---
schema_version: "1"
id: ecfe0980ad513b08afa5932ff5470f4ff0753f26e338c450a352d387e0b6da05
title: Forms
collection: developer
version: current
locale: en-us
portal_url: https://docs.salesforce.com/developer/current/en-us/industries-integrations/health/references/generated-api-specs/questionnaire.md
canonical_url: https://developer.salesforce.com/docs/industries/health/references/questionnaire
source_site: developer.salesforce.com
content_type: documentation
content_hash: f188b9295fb25d1a9133ba00ac9b9c47913278f1833587c29e9fed6324035d8c
products:
  - Salesforce Healthcare API
  - Industries Integrations
---
Forms

# Forms

API for handling FHIR Questionnaires and their responses, adhering to HL7 and FHIR standards.

**Version:** v1

Protocols: https.

## Operations

### GET Get a Questionnaire record

`GET /Questionnaire/{questionnaireId}`

Gets the Questionnaire for the given Questionnaire Id

#### Parameters

*   `questionnaireId` (path, string, required)
*   `Access-Token` (header, string) Salesforce org access token  
    Example: `Bearer asvg473tebdjebdsakl!jsjndkcmldcmdcmedj3o9.asd`.
*   `Instance-Domain-Name` (header, string) Instance domain name of the salesforce org  
    Example: `orgid.salesforce.com`.

#### Responses

*   **200**
    
    Media type: `application/fhir+json`. Schema: `Questionnaire`.
    
    _Example_
    
    ```
    {
      "resourceType" : "Questionnaire",
      "id" : "3141",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      \n      <pre>\n            1.Comorbidity?\n              1.1 Cardial Comorbidity\n                1.1.1 Angina?\n                1.1.2 MI?\n              1.2 Vascular Comorbidity?\n              ...\n            Histopathology\n              Abdominal\n                pT category?\n              ...\n          </pre>\n    \n    </div>"
      },
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
        "valueCode" : "fhir"
      }],
      "url" : "http://hl7.org/fhir/Questionnaire/3141",
      "identifier" : [{
        "system" : "urn:ietf:rfc:3986",
        "value" : "urn:oid:2.16.840.1.113883.4.642.20.2"
      }],
      "name" : "CancerQualityForumQuestionnaire2012",
      "title" : "Cancer Quality Forum Questionnaire 2012",
      "status" : "draft",
      "subjectType" : ["Patient"],
      "date" : "2012-01",
      "publisher" : "HL7 International / FHIR Infrastructure",
      "contact" : [{
        "telecom" : [{
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fiwg"
        }]
      }],
      "description" : "Cancer Quality Forum Questionnaire 2012",
      "item" : [{
        "linkId" : "1",
        "code" : [{
          "system" : "http://example.org/system/code/sections",
          "code" : "COMORBIDITY"
        }],
        "type" : "group",
        "item" : [{
          "linkId" : "1.1",
          "code" : [{
            "system" : "http://example.org/system/code/questions",
            "code" : "COMORB"
          }],
          "prefix" : "1",
          "type" : "coding",
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow",
          "item" : [{
            "linkId" : "1.1.1",
            "code" : [{
              "system" : "http://example.org/system/code/sections",
              "code" : "CARDIAL"
            }],
            "type" : "group",
            "enableWhen" : [{
              "question" : "1.1",
              "operator" : "=",
              "answerCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0136",
                "code" : "Y"
              }
            }],
            "item" : [{
              "linkId" : "1.1.1.1",
              "code" : [{
                "system" : "http://example.org/system/code/questions",
                "code" : "COMORBCAR"
              }],
              "prefix" : "1.1",
              "type" : "coding",
              "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow",
              "item" : [{
                "linkId" : "1.1.1.1.1",
                "code" : [{
                  "system" : "http://example.org/system/code/questions",
                  "code" : "COMCAR00",
                  "display" : "Angina Pectoris"
                },
                {
                  "system" : "http://snomed.info/sct",
                  "code" : "194828000",
                  "display" : "Angina (disorder)"
                }],
                "prefix" : "1.1.1",
                "type" : "coding",
                "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow"
              },
              {
                "linkId" : "1.1.1.1.2",
                "code" : [{
                  "system" : "http://snomed.info/sct",
                  "code" : "22298006",
                  "display" : "Myocardial infarction (disorder)"
                }],
                "prefix" : "1.1.2",
                "type" : "coding",
                "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow"
              }]
            },
            {
              "linkId" : "1.1.1.2",
              "code" : [{
                "system" : "http://example.org/system/code/questions",
                "code" : "COMORBVAS"
              }],
              "prefix" : "1.2",
              "type" : "coding",
              "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow"
            }]
          }]
        }]
      },
      {
        "linkId" : "2",
        "code" : [{
          "system" : "http://example.org/system/code/sections",
          "code" : "HISTOPATHOLOGY"
        }],
        "type" : "group",
        "item" : [{
          "linkId" : "2.1",
          "code" : [{
            "system" : "http://example.org/system/code/sections",
            "code" : "ABDOMINAL"
          }],
          "type" : "group",
          "item" : [{
            "linkId" : "2.1.2",
            "code" : [{
              "system" : "http://example.org/system/code/questions",
              "code" : "STADPT",
              "display" : "pT category"
            }],
            "type" : "coding"
          }]
        }]
      }]
    }
    ```
    
*   **404**
    
    Media type: `application/json`. Schema: `object`.
    
    *   `issue` (_array of object_, required)
        *   `severity` (_string_, required) Severity of the issue. Options are fatal, error, warning, information, success.  
            Allowed values: `fatal`, `error`, `warning`, `information`, `success`.
        *   `code` (_string_, required) Error or warning code.
        *   `details` (_object_) Additional details about the error.
            *   `coding` (_array of object_) Code defined by a terminology system.
                *   `system` (_string_) Code system for this code.
                *   `version` (_string_) Version of the system - if relevant
                *   `code` (_string_) Code for what is being represented.
                *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
                *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
            *   `text` (_string_) Plain text representation of the concept.
        *   `diagnostics` (_string_) Additional diagnostic information about the issue.
        *   `location` (_array of string_) Path of element(s) related to the issue.
        *   `expression` (_array of string_) FHIRPath of element(s) related to the issue.
    
