value="ClaimResponse"/>
</contains>
<contains>
<system value="http://hl7.org/fhir/resource-types"/>
<code value="StatusResponse"/>
<display value="StatusResponse"/>
</contains>
</expansion>
</ValueSet>
</contained>
<identifier>
<system value="urn:ietf:rfc:3986"/>
</identifier>
<status value="draft"/>
<date value="2015-02-23T09:07:27+11:00"/>
<publisher value="HL7 FHIR Project (Financial Management)"/>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="This resource provides the request and response details for the request for which all actions are to be reversed or terminated."/>
</extension>
<linkId value="Reversal"/>
<title value="Reversal request"/>
<required value="true"/>
<repeats value="false"/>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The logical id of the resource, as used in the url for the resoure. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="string"/>
</extension>
<linkId value="Reversal.id"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.id.value"/>
<text value="Logical id of this artefact"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource."/>
</extension>
<linkId value="Reversal.meta"/>
<text value="Metadata about the resource"/>
<required value="false"/>
<repeats value="true"/>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="uri"/>
</extension>
<linkId value="Reversal.implicitRules"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.implicitRules.value"/>
<text value="A set of rules under which this content was created"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource
Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="code"/>
</extension>
<linkId value="Reversal.language"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.language.value"/>
<text value="language"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative."/>
</extension>
<linkId value="Reversal.text"/>
<text value="Text summary of the resource, for human interpretation"/>
<required value="false"/>
<repeats value="true"/>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."/>
</extension>
<linkId value="Reversal.contained"/>
<text value="Contained, inline Resources"/>
<required value="false"/>
<repeats value="true"/>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The Response Business Identifier."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Identifier"/>
</extension>
<linkId value="Reversal.identifier"/>
<text value="Business Identifier"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.identifier.label"/>
<text value="label:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="Reversal.identifier.system"/>
<text value="system:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
<question>
<linkId value="Reversal.identifier.value"/>
<text value="value:"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The version of the style of resource contents. This should be mapped to the allowable profiles for this and supporting resources."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Coding"/>
</extension>
<linkId value="Reversal.ruleset"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.ruleset.value"/>
<text value="Resource version"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The style (standard) and version of the original material which was converted into this resource."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Coding"/>
</extension>
<linkId value="Reversal.originalRuleset"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.originalRuleset.value"/>
<text value="Original version"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The date when this resource was created."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="datetime"/>
</extension>
<linkId value="Reversal.created"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.created.value"/>
<text value="Creation date"/>
<type value="dateTime"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The Insurer who is target of the request."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.target"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Organization?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.target.value"/>
<text value="Insurer"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The practitioner who is responsible for the services rendered to the patient."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.provider"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Practitioner?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.provider.value"/>
<text value="Responsible practitioner"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The organization which is responsible for the services rendered to the patient."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.organization"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Organization?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.organization.value"/>
<text value="Responsible organization"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Reference of resource to reverse."/>
</extension>
<linkId value="Reversal.request"/>
<text value="Request reference"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.request._type"/>
<text value="type"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
<options>
<reference value="#vs2"/>
</options>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.request._OralHealthClaim"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/OralHealthClaim?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.request._OralHealthClaim.value"/>
<text value="OralHealthClaim"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.request._PharmacyClaim"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/PharmacyClaim?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.request._PharmacyClaim.value"/>
<text value="PharmacyClaim"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.request._VisionClaim"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/VisionClaim?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.request._VisionClaim.value"/>
<text value="VisionClaim"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.request._ProfessionalClaim"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/ProfessionalClaim?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.request._ProfessionalClaim.value"/>
<text value="ProfessionalClaim"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.request._InstitutionalClaim"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/InstitutionalClaim?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.request._InstitutionalClaim.value"/>
<text value="InstitutionalClaim"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.request._SupportingDocumentation"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/SupportingDocumentation?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.request._SupportingDocumentation.value"/>
