Connectathon 11 Snapshot

This page is part of the FHIR Specification (v1.2.0: STU 3 Draft). The current version which supercedes this version is 4.0.1. For a full list of available versions, see the Directory of published versions

Explanationofbenefit-questionnaire.xml

Raw XML (canonical form)

Generated Questionnaire for ExplanationOfBenefit

<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="qs1"/>
  <contained>
    <ValueSet>
      <id value="vs2"/>
      <name value="Type options for ExplanationOfBenefit.prescription"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.prescription"/>
      <expansion>
        <identifier value="urn:uuid:88bbe904-faf1-486f-b526-1b0005236565"/>
        <timestamp value="2015-12-11T17:42:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="MedicationOrder"/>
          <display value="MedicationOrder"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="VisionPrescription"/>
          <display value="VisionPrescription"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs3"/>
      <name value="Type options for ExplanationOfBenefit.accidentLocation[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.accidentLocation[x]"/>
      <expansion>
        <identifier value="urn:uuid:458209f0-c472-483c-8290-552bda285cc8"/>
        <timestamp value="2015-12-11T17:42:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="string"/>
          <display value="string"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Address"/>
          <display value="Address"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="Location"/>
          <display value="Location"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs4"/>
      <name value="Type options for ExplanationOfBenefit.onset[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.onset[x]"/>
      <expansion>
        <identifier value="urn:uuid:1c8e078e-d2d8-4d34-a34d-fc6abfc75889"/>
        <timestamp value="2015-12-11T17:42:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="date"/>
          <display value="date"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Period"/>
          <display value="Period"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs5"/>
      <name value="Type options for ExplanationOfBenefit.item.serviced[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.item.serviced[x]"/>
      <expansion>
        <identifier value="urn:uuid:f76d45db-7594-42db-aa30-414f4bf80162"/>
        <timestamp value="2015-12-11T17:42:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="date"/>
          <display value="date"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="Period"/>
          <display value="Period"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs6"/>
      <name value="Type options for ExplanationOfBenefit.benefitBalance.financial.benefit[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.benefitBalance.financial.benefit[x]"/>
      <expansion>
        <identifier value="urn:uuid:cd4b1a45-8f26-4686-b542-c405a1eaee7e"/>
        <timestamp value="2015-12-11T17:42:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="unsignedInt"/>
          <display value="unsignedInt"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="http://hl7.org/fhir/StructureDefinition/Money"/>
          <display value="Quantity"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="vs7"/>
      <name value="Type options for ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]"/>
      <status value="active"/>
      <description value="Type options for ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]"/>
      <expansion>
        <identifier value="urn:uuid:11339438-ecbb-450e-b9b4-7bbb24c69604"/>
        <timestamp value="2015-12-11T17:42:00+11:00"/>
        <contains>
          <system value="http://hl7.org/fhir/data-types"/>
          <code value="unsignedInt"/>
          <display value="unsignedInt"/>
        </contains>
        <contains>
          <system value="http://hl7.org/fhir/resource-types"/>
          <code value="http://hl7.org/fhir/StructureDefinition/Money"/>
          <display value="Quantity"/>
        </contains>
      </expansion>
    </ValueSet>
  </contained>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
  </identifier>
  <status value="draft"/>
  <date value="2015-12-11T17:38:40+11:00"/>
  <publisher value="Health Level Seven International (Financial Management)"/>
  <item>
    <linkId value="ExplanationOfBenefit"/>
    <text value="Explanation of Benefit resource"/>
    <type value="group"/>
    <required value="false"/>
    <repeats value="true"/>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="flyover"/>
            <display value="Fly-over"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <text value="This resource provides: the claim details; adjudication details from the processing of a Claim; and optionally account balance information, for informing the subscriber of the benefits provided."/>
      <type value="display"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="string"/>
      </extension>
      <linkId value="ExplanationOfBenefit.id"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Bundles always have an id, though it is usually a generated UUID."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.id.value"/>
        <text value="Logical id of this artifact"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.meta"/>
      <text value="Metadata about the resource"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource."/>
        <type value="display"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="uri"/>
      </extension>
      <linkId value="ExplanationOfBenefit.implicitRules"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element as much as possible."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.implicitRules.value"/>
        <text value="A set of rules under which this content was created"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="code"/>
      </extension>
      <linkId value="ExplanationOfBenefit.language"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies  to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource  Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.language.value"/>
        <text value="language"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.text"/>
      <text value="Text summary of the resource, for human interpretation"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative."/>
        <type value="display"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.contained"/>
      <text value="Contained, inline Resources"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again."/>
        <type value="display"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.extension"/>
      <text value="Additional Content defined by implementations"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="May be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
        <type value="display"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.modifierExtension"/>
      <text value="Extensions that cannot be ignored"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="May be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
        <type value="display"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="ExplanationOfBenefit.identifier"/>
      <text value="Business Identifier"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The Response Business Identifier."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.identifier.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.identifier.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.identifier.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.claim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Claim"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.claim.value"/>
        <text value="Claim reference"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.claimResponse"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The business identifier for the instance: invoice number, claim number, pre-determination or pre-authorization number."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="ClaimResponse"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.claimResponse.value"/>
        <text value="Claim response reference"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.ruleset"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The version of the specification on which this instance relies."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.ruleset.value"/>
        <text value="Current specification followed"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.originalRuleset"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The version of the specification from which the original instance was created."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.originalRuleset.value"/>
        <text value="Original specification followed"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="datetime"/>
      </extension>
      <linkId value="ExplanationOfBenefit.created"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The date when the EOB was created."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.created.value"/>
        <text value="Creation date"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Period"/>
      </extension>
      <linkId value="ExplanationOfBenefit.billablePeriod"/>