    _Example_
    
    ```
    resourceType: OperationOutcome
    issue:
      -
        severity: error
        code: code-invalid
        details:
          text: Unknown resource.
    ```
    
*   **500**
    
    Media type: `application/json`. Schema: `object`.
    
    *   `issue` (_array of object_, required)
        *   `severity` (_string_, required) Severity of the issue. Options are fatal, error, warning, information, success.  
            Allowed values: `fatal`, `error`, `warning`, `information`, `success`.
        *   `code` (_string_, required) Error or warning code.
        *   `details` (_object_) Additional details about the error.
            *   `coding` (_array of object_) Code defined by a terminology system.
                *   `system` (_string_) Code system for this code.
                *   `version` (_string_) Version of the system - if relevant
                *   `code` (_string_) Code for what is being represented.
                *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
                *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
            *   `text` (_string_) Plain text representation of the concept.
        *   `diagnostics` (_string_) Additional diagnostic information about the issue.
        *   `location` (_array of string_) Path of element(s) related to the issue.
        *   `expression` (_array of string_) FHIRPath of element(s) related to the issue.
    
    _Example_
    
    ```
    resourceType: OperationOutcome
    issue:
      -
        severity: error
        code: code-invalid
        details:
          text: Unknown resource.
    ```
    

### POST Fetch a Questionnaire Package

`POST /Questionnaire/$questionnaire-package`

This operation returns one or more 'collection' Bundles each consisting of a single Questionnaire resource, one or more QuestionnaireResponse resources, as well as any dependency Library and ValueSet instances needed to allow a renderer to fully render and otherwise process the Questionnaire.

#### Parameters

*   `Access-Token` (header, string) Salesforce org access token  
    Example: `Bearer asvg473tebdjebdsakl!jsjndkcmldcmdcmedj3o9.asd`.
*   `Instance-Domain-Name` (header, string) Instance domain name of the salesforce org  
    Example: `orgid.salesforce.com`.
*   `Content-Type` (header, string, required) Media type of the resource.  
    Example: `application/fhir+json`.

#### Request body

Media type: `application/fhir+json`. Schema: `QuestionnairePackageRequest`.

_Example_

```
{
  "resourceType" : "Parameters",
  "id" : "QuestionnairePackageInputParamsExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-input-parameters"
    ]
  },
  "parameter" : [
    {
      "name" : "coverage",
      "resource" : {
            "id": "9876B1",
            "identifier": [
                {
                    "system": "http://benefitsinc.com/certificate",
                    "value": "12345"
                }
            ],
            "status": "active",
            "type": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                        "code": "EHCPOL",
                        "display": "extended healthcare"
                    }
                ]
            },
            "policyHolder": {
                "reference": "http://benefitsinc.com/FHIR/Organization/CBI35"
            },
            "subscriber": {
                "reference": "ok234567xx"
            },
            "beneficiary": {
                "reference": "ok234567xx"
            },
            "dependent": "0",
            "relationship": {
                "coding": [
                    {
                        "code": "self"
                    }
                ]
            },
            "period": {
                "start": "2011-05-23",
                "end": "2012-05-23"
            },
            "payor": [
                {
                    "reference": "Organization/2"
                }
            ]
        }
    },
    {
      "name" : "order",
      "resource" : {
            "resourceType": "ServiceRequest",
            "id": "ServiceRequestExample",
            "meta": {
                "profile": [
                    "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest"
                ]
            },
            "status": "draft",
            "intent": "original-order",
            "code": {
                "coding": [
                    {
                        "system": "http://hl7.org/fhir/sid/icd-10",
                        "code": "S83.511"
                    }
                ],
                "text": "Gas panel - Blood"
            },
            "subject": {
                "reference": "Patient/examplepatient"
            },
            "occurrenceDateTime": "2019-05-08T09:33:27+07:00",
            "authoredOn": "2019-09-18T07:53:21+07:00",
            "requester": {
                "reference": "Practitioner/PractitionerExample"
            },
            "reasonCode": [
                {
                    "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "4565000"
                        }
                    ],
                    "text": "Decreased oxygen affinity"
                }
            ]
        }
    },
    {
      "name" : "referenced",
      "resource" : {
            "resourceType": "requester",
            "identifier": [
                {
                    "code": "code",
                    "system": "ss"
                },
                {
                    "code": "code",
                    "system": "ss"
                }
            ]
        }
    },
    {
       "name" : "referenced",
       "resource" : {
            "resourceType": "Patient",
            "identifier": {
                "code": "",
                "system": ""
            }
        }
    },
    {
      "name" : "referenced",
      "resource" : {
            "resourceType": "performer",
            "code": "",
            "system": ""
        }
    },
    {
      "name" : "context",
      "valueInstant" : "1MOSG000000ErR34AK"
    },
    {
      "name" : "changedsince",
      "valueInstant" : "2025-03-03"
    },
    {
      "name" : "questionnaire",
      "valueCanonical" : "asd/idqwer"
    }
  ]
}
```

#### Responses

*   **200**
    
    Media type: `application/fhir+json`. Schema: `object`.
    