<text value="SupportingDocumentation"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Reference of response to resource to reverse."/>
</extension>
<linkId value="Reversal.response"/>
<text value="Response reference"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.response._type"/>
<text value="type"/>
<type value="choice"/>
<required value="false"/>
<repeats value="false"/>
<options>
<reference value="#vs3"/>
</options>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.response._ClaimResponse"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/ClaimResponse?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.response._ClaimResponse.value"/>
<text value="ClaimResponse"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.response._StatusResponse"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/StatusResponse?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.response._StatusResponse.value"/>
<text value="StatusResponse"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Payee information supplied for matching purposes."/>
</extension>
<linkId value="Reversal.payee"/>
<title value="Payee"/>
<required value="false"/>
<repeats value="false"/>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="unique id for the element within a resource (for internal references)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="string"/>
</extension>
<linkId value="Reversal.payee.id"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.payee.id.value"/>
<text value="xml:id (or equivalent in JSON)"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Party to be reimbursed: Subscriber, provider, other."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Coding"/>
</extension>
<linkId value="Reversal.payee.type"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.payee.type.value"/>
<text value="Payee Type"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The provider who is to be reimbursed for the claim (the party to whom any benefit is assigned)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.payee.provider"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Practitioner?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.payee.provider.value"/>
<text value="Provider who is the payee"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The organization who is to be reimbursed for the claim (the party to whom any benefit is assigned)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.payee.organization"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Organization?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.payee.organization.value"/>
<text value="Organization who is the payee"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The person other than the subscriber who is to be reimbursed for the claim (the party to whom any benefit is assigned)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.payee.person"/>
<required value="false"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Patient?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.payee.person.value"/>
<text value="Other person who is the payee"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Financial instrument by which payment information for health care."/>
</extension>
<linkId value="Reversal.coverage"/>
<title value="Insurance or medical plan"/>
<required value="true"/>
<repeats value="false"/>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="unique id for the element within a resource (for internal references)."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="string"/>
</extension>
<linkId value="Reversal.coverage.id"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.coverage.id.value"/>
<text value="xml:id (or equivalent in JSON)"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="A service line item."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="integer"/>
</extension>
<linkId value="Reversal.coverage.sequence"/>
<required value="true"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.coverage.sequence.value"/>
<text value="Service instance"/>
<type value="integer"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The instance number of the Coverage which is the focus for adjudication, that is the Coverage to which the claim is to be adjudicated against."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="boolean"/>
</extension>
<linkId value="Reversal.coverage.focal"/>
<required value="true"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.coverage.focal.value"/>
<text value="Is the focal Coverage"/>
<type value="boolean"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="Reference to the program or plan identification, underwriter or payor."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Reference"/>
</extension>
<linkId value="Reversal.coverage.coverage"/>
<required value="true"/>
<repeats value="true"/>
<question>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#reference">
<valueString value="/Coverage?subject=$subj&patient=$subj&encounter=$encounter"/>
</extension>
<linkId value="Reversal.coverage.coverage.value"/>
<text value="Insurance information"/>
<type value="reference"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The contract number of a business agreement which describes the terms and conditions."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="string"/>
</extension>
<linkId value="Reversal.coverage.businessArrangement"/>
<required value="false"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.coverage.businessArrangement.value"/>
<text value="Business agreement"/>
<type value="string"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="The relationship of the patient to the subscriber."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="Coding"/>
</extension>
<linkId value="Reversal.coverage.relationship"/>
<required value="true"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.coverage.relationship.value"/>
<text value="Patient relationship to subscriber"/>
<type value="open-choice"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</group>
<group>
<extension url="http://hl7.org/fhir/Profile/questionnaire-extensions#flyover">
<valueString value="If true remove all history excluding audit."/>
</extension>
<extension url="http://www.healthintersections.com.au/fhir/Profile/metadata#type">
<valueString value="boolean"/>
</extension>
<linkId value="Reversal.nullify"/>
<required value="true"/>
<repeats value="true"/>
<question>
<linkId value="Reversal.nullify.value"/>
<text value="Nullify"/>
<type value="boolean"/>
<required value="false"/>
<repeats value="false"/>
</question>
</group>
</group>
</Questionnaire>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
© HL7.org 2011+. FHIR DSTU (v0.4.0-4167) generated on Mon, Feb 23, 2015 09:23+1100.
Links: What's a DSTU? |
Version History |
Compare to DSTU1 |
|
Propose a change