      <text value="Period for charge submission"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The billable period for which charges are being submitted."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.billablePeriod.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.billablePeriod.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="string"/>
      </extension>
      <linkId value="ExplanationOfBenefit.disposition"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="A description of the status of the adjudication. Do we need a disposition code?"/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.disposition.value"/>
        <text value="Disposition Message"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.provider"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The provider which is responsible for the claim."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Practitioner"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.provider.value"/>
        <text value="Responsible provider for the claim"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.organization"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The provider which is responsible for the claim."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Organization"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.organization.value"/>
        <text value="Responsible organization for the claim"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.facility"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Facility where the services were provided."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Location"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.facility.value"/>
        <text value="Servicing Facility"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.relatedClaim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Other claims which are related to this claim such as prior claim versions or for related services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Claim"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.relatedClaim.value"/>
        <text value="Related Claims"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.prescription"/>
      <text value="Prescription"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Prescription to support the dispensing of Pharmacy or Vision products."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.prescription._type"/>
        <text value="type"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
        <options>
          <reference value="#vs2"/>
        </options>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Reference"/>
          </extension>
          <linkId value="ExplanationOfBenefit.prescription._MedicationOrder"/>
          <type value="group"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
              <valueCode value="MedicationOrder"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
              <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
            </extension>
            <linkId value="ExplanationOfBenefit.prescription._MedicationOrder.value"/>
            <text value="MedicationOrder"/>
            <type value="reference"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Reference"/>
          </extension>
          <linkId value="ExplanationOfBenefit.prescription._VisionPrescription"/>
          <type value="group"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
              <valueCode value="VisionPrescription"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
              <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
            </extension>
            <linkId value="ExplanationOfBenefit.prescription._VisionPrescription.value"/>
            <text value="VisionPrescription"/>
            <type value="reference"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.originalPrescription"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Original prescription which has been superceded by this prescription to support the dispensing of pharmacy services, medications or products."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="MedicationOrder"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.originalPrescription.value"/>
        <text value="Original Prescription"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.payee"/>
      <text value="Payee"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="false"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The party to be reimbursed for the services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.payee.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.payee.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.type"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Party to be reimbursed: Subscriber, provider, other."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.payee.type.value"/>
          <text value="Party to be paid any benefits payable"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.provider"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The provider who is to be reimbursed for the claim (the party to whom any benefit is assigned)."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Practitioner"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.payee.provider.value"/>
          <text value="Provider who is the payee"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.organization"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The organization who is to be reimbursed for the claim (the party to whom any benefit is assigned)."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Organization"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.payee.organization.value"/>
          <text value="Organization who is the payee"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.payee.person"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The person other than the subscriber who is to be reimbursed for the claim (the party to whom any benefit is assigned)."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Patient"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.payee.person.value"/>
          <text value="Other person who is the payee"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.referral"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The referral resource which lists the date, practitioner, reason and other supporting information."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="ReferralRequest"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.referral.value"/>
        <text value="Treatment Referral"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.diagnosis"/>
      <text value="Diagnosis"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Ordered list of patient diagnosis for which care is sought."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.diagnosis.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.diagnosis.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Sequence of diagnosis which serves to order and provide a link."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.sequence.value"/>
          <text value="Sequence of diagnosis"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.diagnosis.diagnosis"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The diagnosis."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.diagnosis.diagnosis.value"/>
          <text value="Patient&#39;s list of diagnosis"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.specialCondition"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="List of special conditions relating to the setting, treatment or patient  for which care is sought which may influence the adjudication."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.specialCondition.value"/>
        <text value="List of special Conditions"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Reference"/>
      </extension>
      <linkId value="ExplanationOfBenefit.patient"/>
      <type value="group"/>
      <required value="true"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Patient Resource."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
          <valueCode value="Patient"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
          <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
        </extension>
        <linkId value="ExplanationOfBenefit.patient.value"/>
        <text value="The subject of the Products and Services"/>
        <type value="reference"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="integer"/>
      </extension>
      <linkId value="ExplanationOfBenefit.precedence"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Precedence (primary, secondary, etc.)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.precedence.value"/>
        <text value="Precedence (primary, secondary, etc.)"/>
        <type value="integer"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.coverage"/>
      <text value="Insurance or medical plan"/>
      <type value="group"/>
      <required value="true"/>
      <repeats value="false"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Financial instrument by which payment information for health care."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.coverage.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.coverage.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.coverage.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.coverage.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.coverage.coverage"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Reference to the program or plan identification, underwriter or payor."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Coverage"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.coverage.coverage.value"/>