    *   `resourceType` (_string_, required) Parameters  
        Allowed values: `Parameters`.
    *   `parameter` (_array of object_, required)
        *   `name` (_string_, required)  
            Allowed values: `PackageBundle`, `outcome`.
        *   `resource` (_object_)
    
    _Example_
    
    ```
    {
      "resourceType": "Parameters",
      "id": "QuestionnairePackageOutputParamsExample",
      "meta": {
        "profile": [
          "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-output-parameters"
        ]
      },
      "parameter": [
        {
          "name": "PackageBundle",
          "resource": {
            "resourceType": "Bundle",
            "type": "collection",
            "entry": [
              {
                "resourceType": "Questionnaire",
                "identifier": [],
                "version": "2.0",
                "name": "Contract_Amend_English_2",
                "title": "SurhudTest",
                "status": "active",
                "date": "2024-11-29T05:43:32.000Z",
                "language": "English",
                "item": [
                  {
                    "linkId": "Step1",
                    "text": "Untitled Step",
                    "type": "Step",
                    "disabledDisplay": "Hide if False",
                    "required": "null"
                  }
                ]
              }
            ]
          }
        },
        {
          "name": "outcome",
          "resource": {
            "resourceType": "OperationOutcome",
            "id": "warning",
            "issue": [
              {
                "severity": "warning",
                "code": "error-while-retrieving",
                "details": {
                  "text": "Error while retrieving questionnaireId: 0jNSG000000ByLp2AK. Error: HTTP GET on resource 'https://umcom5-dev-ed.develop.test1.my.pc-rnd.salesforce.com:443/services/data/v63.0/connect/omniscript/0jNSG000000ByLp2AK' failed: bad request (400)."
                }
              }
            ]
          }
        }
      ]
    }
    ```
    
*   **404**
    
    Media type: `application/json`. Schema: `object`.
    
    *   `issue` (_array of object_, required)
        *   `severity` (_string_, required) Severity of the issue. Options are fatal, error, warning, information, success.  
            Allowed values: `fatal`, `error`, `warning`, `information`, `success`.
        *   `code` (_string_, required) Error or warning code.
        *   `details` (_object_) Additional details about the error.
            *   `coding` (_array of object_) Code defined by a terminology system.
                *   `system` (_string_) Code system for this code.
                *   `version` (_string_) Version of the system - if relevant
                *   `code` (_string_) Code for what is being represented.
                *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
                *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
            *   `text` (_string_) Plain text representation of the concept.
        *   `diagnostics` (_string_) Additional diagnostic information about the issue.
        *   `location` (_array of string_) Path of element(s) related to the issue.
        *   `expression` (_array of string_) FHIRPath of element(s) related to the issue.
    
    _Example_
    
    ```
    resourceType: OperationOutcome
    issue:
      -
        severity: error
        code: code-invalid
        details:
          text: Unknown resource.
    ```
    
*   **500**
    
    Media type: `application/json`. Schema: `object`.
    
    *   `issue` (_array of object_, required)
        *   `severity` (_string_, required) Severity of the issue. Options are fatal, error, warning, information, success.  
            Allowed values: `fatal`, `error`, `warning`, `information`, `success`.
        *   `code` (_string_, required) Error or warning code.
        *   `details` (_object_) Additional details about the error.
            *   `coding` (_array of object_) Code defined by a terminology system.
                *   `system` (_string_) Code system for this code.
                *   `version` (_string_) Version of the system - if relevant
                *   `code` (_string_) Code for what is being represented.
                *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
                *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
            *   `text` (_string_) Plain text representation of the concept.
        *   `diagnostics` (_string_) Additional diagnostic information about the issue.
        *   `location` (_array of string_) Path of element(s) related to the issue.
        *   `expression` (_array of string_) FHIRPath of element(s) related to the issue.
    
    _Example_
    
    ```
    resourceType: OperationOutcome
    issue:
      -
        severity: error
        code: code-invalid
        details:
          text: Unknown resource.
    ```
    

### POST Create a Questionnaire Response

`POST /QuestionnaireResponse`

Submit a new QuestionnaireResponse to record the answers to a questionnaire.

#### Parameters

*   `Access-Token` (header, string) Salesforce org access token  
    Example: `Bearer asvg473tebdjebdsakl!jsjndkcmldcmdcmedj3o9.asd`.
*   `Instance-Domain-Name` (header, string) Instance domain name of the salesforce org  
    Example: `orgid.salesforce.com`.
*   `Content-Type` (header, string, required) Media type of the resource.  
    Example: `application/fhir+json`.

#### Request body

Media type: `application/fhir+json`. Schema: `QuestionnaireResponse`.

