Common CQL Artifacts for FHIR (US-Based)
2.0.0-ballot - Informative 2 Ballot

Common CQL Artifacts for FHIR (US-Based) - Downloaded Version null See the Directory of published versions

## : Example Patient and Coverage Questionnaire

Page standards status: Informative

Raw ttl | Download

    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:Questionnaire ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "ExamplePatientAndCoverageQuestionnaire"] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<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 &amp; 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, \" 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-ballot</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, \" 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/7.1.0/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 Informationversion: null6.1.0-derived)</a>\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>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:contained ( [
    a fhir:Library ;
    fhir:id [ fhir:v "effective-data-requirements" ] ;
    fhir:name [ fhir:v "EffectiveDataRequirements" ] ;
    fhir:status [ fhir:v "active" ] ;
    fhir:type [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/library-type"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/library-type>         ] ;
    fhir:code [ fhir:v "module-definition" ]       ] )     ] ;
        ( fhir:relatedArtifact [
    fhir:type [ fhir:v "depends-on" ] ;
    fhir:display [ fhir:v "USCore model information" ] ;
    fhir:resource [
    fhir:v "http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo?version=6.1.0-derived>       ]     ] [
    fhir:type [ fhir:v "depends-on" ] ;
    fhir:display [ fhir:v "FHIR model information" ] ;
    fhir:resource [
    fhir:v "http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo?version=4.0.1>       ]     ] )
      ] ) ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/cqf-library"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/cqf-library>     ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/cql/Library/ExamplePatientAndCoverageInitialExpressions"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/cql/Library/ExamplePatientAndCoverageInitialExpressions>     ]
      ] [
        ( fhir:extension [
    fhir:url [
    fhir:v "name"^^xsd:anyURI ;
    fhir:l fhir:name       ] ;
    fhir:value [
    a fhir:Coding ;
    fhir:system [
    fhir:v "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext>         ] ;
    fhir:code [ fhir:v "patient" ] ;
    fhir:display [ fhir:v "Patient" ]       ]     ] [
    fhir:url [
    fhir:v "type"^^xsd:anyURI ;
    fhir:l fhir:type       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "Patient"       ]     ] [
    fhir:url [
    fhir:v "description"^^xsd:anyURI ;
    fhir:l fhir:description       ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "The patient that is to be used to pre-populate the form"       ]     ] ) ;
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext>     ]
      ] [
        ( fhir:extension [
    fhir:url [
    fhir:v "name"^^xsd:anyURI ;
    fhir:l fhir:name       ] ;
    fhir:value [
    a fhir:Coding ;
    fhir:system [
    fhir:v "http://example.org/fhir/CodeSystem/additionalLaunchContext"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/CodeSystem/additionalLaunchContext>         ] ;
    fhir:code [ fhir:v "Coverage" ] ;
    fhir:display [ fhir:v "Coverage" ]       ]     ] [
    fhir:url [
    fhir:v "type"^^xsd:anyURI ;
    fhir:l fhir:type       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "Coverage"       ]     ] [
    fhir:url [
    fhir:v "description"^^xsd:anyURI ;
    fhir:l fhir:description       ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "The coverage that is to be used to pre-populate the form"       ]     ] ) ;
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext>     ]
      ] [
        ( fhir:extension [
    fhir:url [
    fhir:v "name"^^xsd:anyURI ;
    fhir:l fhir:name       ] ;
    fhir:value [
    a fhir:Coding ;
    fhir:system [
    fhir:v "http://example.org/fhir/CodeSystem/additionalLaunchContext"^^xsd:anyURI ;
    fhir:l <http://example.org/fhir/CodeSystem/additionalLaunchContext>         ] ;
    fhir:code [ fhir:v "ServiceRequest" ] ;
    fhir:display [ fhir:v "ServiceRequest" ]       ]     ] [
    fhir:url [
    fhir:v "type"^^xsd:anyURI ;
    fhir:l fhir:type       ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "ServiceRequest"       ]     ] [
    fhir:url [
    fhir:v "description"^^xsd:anyURI ;
    fhir:l fhir:description       ] ;
    fhir:value [
    a fhir:String ;
    fhir:v "The ServiceRequest that is to be used to pre-populate the form"       ]     ] ) ;
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext>     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "cds"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-effectiveDataRequirements>     ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "#effective-data-requirements"^^xsd:anyURI ;
    fhir:l <#effective-data-requirements>     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "informative" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/cql/ImplementationGuide/hl7.fhir.us.cql"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/cql/ImplementationGuide/hl7.fhir.us.cql>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/cql/Questionnaire/ExamplePatientAndCoverageQuestionnaire>
      ] ; #
      fhir:version [ fhir:v "2.0.0-ballot"] ; #
      fhir:name [ fhir:v "ExamplePatientAndCoverageQuestionnaire"] ; #
      fhir:title [ fhir:v "Example Patient and Coverage Questionnaire"] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:experimental [ fhir:v true] ; #