          <text value="Insurance information"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.coverage.relationship"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The relationship of the patient to the subscriber."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.coverage.relationship.value"/>
          <text value="Patient relationship to subscriber"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.coverage.preAuthRef"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A list of references from the Insurer to which these services pertain."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.coverage.preAuthRef.value"/>
          <text value="Pre-Authorization/Determination Reference"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.exception"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Factors which may influence the applicability of coverage."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.exception.value"/>
        <text value="Eligibility exceptions"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="string"/>
      </extension>
      <linkId value="ExplanationOfBenefit.school"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Name of school for over-aged dependants."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.school.value"/>
        <text value="Name of School"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="datetime"/>
      </extension>
      <linkId value="ExplanationOfBenefit.accidentDate"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Date of an accident which these services are addressing."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.accidentDate.value"/>
        <text value="Accident Date"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.accidentType"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Type of accident: work, auto, etc."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.accidentType.value"/>
        <text value="Accident Type"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.accidentLocation[x]"/>
      <text value="Accident Place"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Accident Place."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.accidentLocation[x]._type"/>
        <text value="type"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
        <options>
          <reference value="#vs3"/>
        </options>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.accidentLocation[x]._string"/>
          <type value="group"/>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._string.value"/>
            <text value="string"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Address"/>
          </extension>
          <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address"/>
          <text value="Address"/>
          <type value="group"/>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.text"/>
            <text value="text:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.line"/>
            <text value="line:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="true"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.city"/>
            <text value="city:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.state"/>
            <text value="state:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.postalCode"/>
            <text value="post code:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.country"/>
            <text value="country:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Address.use"/>
            <text value="use:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Reference"/>
          </extension>
          <linkId value="ExplanationOfBenefit.accidentLocation[x]._Location"/>
          <type value="group"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
              <valueCode value="Location"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
              <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
            </extension>
            <linkId value="ExplanationOfBenefit.accidentLocation[x]._Location.value"/>
            <text value="Location"/>
            <type value="reference"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.interventionException"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="A list of intervention and exception codes which may influence the adjudication of the claim."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.interventionException.value"/>
        <text value="Intervention and exception code (Pharma)"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <linkId value="ExplanationOfBenefit.onset[x]"/>
      <text value="Illness, injury or treatable condition date"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The start or start and end dates for the treatable condition."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.onset[x]._type"/>
        <text value="type"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
        <options>
          <reference value="#vs4"/>
        </options>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="datetime"/>
          </extension>
          <linkId value="ExplanationOfBenefit.onset[x]._date"/>
          <type value="group"/>
          <item>
            <linkId value="ExplanationOfBenefit.onset[x]._date.value"/>
            <text value="date"/>
            <type value="dateTime"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Period"/>
          </extension>
          <linkId value="ExplanationOfBenefit.onset[x]._Period"/>
          <text value="Period"/>
          <type value="group"/>
          <item>
            <linkId value="ExplanationOfBenefit.onset[x]._Period.low"/>
            <text value="start:"/>
            <type value="dateTime"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.onset[x]._Period.end"/>
            <text value="end:"/>
            <type value="dateTime"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Period"/>
      </extension>
      <linkId value="ExplanationOfBenefit.employmentImpacted"/>
      <text value="Period unable to work"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The start and optional end dates of when the patient was precluded from working due to the treatable condition(s)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.employmentImpacted.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.employmentImpacted.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Period"/>
      </extension>
      <linkId value="ExplanationOfBenefit.hospitalization"/>
      <text value="Period in hospital"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The start and optional end dates of when the patient was confined to a treatment center."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.hospitalization.low"/>
        <text value="start:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.hospitalization.end"/>
        <text value="end:"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.item"/>
      <text value="Goods and Services"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="First tier of goods and services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.sequence"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A service line number."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.sequence.value"/>
          <text value="Service instance"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.type"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The type of product or service."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.type.value"/>
          <text value="Group or type of product or service"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Reference"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.provider"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The practitioner who is responsible for the services rendered to the patient."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource">
            <valueCode value="Practitioner"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter">
            <valueString value="subject=$subj&amp;patient=$subj&amp;encounter=$encounter"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.provider.value"/>
          <text value="Responsible practitioner"/>
          <type value="reference"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.diagnosisLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Diagnosis applicable for this service or product line."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.diagnosisLinkId.value"/>
          <text value="Diagnosis Link"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.service"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="If a grouping item then &#39;GROUP&#39; otherwise it is a node therefore a code to indicate the Professional Service or Product supplied."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.service.value"/>
          <text value="Item Code"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.serviced[x]"/>
        <text value="Date or dates of Service"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The date or dates when the enclosed suite of services were performed or completed."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.serviced[x]._type"/>
          <text value="type"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