_Example_

```
{
  "resourceType" : "QuestionnaireResponse",
  "id" : "home-o2-questionnaireresponse",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: QuestionnaireResponse home-o2-questionnaireresponse</b></p><a name=\"home-o2-questionnaireresponse\"> </a><a name=\"hchome-o2-questionnaireresponse\"> </a><a name=\"home-o2-questionnaireresponse-en-US\"> </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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Definition</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Answer</a><span style=\"float: right\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : 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=\"QuestionnaireResponseRoot\" class=\"hierarchy\"/> home-o2-questionnaireresponse</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire:<a href=\"Questionnaire-referred-questionnaire.html\">Referred Questionnaire for QuestionnaireResponse</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" 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\"/> 1</td><td style=\"vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 1.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Last Name but Different This Time</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Quinton</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 1.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">First Name</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Vlad</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 1.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Middle Initial</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">A, N</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 1.4</td><td style=\"vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1956-12-01</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 1.5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Gender</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html#administrative-gender-male\">AdministrativeGender male</a>: Male</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" 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=\"Item\" class=\"hierarchy\"/> 1.6</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Medicare ID</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">10A3D58WH22</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" 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\"/> 2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Provider who is performing face-to-face evaluation</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 2.1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Last Name</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Doe</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 2.2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">First Name</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Jane</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 2.3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Middle Initial</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">B</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 2.4</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">NPI</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1122334455</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 2.5</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Date of Face-To-Face Evaluation</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">2019-07-18</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" 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=\"Item\" class=\"hierarchy\"/> 2.6</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Record</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span><a href=\"Patient-examplepatient.html\">Mr. Saul Moki</a></span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" 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\"/> 3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Coverage Requirements</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 3.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span><a href=\"http://snomed.info/id/313296004\">SNOMED CT 313296004</a>: Mild chronic obstructive pulmonary disease</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 3.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Arterial oxygen saturation (Patient on room air while at rest and awake when tested)</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>95 mm[Hg]<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemm[Hg] = 'mm[Hg]')</span></span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 3.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>83 mm[Hg]<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemm[Hg] = 'mm[Hg]')</span></span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 3.4</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Arterial oxygen saturation (Patient tested during exercise)</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>95 mm[Hg]<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemm[Hg] = 'mm[Hg]')</span></span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 3.5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>78 mm[Hg]<span style=\"background: LightGoldenRodYellow\"> (Details: UCUM  codemm[Hg] = 'mm[Hg]')</span></span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" 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=\"Item\" class=\"hierarchy\"/> 3.6</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Is there a documented improvement of hypoxemia during exercise with oxygen?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">true</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" 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\"/> 4</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Prescribed Use</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 4.1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Start date</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">2019-07-18</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" 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=\"Item\" class=\"hierarchy\"/> 4.2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Length of need: (months) (99 = lifetime)</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>99</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" 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-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> 4.3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Peak Flow Rate</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" 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_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=\"Item\" class=\"hierarchy\"/> 4.3.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">LPM</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>2</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" 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_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=\"Item\" class=\"hierarchy\"/> 4.3.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">oxygen %</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>98</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" 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-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> 4.4</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Average Flow Rate</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" 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_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=\"Item\" class=\"hierarchy\"/> 4.4.1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">LPM</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>2</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" 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_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=\"Item\" class=\"hierarchy\"/> 4.4.2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">oxygen %</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>97</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" 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=\"Item\" class=\"hierarchy\"/> 4.5</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Frequency of use (choose all that apply)</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">At rest and awake</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" 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: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> 5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Oxygen Supply Order Details</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" 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=\"Item\" class=\"hierarchy\"/> 5.1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Current Order Description</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" 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=\"Item\" class=\"hierarchy\"/> 5.1b</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Current Order Is For A Portable Device</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" 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=\"Item\" class=\"hierarchy\"/> 5.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Type</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>example.org 122: Compressed Gas</span></span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" 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=\"Item\" class=\"hierarchy\"/> 5.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Means of oxygen delivery and accessories</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><span><span>example.org 134: Mask</span></span></td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
    "valueReference" : {
      "reference" : "Coverage/CoverageExample"
    }
  },
  {
    "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
    "valueReference" : {
      "reference" : "ServiceRequest/ServiceRequestExample"
    }
  },
  {
    "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/intendedUse",
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
        "code" : "withorder",
        "display" : "Include with order"
      }]
    }
  }],
  "questionnaire" : "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/referred-questionnaire",
  "status" : "completed",
  "subject" : {
    "reference" : "Patient/examplepatient",
    "display" : "Vlad"
  },
  "authored" : "2023-08-21",
  "item" : [{
    "linkId" : "1",
    "text" : "Patient Information",
    "item" : [{
      "linkId" : "1.1",
      "text" : "Last Name but Different This Time",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "override"
          },
          {
            "extension" : [{
              "url" : "role",
              "valueCodeableConcept" : {
                "coding" : [{
                  "system" : "http://terminology.hl7.org/CodeSystem/practitioner-role",
                  "code" : "doctor",
                  "display" : "Doctor"
                }]
              }
            },
            {
              "url" : "practitioner",
              "valueReference" : {
                "reference" : "Practitioner/PractitionerExample",
                "display" : "Dr. Jane Doe"
              }
            }],
            "url" : "author"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "Quinton"
      }]
    },
    {
      "linkId" : "1.2",
      "text" : "First Name",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "Vlad"
      }]
    },
    {
      "linkId" : "1.3",
      "text" : "Middle Initial",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "A, N"
      }]
    },
    {
      "linkId" : "1.4",
      "text" : "Date Of Birth",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueDate" : "1956-12-01"
      }]
    },
    {
      "linkId" : "1.5",
      "text" : "Gender",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueCoding" : {
          "system" : "http://hl7.org/fhir/administrative-gender",
          "code" : "male",
          "display" : "Male"
        }
      }]
    },
    {
      "linkId" : "1.6",
      "text" : "Medicare ID",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "10A3D58WH22"
      }]
    }]
  },
  {
    "linkId" : "2",
    "text" : "Provider who is performing face-to-face evaluation",
    "item" : [{
      "linkId" : "2.1",
      "text" : "Last Name",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "Doe"
      }]
    },
    {
      "linkId" : "2.2",
      "text" : "First Name",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "Jane"
      }]
    },
    {
      "linkId" : "2.3",
      "text" : "Middle Initial",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "B"
      }]
    },
    {
      "linkId" : "2.4",
      "text" : "NPI",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "1122334455"
      }]
    },
    {
      "linkId" : "2.5",
      "text" : "Date of Face-To-Face Evaluation",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "override"
          },
          {
            "extension" : [{
              "url" : "role",
              "valueCodeableConcept" : {
                "coding" : [{
                  "system" : "http://terminology.hl7.org/CodeSystem/practitioner-role",
                  "code" : "doctor",
                  "display" : "Doctor"
                }]
              }
            },
            {
              "url" : "practitioner",
              "valueReference" : {
                "reference" : "Practitioner/PractitionerExample",
                "display" : "Dr. Jane Doe"
              }
            }],
            "url" : "author"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueDate" : "2019-07-18"
      }]
    },
    {
      "linkId" : "2.6",
      "text" : "Record",
      "answer" : [{
        "extension" : [{
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference",
          "valueBoolean" : false
        }],
        "valueReference" : {
          "reference" : "Patient/examplepatient",
          "display" : "Mr. Saul Moki"
        }
      }]
    }]
  },
  {
    "linkId" : "3",
    "text" : "Coverage Requirements",
    "item" : [{
      "linkId" : "3.1",
      "text" : "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueCoding" : {
          "system" : "http://snomed.info/sct",
          "code" : "313296004",
          "display" : "Mild chronic obstructive pulmonary disease"
        }
      }]
    },
    {
      "linkId" : "3.2",
      "text" : "Arterial oxygen saturation (Patient on room air while at rest and awake when tested)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueQuantity" : {
          "value" : 95,
          "system" : "http://unitsofmeasure.org",
          "code" : "mm[Hg]"
        }
      }]
    },
    {
      "linkId" : "3.3",
      "text" : "Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueQuantity" : {
          "value" : 83,
          "system" : "http://unitsofmeasure.org",
          "code" : "mm[Hg]"
        }
      }]
    },
    {
      "linkId" : "3.4",
      "text" : "Arterial oxygen saturation (Patient tested during exercise)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueQuantity" : {
          "value" : 95,
          "system" : "http://unitsofmeasure.org",
          "code" : "mm[Hg]"
        }
      }]
    },
    {
      "linkId" : "3.5",
      "text" : "Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueQuantity" : {
          "value" : 78,
          "system" : "http://unitsofmeasure.org",
          "code" : "mm[Hg]"
        }
      }]
    },
    {
      "linkId" : "3.6",
      "text" : "Is there a documented improvement of hypoxemia during exercise with oxygen?",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueBoolean" : true
      }]
    }]
  },
  {
    "linkId" : "4",
    "text" : "Prescribed Use",
    "item" : [{
      "linkId" : "4.1",
      "text" : "Start date",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueDate" : "2019-07-18"
      }]
    },
    {
      "linkId" : "4.2",
      "text" : "Length of need: (months) (99 = lifetime)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueQuantity" : {
          "value" : 99
        }
      }]
    },
    {
      "linkId" : "4.3",
      "text" : "Peak Flow Rate",
      "item" : [{
        "linkId" : "4.3.1",
        "text" : "LPM",
        "answer" : [{
          "extension" : [{
            "extension" : [{
              "url" : "source",
              "valueCode" : "auto"
            }],
            "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
          }],
          "valueQuantity" : {
            "value" : 2
          }
        }]
      },
      {
        "linkId" : "4.3.2",
        "text" : "oxygen %",
        "answer" : [{
          "extension" : [{
            "extension" : [{
              "url" : "source",
              "valueCode" : "auto"
            }],
            "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
          }],
          "valueQuantity" : {
            "value" : 98
          }
        }]
      }]
    },
    {
      "linkId" : "4.4",
      "text" : "Average Flow Rate",
      "item" : [{
        "linkId" : "4.4.1",
        "text" : "LPM",
        "answer" : [{
          "extension" : [{
            "extension" : [{
              "url" : "source",
              "valueCode" : "auto"
            }],
            "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
          }],
          "valueQuantity" : {
            "value" : 2
          }
        }]
      },
      {
        "linkId" : "4.4.2",
        "text" : "oxygen %",
        "answer" : [{
          "extension" : [{
            "extension" : [{
              "url" : "source",
              "valueCode" : "auto"
            }],
            "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
          }],
          "valueQuantity" : {
            "value" : 97
          }
        }]
      }]
    },
    {
      "linkId" : "4.5",
      "text" : "Frequency of use (choose all that apply)",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "At rest and awake"
      }]
    }]
  },
  {
    "linkId" : "5",
    "text" : "Oxygen Supply Order Details",
    "item" : [{
      "linkId" : "5.1",
      "text" : "Current Order Description",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueString" : "HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"
      }]
    },
    {
      "linkId" : "5.1b",
      "text" : "Current Order Is For A Portable Device"
    },
    {
      "linkId" : "5.2",
      "text" : "Type",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueCoding" : {
          "system" : "http://example.org",
          "code" : "122",
          "display" : "Compressed Gas"
        }
      }]
    },
    {
      "linkId" : "5.3",
      "text" : "Means of oxygen delivery and accessories",
      "answer" : [{
        "extension" : [{
          "extension" : [{
            "url" : "source",
            "valueCode" : "auto"
          }],
          "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
        }],
        "valueCoding" : {
          "system" : "http://example.org",
          "code" : "134",
          "display" : "Mask"
        }
      }]
    }]
  }]
}
```

