R4 Draft for Comment

This page is part of the FHIR Specification (v3.2.0: R4 Ballot 1). The current version which supercedes this version is 4.0.1. For a full list of available versions, see the Directory of published versions

Devicerequest-questionnaire.json

Orders and Observations Work GroupMaturity Level: N/ABallot Status: InformativeCompartments: Device, Encounter, Patient, Practitioner

Raw JSON (canonical form)

Generated Questionnaire for DeviceRequest

{
  "resourceType": "Questionnaire",
  "id": "qs1",
  "contained": [
    {
      "resourceType": "ValueSet",
      "id": "vs2",
      "name": "Type options for DeviceRequest.code[x]",
      "status": "active",
      "description": "Type options for DeviceRequest.code[x]",
      "expansion": {
        "identifier": "urn:uuid:2b54b65f-03cd-44b0-b11d-6399b33f39ee",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Device",
            "display": "Device"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "CodeableConcept",
            "display": "CodeableConcept"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs3",
      "name": "Type options for DeviceRequest.parameter.value[x]",
      "status": "active",
      "description": "Type options for DeviceRequest.parameter.value[x]",
      "expansion": {
        "identifier": "urn:uuid:d5d56aa0-d731-49f9-993f-20e4c4be98b8",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "CodeableConcept",
            "display": "CodeableConcept"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Quantity",
            "display": "Quantity"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Range",
            "display": "Range"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "boolean",
            "display": "boolean"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs4",
      "name": "Type options for DeviceRequest.subject",
      "status": "active",
      "description": "Type options for DeviceRequest.subject",
      "expansion": {
        "identifier": "urn:uuid:a505ca58-6838-461b-88b0-f8cf5695a704",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Patient",
            "display": "Patient"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Group",
            "display": "Group"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Location",
            "display": "Location"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Device",
            "display": "Device"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs5",
      "name": "Type options for DeviceRequest.context",
      "status": "active",
      "description": "Type options for DeviceRequest.context",
      "expansion": {
        "identifier": "urn:uuid:a90a6713-a0b6-4542-acc2-2bdcf1fd8315",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Encounter",
            "display": "Encounter"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "EpisodeOfCare",
            "display": "EpisodeOfCare"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs6",
      "name": "Type options for DeviceRequest.occurrence[x]",
      "status": "active",
      "description": "Type options for DeviceRequest.occurrence[x]",
      "expansion": {
        "identifier": "urn:uuid:f2ac49e2-587e-4201-a43b-169089a13a84",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "dateTime",
            "display": "dateTime"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Period",
            "display": "Period"
          },
          {
            "system": "http://hl7.org/fhir/data-types",
            "code": "Timing",
            "display": "Timing"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs7",
      "name": "Type options for DeviceRequest.requester",
      "status": "active",
      "description": "Type options for DeviceRequest.requester",
      "expansion": {
        "identifier": "urn:uuid:82345e76-7db8-4a3d-9af0-37fbd4eb0872",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Device",
            "display": "Device"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Practitioner",
            "display": "Practitioner"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "PractitionerRole",
            "display": "PractitionerRole"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Organization",
            "display": "Organization"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs8",
      "name": "Type options for DeviceRequest.performer",
      "status": "active",
      "description": "Type options for DeviceRequest.performer",
      "expansion": {
        "identifier": "urn:uuid:76857aec-8d88-4b6b-844b-eb0cbf62adc5",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Practitioner",
            "display": "Practitioner"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "PractitionerRole",
            "display": "PractitionerRole"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Organization",
            "display": "Organization"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "CareTeam",
            "display": "CareTeam"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "HealthcareService",
            "display": "HealthcareService"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Patient",
            "display": "Patient"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Device",
            "display": "Device"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "RelatedPerson",
            "display": "RelatedPerson"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs9",
      "name": "Type options for DeviceRequest.reasonReference",
      "status": "active",
      "description": "Type options for DeviceRequest.reasonReference",
      "expansion": {
        "identifier": "urn:uuid:733ddb84-9159-437a-893b-05a2b608bf27",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Condition",
            "display": "Condition"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Observation",
            "display": "Observation"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "DiagnosticReport",
            "display": "DiagnosticReport"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "DocumentReference",
            "display": "DocumentReference"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "vs10",
      "name": "Type options for DeviceRequest.insurance",
      "status": "active",
      "description": "Type options for DeviceRequest.insurance",
      "expansion": {
        "identifier": "urn:uuid:9a85e84c-0448-4bc0-915d-d6fdc64d60c6",
        "timestamp": "2017-12-20T15:56:59+11:00",
        "contains": [
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "Coverage",
            "display": "Coverage"
          },
          {
            "system": "http://hl7.org/fhir/resource-types",
            "code": "ClaimResponse",
            "display": "ClaimResponse"
          }
        ]
      }
    }
  ],
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986"
    }
  ],
  "status": "draft",
  "date": "2017-12-20T15:52:34+11:00",
  "publisher": "Health Level Seven International (Orders and Observations)",
  "item": [
    {
      "linkId": "DeviceRequest",
      "text": "Medical device request",
      "type": "group",
      "required": false,
      "repeats": true,
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "flyover",
                    "display": "Fly-over"
                  }
                ]
              }
            }
          ],
          "text": "Represents a request for a patient to employ a medical device. The device may be an implantable device, or an external assistive device, such as a walker.",
          "type": "display"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "string"
            }
          ],
          "linkId": "DeviceRequest.id",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "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.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.id.value",
              "text": "Logical id of this artifact",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.meta",
          "text": "Metadata about the resource",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.",
              "type": "display"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "uri"
            }
          ],
          "linkId": "DeviceRequest.implicitRules",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.implicitRules.value",
              "text": "A set of rules under which this content was created",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "code"
            }
          ],
          "linkId": "DeviceRequest.language",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "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": "display"
            },
            {
              "linkId": "DeviceRequest.language.value",
              "text": "language",
              "type": "choice",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.text",