      fhir:date [ fhir:v "2024-09-16T00:00:00+00:00"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Clinical Decision Support"] ; #
      fhir:contact ( [
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/dss" ]     ] )
      ] ) ; #
      fhir:description [ fhir: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."] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ] ;
    fhir:display [ fhir:v "United States of America" ]     ] )
      ] ) ; #
      fhir:item ( [
    fhir:linkId [ fhir:v "patient-info" ] ;
    fhir:text [ fhir:v "Patient Information" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Patient Name" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|patient-name" ] ;
    fhir:text [ fhir:v "Name" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Date of Birth" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|date-of-birth" ] ;
    fhir:text [ fhir:v "Date of Birth" ] ;
    fhir:type [ fhir:v "date" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Birth Sex" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|birth-sex" ] ;
    fhir:text [ fhir:v "Birth Sex" ] ;
    fhir:type [ fhir:v "choice" ] ;
    fhir:answerValueSet [
    fhir:v "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24"^^xsd:anyURI ;
    fhir:l <http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1021.24>       ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Medical Record Number" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|medical-record-number" ] ;
    fhir:text [ fhir:v "Medical Record Number" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Phone Number" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|phone-number" ] ;
    fhir:text [ fhir:v "Phone Number" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Email Address" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|email-address" ] ;
    fhir:text [ fhir:v "Email Address" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Address" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|address" ] ;
    fhir:text [ fhir:v "Address" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "City" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|city" ] ;
    fhir:text [ fhir:v "City" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "State" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|state" ] ;
    fhir:text [ fhir:v "State" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Postal Code" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "patient-info|postal-code" ] ;
    fhir:text [ fhir:v "Postal Code" ] ;
    fhir:type [ fhir:v "string" ]     ] )
      ] [
    fhir:linkId [ fhir:v "coverage-info" ] ;
    fhir:text [ fhir:v "Coverage Information" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Member ID" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "coverage-info|member-id" ] ;
    fhir:text [ fhir:v "Member ID" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Policy Number" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "completing-form|patient-info|policy-number" ] ;
    fhir:text [ fhir:v "Policy Number" ] ;
    fhir:type [ fhir:v "string" ]     ] )
      ] [
    fhir:linkId [ fhir:v "provider-info" ] ;
    fhir:text [ fhir:v "Requesting Provider Information" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Requesting Provider Name" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "provider-info|name" ] ;
    fhir:text [ fhir:v "Requesting provider name" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Requesting Provider Phone" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "provider-info|phone-number" ] ;
    fhir:text [ fhir:v "Phone" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Requesting Provider Address" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "provider-info|address" ] ;
    fhir:text [ fhir:v "Ordering provider address" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Requesting Provider NPI" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "provider-info|npi" ] ;
    fhir:text [ fhir:v "Ordering provider Tax ID/NPI #" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Requesting Provider Fax" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "provider-info|fax" ] ;
    fhir:text [ fhir:v "Fax" ] ;
    fhir:type [ fhir:v "string" ]     ] )
      ] [
    fhir:linkId [ fhir:v "servicing-provider" ] ;
    fhir:text [ fhir:v "Laboratory performing testing/Servicing Provider" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Servicing Provider Name" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "servicing-provider|name" ] ;
    fhir:text [ fhir:v "Servicing Provider name" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Servicing Provider Phone" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "servicing-provider|phone-number" ] ;
    fhir:text [ fhir:v "Phone" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Servicing Provider Address" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "servicing-provider|address" ] ;
    fhir:text [ fhir:v "Ordering provider address" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Servicing Provider NPI" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "servicing-provider|npi" ] ;
    fhir:text [ fhir:v "Ordering provider Tax ID/NPI #" ] ;
    fhir:type [ fhir:v "string" ]     ] [
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression>         ] ;
    fhir:value [
    a fhir:Expression ;
    fhir:language [ fhir:v "text/cql-identifier" ] ;
    fhir:expression [ fhir:v "Servicing Provider Fax" ]         ]       ] ) ;
    fhir:linkId [ fhir:v "servicing-provider|fax" ] ;
    fhir:text [ fhir:v "Fax" ] ;
    fhir:type [ fhir:v "string" ]     ] )
      ] ) . #