#### Responses

*   **201**
    
    Headers:
    
    *   `example` (string, required)
    
    Media type: `-application/json`. Schema: `any`.
    
    Type: `any`.
    
*   **404**
    
    Media type: `application/json`. Schema: `object`.
    
    *   `issue` (_array of object_, required)
        *   `severity` (_string_, required) Severity of the issue. Options are fatal, error, warning, information, success.  
            Allowed values: `fatal`, `error`, `warning`, `information`, `success`.
        *   `code` (_string_, required) Error or warning code.
        *   `details` (_object_) Additional details about the error.
            *   `coding` (_array of object_) Code defined by a terminology system.
                *   `system` (_string_) Code system for this code.
                *   `version` (_string_) Version of the system - if relevant
                *   `code` (_string_) Code for what is being represented.
                *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
                *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
            *   `text` (_string_) Plain text representation of the concept.
        *   `diagnostics` (_string_) Additional diagnostic information about the issue.
        *   `location` (_array of string_) Path of element(s) related to the issue.
        *   `expression` (_array of string_) FHIRPath of element(s) related to the issue.
    
    _Example_
    
    ```
    resourceType: OperationOutcome
    issue:
      -
        severity: error
        code: code-invalid
        details:
          text: Unknown resource.
    ```
    
*   **500**
    
    Media type: `application/json`. Schema: `object`.
    
    *   `issue` (_array of object_, required)
        *   `severity` (_string_, required) Severity of the issue. Options are fatal, error, warning, information, success.  
            Allowed values: `fatal`, `error`, `warning`, `information`, `success`.
        *   `code` (_string_, required) Error or warning code.
        *   `details` (_object_) Additional details about the error.
            *   `coding` (_array of object_) Code defined by a terminology system.
                *   `system` (_string_) Code system for this code.
                *   `version` (_string_) Version of the system - if relevant
                *   `code` (_string_) Code for what is being represented.
                *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
                *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
            *   `text` (_string_) Plain text representation of the concept.
        *   `diagnostics` (_string_) Additional diagnostic information about the issue.
        *   `location` (_array of string_) Path of element(s) related to the issue.
        *   `expression` (_array of string_) FHIRPath of element(s) related to the issue.
    