          <options>
            <reference value="#vs5"/>
          </options>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="datetime"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.serviced[x]._date"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.item.serviced[x]._date.value"/>
              <text value="date"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Period"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.serviced[x]._Period"/>
            <text value="Period"/>
            <type value="group"/>
            <item>
              <linkId value="ExplanationOfBenefit.item.serviced[x]._Period.low"/>
              <text value="start:"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.serviced[x]._Period.end"/>
              <text value="end:"/>
              <type value="dateTime"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.place"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Where the service was provided."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.place.value"/>
          <text value="Place of service"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.quantity"/>
        <text value="Count of Products or Services"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The number of repetitions of a service or product."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.quantity.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.unitPrice"/>
        <text value="Fee, charge or cost per point"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.unitPrice.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="decimal"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.factor"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.factor.value"/>
          <text value="Price scaling factor"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="decimal"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.points"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.points.value"/>
          <text value="Difficulty scaling factor"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.net"/>
        <text value="Total item cost"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number  * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.net.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.udi"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="List of Unique Device Identifiers associated with this line item."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.udi.value"/>
          <text value="Unique Device Identifier"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.bodySite"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Physical service site on the patient (limb, tooth, etc)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.bodySite.value"/>
          <text value="Service Location"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.subSite"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A region or surface of the site, eg. limb region or tooth surface(s)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.subSite.value"/>
          <text value="Service Sub-location"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.modifier"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Item typification or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.modifier.value"/>
          <text value="Service/Product billing modifiers"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.noteNumber"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A list of note references to the notes provided below."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.noteNumber.value"/>
          <text value="List of note numbers which apply"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.adjudication"/>
        <text value="Adjudication details"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The adjudications results."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.adjudication.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.adjudication.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.category"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.category.value"/>
            <text value="Adjudication category such as co-pay, eligible, benefit, etc."/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.reason"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Adjudication reason such as limit reached."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.reason.value"/>
            <text value="Adjudication reason"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.amount"/>
          <text value="Monetary amount"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Monitory amount associated with the code."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.amount.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="decimal"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.adjudication.value"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.adjudication.value.value"/>
            <text value="Non-monitory value"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.item.detail"/>
        <text value="Additional items"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Second tier of goods and services."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="integer"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.sequence"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A service line number."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.sequence.value"/>
            <text value="Service instance"/>
            <type value="integer"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.type"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The type of product or service. ItemType."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.type.value"/>
            <text value="Group or type of product or service"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.service"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="If a grouping item then &#39;GROUP&#39; otherwise it is a node therefore a code to indicate the Professional Service or Product supplied."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.service.value"/>
            <text value="Additional item codes"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.quantity"/>
          <text value="Count of Products or Services"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The number of repetitions of a service or product."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.quantity.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.unitPrice"/>
          <text value="Fee, charge or cost per point"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="If the item is a node then this is the fee for the product or service, otherwise this is the total of the fees for the children of the group."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.unitPrice.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="decimal"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.factor"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.factor.value"/>
            <text value="Price scaling factor"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="decimal"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.points"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.points.value"/>
            <text value="Difficulty scaling factor"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.net"/>
          <text value="Total additional item cost"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number  * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.net.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.detail.udi"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="List of Unique Device Identifiers associated with this line item."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.udi.value"/>
            <text value="Unique Device Identifier"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.adjudication"/>
          <text value="Detail adjudication"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The adjudications results."/>
            <type value="display"/>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="string"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.id"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="unique id for the element within a resource (for internal references)."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.id.value"/>
              <text value="xml:id (or equivalent in JSON)"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.extension"/>
            <text value="Additional Content defined by implementations"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
              <type value="display"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.modifierExtension"/>
            <text value="Extensions that cannot be ignored"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
              <type value="display"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Coding"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.code"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.code.value"/>
              <text value="Adjudication category such as co-pay, eligible, benefit, etc."/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Coding"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.reason"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="Adjudication reason such as limit reached."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.reason.value"/>
