ExamplePatientAndCoverageQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: ExamplePatientAndCoverageQuestionnaire
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire ExamplePatientAndCoverageQuestionnaire LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> ExamplePatientAndCoverageQuestionnaire 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. Questionnaire http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire#2.0.0-ballot #xD; patient-info Patient Information 0..1 group #xD; patient-info|patient-name Name 0..1 string #xD; patient-info|date-of-birth Date of Birth 0..1 date #xD; patient-info|birth-sex Birth Sex 0..1 choice Value Set: Birth Sex #xD; patient-info|medical-record-number Medical Record Number 0..1 string #xD; patient-info|phone-number Phone Number 0..1 string #xD; patient-info|email-address Email Address 0..1 string #xD; patient-info|address Address 0..1 string #xD; patient-info|city City 0..1 string #xD; patient-info|state State 0..1 string #xD; patient-info|postal-code Postal Code 0..1 string #xD; coverage-info Coverage Information 0..1 group #xD; coverage-info|member-id Member ID 0..1 string #xD; completing-form|patient-info|policy-number Policy Number 0..1 string #xD; provider-info Requesting Provider Information 0..1 group #xD; provider-info|name Requesting provider name 0..1 string #xD; provider-info|phone-number Phone 0..1 string #xD; provider-info|address Ordering provider address 0..1 string #xD; provider-info|npi Ordering provider Tax ID/NPI # 0..1 string #xD; provider-info|fax Fax 0..1 string #xD; servicing-provider Laboratory performing testing/Servicing Provider 0..1 group #xD; servicing-provider|name Servicing Provider name 0..1 string #xD; servicing-provider|phone-number Phone 0..1 string #xD; servicing-provider|address Ordering provider address 0..1 string #xD; servicing-provider|npi Orderi…
contained: Library
  id:
    v: effective-data-requirements
  name:
    v: EffectiveDataRequirements
  status:
    v: active
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/library-type
        l: library-type
      code:
        v: module-definition
  related artifact:
    type:
      v: depends-on
    display:
      v: USCore model information
    resource:
      v: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
      l: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo
  related artifact:
    type:
      v: depends-on
    display:
      v: FHIR model information
    resource:
      v: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
      l: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/cqf-library
    l: cqf-library
  value: Canonical
    v: http://hl7.org/fhir/us/cql/Library/ExamplePatientAndCoverageInitialExpressions
    l: ExamplePatientAndCoverageInitialExpressions
extension:
  extension:
    url:
      v: name
      l: name
    value: Coding
      system:
        v: http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext
        l: launchContext
      code:
        v: patient
      display:
        v: Patient
  extension:
    url:
      v: type
      l: type
    value: Code
      v: Patient
  extension:
    url:
      v: description
      l: description
    value: String
      v: The patient that is to be used to pre-populate the form
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext
    l: sdc-questionnaire-launchContext
extension:
  extension:
    url:
      v: name
      l: name
    value: Coding
      system:
        v: http://example.org/fhir/CodeSystem/additionalLaunchContext
        l: additionalLaunchContext
      code:
        v: Coverage
      display:
        v: Coverage
  extension:
    url:
      v: type
      l: type
    value: Code
      v: Coverage
  extension:
    url:
      v: description
      l: description
    value: String
      v: The coverage that is to be used to pre-populate the form
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext
    l: sdc-questionnaire-launchContext
extension:
  extension:
    url:
      v: name
      l: name
    value: Coding
      system:
        v: http://example.org/fhir/CodeSystem/additionalLaunchContext
        l: additionalLaunchContext
      code:
        v: ServiceRequest
      display:
        v: ServiceRequest
  extension:
    url:
      v: type
      l: type
    value: Code
      v: ServiceRequest
  extension:
    url:
      v: description
      l: description
    value: String
      v: The ServiceRequest that is to be used to pre-populate the form
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext
    l: sdc-questionnaire-launchContext
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: cds
extension:
  url:
    v: http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements
    l: crmi-effectiveDataRequirements
  value: Canonical
    v: #effective-data-requirements
    l: effective-data-requirements
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: informative
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/us/cql/ImplementationGuide/hl7.fhir.us.cql
        l: hl7.fhir.us.cql
url:
  v: http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire
  l: ExamplePatientAndCoverageQuestionnaire
version:
  v: 2.0.0-ballot
name:
  v: ExamplePatientAndCoverageQuestionnaire
title:
  v: Example Patient and Coverage Questionnaire
status:
  v: active
experimental:
  v: true
date:
  v: 2024-09-16T00:00:00+00:00
publisher:
  v: HL7 International / Clinical Decision Support
contact:
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/dss
description:
  v: 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.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
      l: 3166
    code:
      v: US
    display:
      v: United States of America
item:
  link id:
    v: patient-info
  text:
    v: Patient Information
  type:
    v: group
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
        l: sdc-questionnaire-initialExpression
      value: Expression