    _Example_
    
    ```
    resourceType: OperationOutcome
    issue:
      -
        severity: error
        code: code-invalid
        details:
          text: Unknown resource.
    ```
    

## Schemas

### Questionnaire

A structured set of questions representing a Questionnaire resource in FHIR. Includes constraints, rules, and metadata for validation and usage.

*   `url` (_string_) Canonical identifier for the questionnaire (globally unique).
*   `identifier` (_array of object_) Business identifier for the questionnaire.
    
    Each item: Identifier intended for computation.
    
    *   `use` (_string_) Purpose of the identifier (for example, usual, official, temp, secondary, old).  
        Allowed values: `usual`, `official`, `temp`, `secondary`, `old`.
    *   `type` (_object_) Description of identifier.
        *   `coding` (_array of object_) Code defined by a terminology system.
            *   `system` (_string_) Code system for this code.
            *   `version` (_string_) Version of the system - if relevant
            *   `code` (_string_) Code for what is being represented.
            *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
            *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
        *   `text` (_string_) Plain text representation of the concept.
    *   `system` (_string_) Namespace for the identifier value.
    *   `value` (_string_) Unique value of the identifier.
    *   `period` (_object_) Time period when the identifier is or was valid for use.
        *   `start` (_string_) Starting time with inclusive boundary.
        *   `end` (_string_) End time with inclusive boundary, if not ongoing.
    *   `assigner` (_object_) The organization that issued the identifier (can be just text).
        *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
        *   `type` (_string_) Type the reference refers to (for example, "Patient").
        *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
        *   `display` (_string_) Displayable name for the reference.
*   `version` (_string_) Business version of the questionnaire.
*   `versionAlgorithmString` (_string_) How to compare versions.
*   `versionAlgorithmCoding` (_object_) How to compare versions.
    *   `system` (_string_) Code system for this code.
    *   `version` (_string_) Version of the system - if relevant
    *   `code` (_string_) Code for what is being represented.
    *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
    *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
*   `name` (_string_) Computer-friendly name for the questionnaire.
*   `title` (_string_) Human-friendly name for the questionnaire.
*   `derivedFrom` (_array of string_) Canonical reference to other questionnaires this is based on.
*   `status` (_string_, required) Status of the questionnaire (draft | active | retired | unknown).  
    Allowed values: `draft`, `active`, `retired`, `unknown`.
*   `experimental` (_boolean_) Whether the questionnaire is for testing purposes.
*   `subjectType` (_array of string_) Resource types that can be the subject of QuestionnaireResponse.
*   `date` (_string_) Date when the questionnaire was last changed.
*   `publisher` (_string_) Name of the publisher/steward (organization or individual).
*   `contact` (_array of object_) Contact details for the publisher.
*   `description` (_string_) Natural language description of the questionnaire.
*   `useContext` (_array of object_) The context intended to support the content.
*   `jurisdiction` (_array of object_) Intended jurisdiction for the questionnaire.
    
    Each item: Concept - reference to a terminology or just text.
    
    *   `coding` (_array of object_) Code defined by a terminology system.
        *   `system` (_string_) Code system for this code.
        *   `version` (_string_) Version of the system - if relevant
        *   `code` (_string_) Code for what is being represented.
        *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
        *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
    *   `text` (_string_) Plain text representation of the concept.
*   `purpose` (_string_) Why this questionnaire is defined.
*   `copyright` (_string_) Use and/or publishing restrictions.
*   `copyrightLabel` (_string_) Copyright holder and year(s).
*   `approvalDate` (_string_) Date when the questionnaire was approved.
*   `lastReviewDate` (_string_) Date when the questionnaire was last reviewed.
*   `effectivePeriod` (_object_) When the questionnaire is expected to be used.
    *   `start` (_string_) Starting time with inclusive boundary.
    *   `end` (_string_) End time with inclusive boundary, if not ongoing.
*   `code` (_array of object_) Concept representing the overall questionnaire.
    *   `system` (_string_) Code system for this code.
    *   `version` (_string_) Version of the system - if relevant
    *   `code` (_string_) Code for what is being represented.
    *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
    *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
*   `item` (_array of object_) Questions and sections within the questionnaire.
    
    Each item: Items within a questionnaire, representing questions or groups.
    