              <text value="Adjudication reason"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.amount"/>
            <text value="Monetary amount"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="Monitory amount associated with the code."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.amount.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.amount.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.amount.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.amount.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.amount.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="decimal"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.adjudication.value"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.adjudication.value.value"/>
              <text value="Non-monitory value"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.detail.subDetail"/>
          <text value="Additional items"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Third tier of goods and services."/>
            <type value="display"/>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="string"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.id"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="unique id for the element within a resource (for internal references)."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.id.value"/>
              <text value="xml:id (or equivalent in JSON)"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.extension"/>
            <text value="Additional Content defined by implementations"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
              <type value="display"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.modifierExtension"/>
            <text value="Extensions that cannot be ignored"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
              <type value="display"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="integer"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.sequence"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A service line number."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.sequence.value"/>
              <text value="Service instance"/>
              <type value="integer"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Coding"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.type"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The type of product or service."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.type.value"/>
              <text value="Type of product or service"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Coding"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.service"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The fee for an addittional service or product or charge."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.service.value"/>
              <text value="Additional item codes"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity"/>
            <text value="Count of Products or Services"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The number of repetitions of a service or product."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.quantity.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice"/>
            <text value="Fee, charge or cost per point"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The fee for an addittional service or product or charge."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.unitPrice.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="decimal"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.factor"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A real number that represents a multiplier used in determining the overall value of services delivered and/or goods received. The concept of a Factor allows for a discount or surcharge multiplier to be applied to a monetary amount."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.factor.value"/>
              <text value="Price scaling factor"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="decimal"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.points"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="An amount that expresses the weighting (based on difficulty, cost and/or resource intensiveness) associated with the good or service delivered. The concept of Points allows for assignment of point values for services and/or goods, such that a monetary amount can be assigned to each point."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.points.value"/>
              <text value="Difficulty scaling factor"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.net"/>
            <text value="Net additional item cost"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The quantity times the unit price for an addittional service or product or charge. For example, the formula: unit Quantity * unit Price (Cost per Point) * factor Number  * points = net Amount. Quantity, factor and points are assumed to be 1 if not supplied."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.net.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Coding"/>
            </extension>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.udi"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="List of Unique Device Identifiers associated with this line item."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.udi.value"/>
              <text value="Unique Device Identifier"/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication"/>
            <text value="SubDetail adjudication"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="The adjudications results."/>
              <type value="display"/>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
                <valueInteger value="1"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="string"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.id"/>
              <type value="group"/>
              <required value="false"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="unique id for the element within a resource (for internal references)."/>
                <type value="display"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.id.value"/>
                <text value="xml:id (or equivalent in JSON)"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.extension"/>
              <text value="Additional Content defined by implementations"/>
              <type value="group"/>
              <required value="false"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
                <type value="display"/>
              </item>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.modifierExtension"/>
              <text value="Extensions that cannot be ignored"/>
              <type value="group"/>
              <required value="false"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
                <type value="display"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
                <valueInteger value="1"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
                <valueInteger value="1"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Coding"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.code"/>
              <type value="group"/>
              <required value="true"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."/>
                <type value="display"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.code.value"/>
                <text value="Adjudication category such as co-pay, eligible, benefit, etc."/>
                <type value="open-choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
                <valueInteger value="1"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Coding"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.reason"/>
              <type value="group"/>
              <required value="false"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="Adjudication reason such as limit reached."/>
                <type value="display"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.reason.value"/>
                <text value="Adjudication reason"/>
                <type value="open-choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
                <valueInteger value="1"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Quantity"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.amount"/>
              <text value="Monetary amount"/>
              <type value="group"/>
              <required value="false"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="Monitory amount associated with the code."/>
                <type value="display"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.amount.comparator"/>
                <text value="comp:"/>
                <type value="choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.amount.value"/>
                <text value="value:"/>
                <type value="decimal"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.amount.units"/>
                <text value="units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.amount.code"/>
                <text value="coded units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.amount.system"/>
                <text value="units system:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
                <valueInteger value="1"/>
              </extension>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="decimal"/>
              </extension>