v: text/cql-identifier

v: Patient Name

v: patient-info|patient-name

v: Name

v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Date of Birth
link id:
  v: patient-info|date-of-birth
text:
  v: Date of Birth
type:
  v: date

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Birth Sex
link id:
  v: patient-info|birth-sex
text:
  v: Birth Sex
type:
  v: choice
answer value set:
  v: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24
  l: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Medical Record Number
link id:
  v: patient-info|medical-record-number
text:
  v: Medical Record Number
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Phone Number
link id:
  v: patient-info|phone-number
text:
  v: Phone Number
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Email Address
link id:
  v: patient-info|email-address
text:
  v: Email Address
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Address
link id:
  v: patient-info|address
text:
  v: Address
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: City
link id:
  v: patient-info|city
text:
  v: City
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: State
link id:
  v: patient-info|state
text:
  v: State
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
    l: sdc-questionnaire-initialExpression
  value: Expression
    language:
      v: text/cql-identifier
    expression:
      v: Postal Code
link id:
  v: patient-info|postal-code
text:
  v: Postal Code
type:
  v: string

link id:
  v: coverage-info
text:
  v: Coverage Information
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Member ID
  link id:
    v: coverage-info|member-id
  text:
    v: Member ID
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Policy Number
  link id:
    v: completing-form|patient-info|policy-number
  text:
    v: Policy Number
  type:
    v: string

link id:
  v: provider-info
text:
  v: Requesting Provider Information
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Requesting Provider Name
  link id:
    v: provider-info|name
  text:
    v: Requesting provider name
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Requesting Provider Phone
  link id:
    v: provider-info|phone-number
  text:
    v: Phone
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Requesting Provider Address
  link id:
    v: provider-info|address
  text:
    v: Ordering provider address
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Requesting Provider NPI
  link id:
    v: provider-info|npi
  text:
    v: Ordering provider Tax ID/NPI #
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Requesting Provider Fax
  link id:
    v: provider-info|fax
  text:
    v: Fax
  type:
    v: string

link id:
  v: servicing-provider
text:
  v: Laboratory performing testing/Servicing Provider
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Servicing Provider Name
  link id:
    v: servicing-provider|name
  text:
    v: Servicing Provider name
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Servicing Provider Phone
  link id:
    v: servicing-provider|phone-number
  text:
    v: Phone
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Servicing Provider Address
  link id:
    v: servicing-provider|address
  text:
    v: Ordering provider address
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Servicing Provider NPI
  link id:
    v: servicing-provider|npi
  text:
    v: Ordering provider Tax ID/NPI #
  type:
    v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression
      l: sdc-questionnaire-initialExpression
    value: Expression
      language:
        v: text/cql-identifier
      expression:
        v: Servicing Provider Fax
  link id:
    v: servicing-provider|fax
  text:
    v: Fax
  type:
    v: string