          "text": "Text summary of the resource, for human interpretation",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "A human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it \"clinically safe\" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded in formation is added later.",
              "type": "display"
            }
          ]
        },
        {
          "linkId": "DeviceRequest.contained",
          "text": "Contained, inline Resources",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "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": "display"
            }
          ]
        },
        {
          "linkId": "DeviceRequest.extension",
          "text": "Additional Content defined by implementations",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "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": "display"
            }
          ]
        },
        {
          "linkId": "DeviceRequest.modifierExtension",
          "text": "Extensions that cannot be ignored",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "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": "display"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Identifier"
            }
          ],
          "linkId": "DeviceRequest.identifier",
          "text": "External Request identifier",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Identifiers assigned to this order by the orderer or by the receiver.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.identifier.label",
              "text": "label:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.identifier.system",
              "text": "system:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.identifier.value",
              "text": "value:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "uri"
            }
          ],
          "linkId": "DeviceRequest.instantiates",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Protocol or definition followed by this request. For example: The proposed act must be performed if the indicated conditions occur, e.g.., shortness of breath, SpO2 less than x%.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.instantiates.value",
              "text": "Protocol or definition",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "DeviceRequest.basedOn",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Plan/proposal/order fulfilled by this request.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Resource"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "DeviceRequest.basedOn.value",
              "text": "What request fulfills",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "DeviceRequest.priorRequest",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The request takes the place of the referenced completed or terminated request(s).",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Resource"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "DeviceRequest.priorRequest.value",
              "text": "What request replaces",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Identifier"
            }
          ],
          "linkId": "DeviceRequest.groupIdentifier",
          "text": "Identifier of composite request",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Composite request this is part of.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.groupIdentifier.label",
              "text": "label:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.groupIdentifier.system",
              "text": "system:",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.groupIdentifier.value",
              "text": "value:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "code"
            }
          ],
          "linkId": "DeviceRequest.status",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The status of the request. This element is labeled as a modifier because the status contains the codes cancelled and entered-in-error that mark the request as not currently valid.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.status.value",
              "text": "status",
              "type": "choice",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "CodeableConcept"
            }
          ],
          "linkId": "DeviceRequest.intent",
          "text": "proposal | plan | original-order | encoded | reflex-order",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Whether the request is a proposal, plan, an original order or a reflex order.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.intent.coding",
              "text": "code:",
              "type": "choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.intent.text",
              "text": "text:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "code"
            }
          ],
          "linkId": "DeviceRequest.priority",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Indicates how quickly the {{title}} should be addressed with respect to other requests.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.priority.value",
              "text": "priority",
              "type": "choice",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.code[x]",
          "text": "Device requested",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The details of the device to be used.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.code[x]._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs2"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.code[x]._Device",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Device"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.code[x]._Device.value",
                      "text": "Device",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "CodeableConcept"
                    }
                  ],
                  "linkId": "DeviceRequest.code[x]._CodeableConcept",
                  "text": "CodeableConcept",
                  "type": "group",
                  "item": [
                    {
                      "linkId": "DeviceRequest.code[x]._CodeableConcept.coding",
                      "text": "code:",
                      "type": "open-choice",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "DeviceRequest.code[x]._CodeableConcept.text",
                      "text": "text:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "linkId": "DeviceRequest.parameter",
          "text": "Device details",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Specific parameters for the ordered item.  For example, the prism value for lenses.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "string"
                }
              ],
              "linkId": "DeviceRequest.parameter.id",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
                  "type": "display"
                },
                {
                  "linkId": "DeviceRequest.parameter.id.value",
                  "text": "xml:id (or equivalent in JSON)",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "DeviceRequest.parameter.extension",
              "text": "Additional Content defined by implementations",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "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": "display"
                }
              ]
            },
            {
              "linkId": "DeviceRequest.parameter.modifierExtension",
              "text": "Extensions that cannot be ignored",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "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": "display"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                  "valueString": "CodeableConcept"
                }
              ],
              "linkId": "DeviceRequest.parameter.code",
              "text": "Device detail",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "A code or string that identifies the device detail being asserted.",
                  "type": "display"
                },
                {
                  "linkId": "DeviceRequest.parameter.code.coding",
                  "text": "code:",
                  "type": "open-choice",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "DeviceRequest.parameter.code.text",
                  "text": "text:",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
                  "valueInteger": 1
                }
              ],
              "linkId": "DeviceRequest.parameter.value[x]",
              "text": "Value of detail",
              "type": "group",
              "required": false,
              "repeats": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "flyover",
                            "display": "Fly-over"
                          }
                        ]
                      }
                    }
                  ],
                  "text": "The value of the device detail. Range means device should have a value that falls somewhere within the specified range.",
                  "type": "display"
                },
                {