              <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.value"/>
              <type value="group"/>
              <required value="false"/>
              <repeats value="true"/>
              <item>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                  <valueCodeableConcept>
                    <coding>
                      <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                      <code value="flyover"/>
                      <display value="Fly-over"/>
                    </coding>
                  </valueCodeableConcept>
                </extension>
                <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/>
                <type value="display"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.item.detail.subDetail.adjudication.value.value"/>
                <text value="Non-monitory value"/>
                <type value="decimal"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
          </item>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <linkId value="ExplanationOfBenefit.item.prosthesis"/>
        <text value="Prosthetic details"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="false"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The materials and placement date of prior fixed prosthesis."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.prosthesis.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.prosthesis.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.prosthesis.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.item.prosthesis.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="boolean"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.prosthesis.initial"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Indicates whether this is the initial placement of a fixed prosthesis."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.prosthesis.initial.value"/>
            <text value="Is this the initial service"/>
            <type value="boolean"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="datetime"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.prosthesis.priorDate"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Date of the initial placement."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.prosthesis.priorDate.value"/>
            <text value="Initial service Date"/>
            <type value="dateTime"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.item.prosthesis.priorMaterial"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Material of the prior denture or bridge prosthesis. (Oral)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.item.prosthesis.priorMaterial.value"/>
            <text value="Prosthetic Material"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.addItem"/>
      <text value="Insurer added line items"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The first tier service adjudications for payor added services."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.sequenceLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="List of input service items which this service line is intended to replace."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.sequenceLinkId.value"/>
          <text value="Service instances"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.service"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A code to indicate the Professional Service or Product supplied."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.service.value"/>
          <text value="Group, Service or Product"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Quantity"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.fee"/>
        <text value="Professional fee or Product charge"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The fee charged for the professional service or product.."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.comparator"/>
          <text value="comp:"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.value"/>
          <text value="value:"/>
          <type value="decimal"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.units"/>
          <text value="units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.code"/>
          <text value="coded units:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.fee.system"/>
          <text value="units system:"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.addItem.noteNumberLinkId"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="A list of note references to the notes provided below."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.noteNumberLinkId.value"/>
          <text value="List of note numbers which apply"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.adjudication"/>
        <text value="Added items adjudication"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The adjudications results."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.adjudication.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.adjudication.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.adjudication.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.adjudication.code"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.code.value"/>
            <text value="Adjudication category such as co-pay, eligible, benefit, etc."/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.adjudication.amount"/>
          <text value="Monetary amount"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Monitory amount associated with the code."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.amount.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.amount.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.amount.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.amount.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.amount.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="decimal"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.adjudication.value"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.adjudication.value.value"/>
            <text value="Non-monitory value"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.addItem.detail"/>
        <text value="Added items details"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The second tier service adjudications for payor added services."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.detail.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.detail.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.service"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="A code to indicate the Professional Service or Product supplied."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.service.value"/>
            <text value="Service or Product"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Quantity"/>
          </extension>
          <linkId value="ExplanationOfBenefit.addItem.detail.fee"/>
          <text value="Professional fee or Product charge"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The fee charged for the professional service or product.."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.comparator"/>
            <text value="comp:"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.value"/>
            <text value="value:"/>
            <type value="decimal"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.units"/>
            <text value="units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.code"/>
            <text value="coded units:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.fee.system"/>
            <text value="units system:"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.addItem.detail.adjudication"/>
          <text value="Added items detail adjudication"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="The adjudications results."/>
            <type value="display"/>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="string"/>
            </extension>
            <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.id"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="unique id for the element within a resource (for internal references)."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.id.value"/>
              <text value="xml:id (or equivalent in JSON)"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.extension"/>
            <text value="Additional Content defined by implementations"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
              <type value="display"/>
            </item>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.modifierExtension"/>
            <text value="Extensions that cannot be ignored"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
              <type value="display"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Coding"/>
            </extension>
            <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.code"/>
            <type value="group"/>
            <required value="true"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="Code indicating: Co-Pay, deductable, elegible, benefit, tax, etc."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.code.value"/>
              <text value="Adjudication category such as co-pay, eligible, benefit, etc."/>
              <type value="open-choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="Quantity"/>
            </extension>
            <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.amount"/>
            <text value="Monetary amount"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="Monitory amount associated with the code."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.amount.comparator"/>