    *   `linkId` (_string_, required) Unique ID for an item in the questionnaire.
    *   `definition` (_string_) ElementDefinition - details for the item.
    *   `code` (_array of object_) Corresponding concept for this item in a terminology.
        *   `system` (_string_) Code system for this code.
        *   `version` (_string_) Version of the system - if relevant
        *   `code` (_string_) Code for what is being represented.
        *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
        *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
    *   `prefix` (_string_) Prefix for display, for example, "1(a)".
    *   `text` (_string_) Primary text for the item.
    *   `type` (_string_, required) Type of the questionnaire item.  
        Allowed values: `group`, `display`, `boolean`, `decimal`, `integer`, `date`, `dateTime`, `time`, `string`, `coding`, `quantity`.
    *   `enableWhen` (_array of object_) Logic for when this item is enabled.
        *   `question` (_string_, required) The linkId of the question.
        *   `operator` (_string_, required) Operator for comparison.  
            Allowed values: `exists`, `=`, `!=`, `>`, `<`, `>=`, `<=`.
        *   `answerBoolean` (_boolean_) Answer value as a boolean.
        *   `answerDecimal` (_number (float)_) Answer value as a decimal number.
        *   `answerInteger` (_integer_) Answer value as an integer.
        *   `answerDate` (_date-only_) Answer value as a date.
        *   `answerDateTime` (_datetime_) Answer value as a date-time.
        *   `answerTime` (_time-only_) Answer value as a time.
        *   `answerString` (_string_) Answer value as a string.
        *   `answerCoding` (_object_) Answer value represented as a coding object.
            *   `system` (_string_) Code system for this code.
            *   `version` (_string_) Version of the system - if relevant
            *   `code` (_string_) Code for what is being represented.
            *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
            *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
        *   `answerQuantity` (_object_) Answer value represented as a quantity object.
            *   `value` (_number_) Numerical value (with implicit precision).
            *   `comparator` (_string_) How to understand the value (for example, <, <=, >=, >).  
                Allowed values: `<`, `<=`, `>=`, `>`.
            *   `unit` (_string_) Unit representation.
            *   `system` (_string_) System that defines the coded unit form.
            *   `code` (_string_) Coded form of the unit.
        *   `answerReference` (_object_) Answer value represented as a reference to another resource.
            *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
            *   `type` (_string_) Type the reference refers to (for example, "Patient").
            *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
            *   `display` (_string_) Displayable name for the reference.
    *   `enableBehavior` (_string_) Specifies behavior when multiple enableWhen conditions are present.  
        Allowed values: `all`, `any`.
    *   `disabledDisplay` (_string_) How the item is displayed when disabled.  
        Allowed values: `hidden`, `protected`.
    *   `required` (_boolean_) Whether the item must be included in data results.
    *   `repeats` (_boolean_) Whether the item can repeat.
    *   `readOnly` (_boolean_) Whether human editing is allowed for the item.
    *   `maxLength` (_integer_) The maximum number of characters allowed in the item.
    *   `answerConstraint` (_string_) Constraints on the type of answers allowed.  
        Allowed values: `optionsOnly`, `optionsOrType`, `optionsOrString`.
    *   `answerValueSet` (_string_) A canonical reference to a ValueSet containing permitted answers.
    *   `answerOption` (_array of object_) Permitted answers for the question.
        *   `valueInteger` (_integer_) Initial value as an integer.
        *   `valueDate` (_date-only_) Initial value as a date.
        *   `valueTime` (_time-only_) Initial value as a time.
        *   `valueString` (_string_) Initial value as a string.
        *   `valueCoding` (_object_) Initial value represented as a coding object.
            *   `system` (_string_) Code system for this code.
            *   `version` (_string_) Version of the system - if relevant
            *   `code` (_string_) Code for what is being represented.
            *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
            *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
        *   `valueReference` (_object_) Initial value represented as a reference to another resource.
            *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
            *   `type` (_string_) Type the reference refers to (for example, "Patient").
            *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
            *   `display` (_string_) Displayable name for the reference.
        *   `initialSelected` (_boolean_) Whether the option is selected by default.
    *   `initial` (_array of object_) Initial values when the item is first rendered.
        *   `valueBoolean` (_boolean_) Value represented as a boolean.
        *   `valueDecimal` (_number (float)_) Value represented as a decimal.
        *   `valueInteger` (_integer_) Value represented as an integer.
        *   `valueDate` (_date-only_) Value represented as a date.
        *   `valueDateTime` (_datetime_) Value represented as a date-time.
        *   `valueTime` (_time-only_) Value represented as a time.
        *   `valueString` (_string_) Value represented as a string.
        *   `valueUri` (_string_) Value represented as a URI.
        *   `valueAttachment` (_object_) Value represented as an attachment object.
            *   `contentType` (_string_) MIME type of the content, with charset, and so on.
            *   `language` (_string_) Human language of the content (BCP-47).
            *   `data` (_string_) Data inline, base64-encoded.
            *   `url` (_string_) URI where the data is located.
            *   `size` (_integer_) Number of bytes of content (if the URL is provided).  
                Minimum: 0.
            *   `hash` (_string_) Hash of the data (SHA-1, base64-encoded).
            *   `title` (_string_) Label to display in place of the data.
            *   `creation` (_datetime_) Date the attachment was first created.
            *   `height` (_integer_) Height of the image in pixels (photo/video).
            *   `width` (_integer_) Width of the image in pixels (photo/video).
            *   `frames` (_integer_) Number of frames if > 1 (photo).
            *   `duration` (_number_) Length in seconds (audio or video).
            *   `pages` (_integer_) Number of printed pages.
        *   `valueCoding` (_object_) Value represented as a coding object.
            *   `system` (_string_) Code system for this code.
            *   `version` (_string_) Version of the system - if relevant
            *   `code` (_string_) Code for what is being represented.
            *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
            *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
        *   `valueQuantity` (_object_) Value represented as a quantity object.
            *   `value` (_number_) Numerical value (with implicit precision).
            *   `comparator` (_string_) How to understand the value (for example, <, <=, >=, >).  
                Allowed values: `<`, `<=`, `>=`, `>`.
            *   `unit` (_string_) Unit representation.
            *   `system` (_string_) System that defines the coded unit form.
            *   `code` (_string_) Coded form of the unit.
        *   `valueReference` (_object_) Value represented as a reference to another resource.
            *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
            *   `type` (_string_) Type the reference refers to (for example, "Patient").
            *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
            *   `display` (_string_) Displayable name for the reference.
    *   `item` (_array of object_) Nested questionnaire items.

### QuestionnairePackageRequest

*   `resourceType` (_string_, required) Parameters  
    Allowed values: `Parameters`.
*   `parameter` (_array of object_, required)
    *   `name` (_string_, required)  
        Allowed values: `coverage`, `order`, `referenced`, `questionnaire`, `context`, `changedsince`.
    *   `resource` (_object_)
    *   `valueString` (_string_)
    *   `valueInstance` (_string_)
    *   `valueCanonical` (_string_)

### QuestionnaireResponse

Represents a response to a Questionnaire, containing answers to the questions.

*   `identifier` (_array of object_) Business identifier for this set of answers.
    
    Each item: Identifier intended for computation.
    