              <text value="comp:"/>
              <type value="choice"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.amount.value"/>
              <text value="value:"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.amount.units"/>
              <text value="units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.amount.code"/>
              <text value="coded units:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.amount.system"/>
              <text value="units system:"/>
              <type value="string"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
              <valueInteger value="1"/>
            </extension>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
              <valueString value="decimal"/>
            </extension>
            <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.value"/>
            <type value="group"/>
            <required value="false"/>
            <repeats value="true"/>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="flyover"/>
                    <display value="Fly-over"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <text value="A non-monetary value for example a percentage. Mutually exclusive to the amount element above."/>
              <type value="display"/>
            </item>
            <item>
              <linkId value="ExplanationOfBenefit.addItem.detail.adjudication.value.value"/>
              <text value="Non-monitory value"/>
              <type value="decimal"/>
              <required value="false"/>
              <repeats value="false"/>
            </item>
          </item>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.claimTotal"/>
      <text value="Total claim cost"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The total value of the claim."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.claimTotal.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.claimTotal.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.claimTotal.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.claimTotal.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.claimTotal.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.missingTeeth"/>
      <text value="Only if type = oral"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="A list of teeth which would be expected but are not found due to having been previously  extracted or for other reasons."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.missingTeeth.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.missingTeeth.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.missingTeeth.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.missingTeeth.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.missingTeeth.tooth"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The code identifying which tooth is missing."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.missingTeeth.tooth.value"/>
          <text value="Tooth Code"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.missingTeeth.reason"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Missing reason may be: E-extraction, O-other."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.missingTeeth.reason.value"/>
          <text value="Reason for missing"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="datetime"/>
        </extension>
        <linkId value="ExplanationOfBenefit.missingTeeth.extractionDate"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The date of the extraction either known from records or patient reported estimate."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.missingTeeth.extractionDate.value"/>
          <text value="Date of Extraction"/>
          <type value="dateTime"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.unallocDeductable"/>
      <text value="Unallocated deductable"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The amount of deductable applied which was not allocated to any particular service line."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.unallocDeductable.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.totalBenefit"/>
      <text value="Total benefit payable for the Claim"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Total amount of benefit payable (Equal to sum of the Benefit amounts from all detail lines and additions less the Unallocated Deductable)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.totalBenefit.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.paymentAdjustment"/>
      <text value="Payment adjustment for non-Claim issues"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Adjustment to the payment of this transaction which is not related to adjudication of this transaction."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAdjustment.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAdjustment.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAdjustment.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAdjustment.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAdjustment.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.paymentAdjustmentReason"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Reason for the payment adjustment."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAdjustmentReason.value"/>
        <text value="Reason for Payment adjustment"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="datetime"/>
      </extension>
      <linkId value="ExplanationOfBenefit.paymentDate"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Estimated payment data."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentDate.value"/>
        <text value="Expected data of Payment"/>
        <type value="dateTime"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Quantity"/>
      </extension>
      <linkId value="ExplanationOfBenefit.paymentAmount"/>
      <text value="Payment amount"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Payable less any payment adjustment."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAmount.comparator"/>
        <text value="comp:"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAmount.value"/>
        <text value="value:"/>
        <type value="decimal"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAmount.units"/>
        <text value="units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAmount.code"/>
        <text value="coded units:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentAmount.system"/>
        <text value="units system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Identifier"/>
      </extension>
      <linkId value="ExplanationOfBenefit.paymentRef"/>
      <text value="Payment identifier"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Payment identifer."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentRef.label"/>
        <text value="label:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentRef.system"/>
        <text value="system:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.paymentRef.value"/>
        <text value="value:"/>
        <type value="string"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.reserved"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Status of funds reservation (For provider, for Patient, None)."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.reserved.value"/>
        <text value="Funds reserved status"/>
        <type value="open-choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="1"/>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
        <valueString value="Coding"/>
      </extension>
      <linkId value="ExplanationOfBenefit.form"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="The form to be used for printing the content."/>
        <type value="display"/>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.form.value"/>
        <text value="Printed Form Identifier"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="false"/>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.note"/>
      <text value="Processing notes"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Note text."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.note.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.note.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.note.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.note.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="integer"/>
        </extension>
        <linkId value="ExplanationOfBenefit.note.number"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="An integer associated with each note which may be referred to from each service line item."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.note.number.value"/>
          <text value="Note Number for this note"/>
          <type value="integer"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.note.type"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The note purpose: Print/Display."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.note.type.value"/>
          <text value="display | print | printoper"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.note.text"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The note text."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.note.text.value"/>
          <text value="Note explanitory text"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="ExplanationOfBenefit.benefitBalance"/>
      <text value="Balance by Benefit Category"/>
      <type value="group"/>
      <required value="false"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="flyover"/>
              <display value="Fly-over"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <text value="Balance by Benefit Category."/>
        <type value="display"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="string"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.id"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="unique id for the element within a resource (for internal references)."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.id.value"/>
          <text value="xml:id (or equivalent in JSON)"/>
          <type value="string"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.benefitBalance.extension"/>
        <text value="Additional Content defined by implementations"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.benefitBalance.modifierExtension"/>
        <text value="Extensions that cannot be ignored"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
          <type value="display"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.category"/>
        <type value="group"/>
        <required value="true"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Dental, Vision, Medical, Pharmacy, Rehab etc."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.category.value"/>
          <text value="Benefit Category"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.subCategory"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Dental: basic, major, ortho; Vision exam, glasses, contacts; etc."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.subCategory.value"/>
          <text value="Benefit SubCategory"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.network"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Network designation."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.network.value"/>
          <text value="In or out of network"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.unit"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Unit designation: individual or family."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.unit.value"/>
          <text value="Individual or family"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
          <valueInteger value="1"/>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
          <valueString value="Coding"/>
        </extension>
        <linkId value="ExplanationOfBenefit.benefitBalance.term"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="The term or period of the values such as &#39;maximum lifetime benefit&#39; or &#39;maximum annual vistis&#39;."/>
          <type value="display"/>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.term.value"/>
          <text value="Annual or lifetime"/>
          <type value="open-choice"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
      <item>
        <linkId value="ExplanationOfBenefit.benefitBalance.financial"/>
        <text value="Benefit Summary"/>
        <type value="group"/>
        <required value="false"/>
        <repeats value="true"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="flyover"/>
                <display value="Fly-over"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <text value="Benefits Used to date."/>
          <type value="display"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="string"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.id"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="unique id for the element within a resource (for internal references)."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.id.value"/>
            <text value="xml:id (or equivalent in JSON)"/>
            <type value="string"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.extension"/>
          <text value="Additional Content defined by implementations"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.modifierExtension"/>
          <text value="Extensions that cannot be ignored"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="May be used to represent additional information that is not part of the basic definition of the element, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions.  The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone."/>
            <type value="display"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
            <valueString value="Coding"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.type"/>
          <type value="group"/>
          <required value="true"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Deductable, visits, benefit amount."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.type.value"/>
            <text value="Deductable, visits, benefit amount"/>
            <type value="open-choice"/>
            <required value="false"/>
            <repeats value="false"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]"/>
          <text value="Benefits allowed"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Benefits allowed."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._type"/>
            <text value="type"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
            <options>
              <reference value="#vs6"/>
            </options>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="integer"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._unsignedInt"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._unsignedInt.value"/>
                <text value="unsignedInt"/>
                <type value="integer"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Quantity"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._http://hl7.org/fhir/StructureDefinition/Money"/>
              <text value="http://hl7.org/fhir/StructureDefinition/Money"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._http://hl7.org/fhir/StructureDefinition/Money.comparator"/>
                <text value="comp:"/>
                <type value="choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._http://hl7.org/fhir/StructureDefinition/Money.value"/>
                <text value="value:"/>
                <type value="decimal"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._http://hl7.org/fhir/StructureDefinition/Money.units"/>
                <text value="units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._http://hl7.org/fhir/StructureDefinition/Money.code"/>
                <text value="coded units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefit[x]._http://hl7.org/fhir/StructureDefinition/Money.system"/>
                <text value="units system:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
            <valueInteger value="1"/>
          </extension>
          <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]"/>
          <text value="Benefits used"/>
          <type value="group"/>
          <required value="false"/>
          <repeats value="true"/>
          <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="flyover"/>
                  <display value="Fly-over"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <text value="Benefits used."/>
            <type value="display"/>
          </item>
          <item>
            <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._type"/>
            <text value="type"/>
            <type value="choice"/>
            <required value="false"/>
            <repeats value="false"/>
            <options>
              <reference value="#vs7"/>
            </options>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="integer"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._unsignedInt"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._unsignedInt.value"/>
                <text value="unsignedInt"/>
                <type value="integer"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
            <item>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType">
                <valueString value="Quantity"/>
              </extension>
              <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._http://hl7.org/fhir/StructureDefinition/Money"/>
              <text value="http://hl7.org/fhir/StructureDefinition/Money"/>
              <type value="group"/>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._http://hl7.org/fhir/StructureDefinition/Money.comparator"/>
                <text value="comp:"/>
                <type value="choice"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._http://hl7.org/fhir/StructureDefinition/Money.value"/>
                <text value="value:"/>
                <type value="decimal"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._http://hl7.org/fhir/StructureDefinition/Money.units"/>
                <text value="units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._http://hl7.org/fhir/StructureDefinition/Money.code"/>
                <text value="coded units:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
              <item>
                <linkId value="ExplanationOfBenefit.benefitBalance.financial.benefitUsed[x]._http://hl7.org/fhir/StructureDefinition/Money.system"/>
                <text value="units system:"/>
                <type value="string"/>
                <required value="false"/>
                <repeats value="false"/>
              </item>
            </item>
          </item>
        </item>
      </item>
    </item>
  </item>
</Questionnaire>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.