    *   `use` (_string_) Purpose of the identifier (for example, usual, official, temp, secondary, old).  
        Allowed values: `usual`, `official`, `temp`, `secondary`, `old`.
    *   `type` (_object_) Description of identifier.
        *   `coding` (_array of object_) Code defined by a terminology system.
            *   `system` (_string_) Code system for this code.
            *   `version` (_string_) Version of the system - if relevant
            *   `code` (_string_) Code for what is being represented.
            *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
            *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
        *   `text` (_string_) Plain text representation of the concept.
    *   `system` (_string_) Namespace for the identifier value.
    *   `value` (_string_) Unique value of the identifier.
    *   `period` (_object_) Time period when the identifier is or was valid for use.
        *   `start` (_string_) Starting time with inclusive boundary.
        *   `end` (_string_) End time with inclusive boundary, if not ongoing.
    *   `assigner` (_object_) The organization that issued the identifier (can be just text).
        *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
        *   `type` (_string_) Type the reference refers to (for example, "Patient").
        *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
        *   `display` (_string_) Displayable name for the reference.
*   `basedOn` (_array of object_) Request fulfilled by this QuestionnaireResponse.
    
    Each item: A reference from one resource to another. It SHALL have a contained resource if a local reference is provided.
    
    *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
    *   `type` (_string_) Type the reference refers to (for example, "Patient").
    *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
    *   `display` (_string_) Displayable name for the reference.
*   `partOf` (_array of object_) Part of the referenced event.
    
    Each item: A reference from one resource to another. It SHALL have a contained resource if a local reference is provided.
    
    *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
    *   `type` (_string_) Type the reference refers to (for example, "Patient").
    *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
    *   `display` (_string_) Displayable name for the reference.
*   `questionnaire` (_string_, required) Canonical URL of the Questionnaire being answered.
*   `status` (_string_, required) Current status of the response.  
    Allowed values: `in-progress`, `completed`, `amended`, `entered-in-error`, `stopped`.
*   `subject` (_object_) The subject of the questions.
    *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
    *   `type` (_string_) Type the reference refers to (for example, "Patient").
    *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
    *   `display` (_string_) Displayable name for the reference.
*   `encounter` (_object_) The subject of the questions.
    *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
    *   `type` (_string_) Type the reference refers to (for example, "Patient").
    *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
    *   `display` (_string_) Displayable name for the reference.
*   `authored` (_string_, required) Date the answers were gathered.
*   `author` (_object_) Person who recorded the answers.
    *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
    *   `type` (_string_) Type the reference refers to (for example, "Patient").
    *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
    *   `display` (_string_) Displayable name for the reference.
*   `source` (_object_) Person who answered the questions.
    *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
    *   `type` (_string_) Type the reference refers to (for example, "Patient").
    *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
    *   `display` (_string_) Displayable name for the reference.
*   `item` (_array of object_, required) Groups and questions.
    
    Each item: BackboneElement representing groups and questions in a QuestionnaireResponse. Nested items cannot exist beneath both `item` and `answer`.
    
    *   `linkId` (_string_, required) Pointer to a specific item from the Questionnaire.
    *   `definition` (_string_) URI pointing to ElementDefinition details for the item.
    *   `text` (_string_) Name for the group or question text.
    *   `answer` (_array of object_) BackboneElement representing the response(s) to the question.
        *   `valueBoolean` (_boolean_) Boolean value.
        *   `valueDate` (_string_) Date value.
        *   `valueDateTime` (_string_) DateTime value.
        *   `valueTime` (_string_) Time value.
        *   `valueDecimal` (_number_) Decimal value.
        *   `valueInteger` (_integer_) Integer value.
        *   `valueString` (_string_) String value.
        *   `valueCoding` (_object_) Coding value.
            *   `system` (_string_) Code system for this code.
            *   `version` (_string_) Version of the system - if relevant
            *   `code` (_string_) Code for what is being represented.
            *   `display` (_string_) A short, human-readable label to display. REQUIRED for Override Reasons provided by the CDS Service, OPTIONAL for Topic.
            *   `userSelected` (_boolean_) Whether this coding was chosen directly by the user.
        *   `valueUri` (_string_) URI value.
        *   `valueQuantity` (_object_) Quantity value.
            *   `value` (_number_) Numerical value (with implicit precision).
            *   `comparator` (_string_) How to understand the value (for example, <, <=, >=, >).  
                Allowed values: `<`, `<=`, `>=`, `>`.
            *   `unit` (_string_) Unit representation.
            *   `system` (_string_) System that defines the coded unit form.
            *   `code` (_string_) Coded form of the unit.
        *   `valueAttachment` (_object_) Attachment value.
            *   `contentType` (_string_) MIME type of the content, with charset, and so on.
            *   `language` (_string_) Human language of the content (BCP-47).
            *   `data` (_string_) Data inline, base64-encoded.
            *   `url` (_string_) URI where the data is located.
            *   `size` (_integer_) Number of bytes of content (if the URL is provided).  
                Minimum: 0.
            *   `hash` (_string_) Hash of the data (SHA-1, base64-encoded).
            *   `title` (_string_) Label to display in place of the data.
            *   `creation` (_datetime_) Date the attachment was first created.
            *   `height` (_integer_) Height of the image in pixels (photo/video).
            *   `width` (_integer_) Width of the image in pixels (photo/video).
            *   `frames` (_integer_) Number of frames if > 1 (photo).
            *   `duration` (_number_) Length in seconds (audio or video).
            *   `pages` (_integer_) Number of printed pages.
        *   `valueReference` (_object_) Reference value.
            *   `reference` (_string_) Literal reference (relative, internal, or absolute URL).
            *   `type` (_string_) Type the reference refers to (for example, "Patient").
            *   `identifier` (_object_) Logical reference, when the literal reference is unknown.
            *   `display` (_string_) Displayable name for the reference.
        *   `item` (_array of object_) Nested groups and questions under this answer.
    *   `item` (_array of object_) Nested groups and questions.