                  "linkId": "DeviceRequest.parameter.value[x]._type",
                  "text": "type",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "options": {
                    "reference": "#vs3"
                  },
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "CodeableConcept"
                        }
                      ],
                      "linkId": "DeviceRequest.parameter.value[x]._CodeableConcept",
                      "text": "CodeableConcept",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._CodeableConcept.coding",
                          "text": "code:",
                          "type": "open-choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._CodeableConcept.text",
                          "text": "text:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Quantity"
                        }
                      ],
                      "linkId": "DeviceRequest.parameter.value[x]._Quantity",
                      "text": "Quantity",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Quantity.comparator",
                          "text": "comp:",
                          "type": "choice",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Quantity.value",
                          "text": "value:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Quantity.units",
                          "text": "units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Quantity.code",
                          "text": "coded units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Quantity.system",
                          "text": "units system:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "Range"
                        }
                      ],
                      "linkId": "DeviceRequest.parameter.value[x]._Range",
                      "text": "Range",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Range.low",
                          "text": "low:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Range.high",
                          "text": "high:",
                          "type": "decimal",
                          "required": false,
                          "repeats": false
                        },
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._Range.units",
                          "text": "units:",
                          "type": "string",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                          "valueString": "boolean"
                        }
                      ],
                      "linkId": "DeviceRequest.parameter.value[x]._boolean",
                      "type": "group",
                      "item": [
                        {
                          "linkId": "DeviceRequest.parameter.value[x]._boolean.value",
                          "text": "boolean",
                          "type": "boolean",
                          "required": false,
                          "repeats": false
                        }
                      ]
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.subject",
          "text": "Focus of request",
          "type": "group",
          "required": true,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The patient who will use the device.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.subject._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs4"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.subject._Patient",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Patient"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.subject._Patient.value",
                      "text": "Patient",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.subject._Group",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Group"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.subject._Group.value",
                      "text": "Group",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.subject._Location",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Location"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.subject._Location.value",
                      "text": "Location",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.subject._Device",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Device"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.subject._Device.value",
                      "text": "Device",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.context",
          "text": "Encounter or Episode motivating request",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "An encounter that provides additional context in which this request is made.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.context._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs5"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.context._Encounter",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Encounter"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.context._Encounter.value",
                      "text": "Encounter",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.context._EpisodeOfCare",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "EpisodeOfCare"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.context._EpisodeOfCare.value",
                      "text": "EpisodeOfCare",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.occurrence[x]",
          "text": "Desired time or schedule for use",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The timing schedule for the use of the device. The Schedule data type allows many different expressions, for example. \"Every 8 hours\"; \"Three times a day\"; \"1/2 an hour before breakfast for 10 days from 23-Dec 2011:\"; \"15 Oct 2013, 17 Oct 2013 and 1 Nov 2013\".",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.occurrence[x]._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs6"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "datetime"
                    }
                  ],
                  "linkId": "DeviceRequest.occurrence[x]._dateTime",
                  "type": "group",
                  "item": [
                    {
                      "linkId": "DeviceRequest.occurrence[x]._dateTime.value",
                      "text": "dateTime",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Period"
                    }
                  ],
                  "linkId": "DeviceRequest.occurrence[x]._Period",
                  "text": "Period",
                  "type": "group",
                  "item": [
                    {
                      "linkId": "DeviceRequest.occurrence[x]._Period.low",
                      "text": "start:",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "DeviceRequest.occurrence[x]._Period.end",
                      "text": "end:",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Schedule"
                    }
                  ],
                  "linkId": "DeviceRequest.occurrence[x]._Timing",
                  "text": "Timing",
                  "type": "group",
                  "item": [
                    {
                      "linkId": "DeviceRequest.occurrence[x]._Timing.text",
                      "text": "text:",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "DeviceRequest.occurrence[x]._Timing.date",
                      "text": "date:",
                      "type": "dateTime",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Patient"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Practitioner"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "RelatedPerson"
                        }
                      ],
                      "linkId": "DeviceRequest.occurrence[x]._Timing.author",
                      "text": "author:",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "datetime"
            }
          ],
          "linkId": "DeviceRequest.authoredOn",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "When the request transitioned to being actionable.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.authoredOn.value",
              "text": "When recorded",
              "type": "dateTime",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.requester",
          "text": "Who/what is requesting diagnostics",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The individual who initiated the request and has responsibility for its activation.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.requester._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs7"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.requester._Device",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Device"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.requester._Device.value",
                      "text": "Device",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.requester._Practitioner",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Practitioner"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.requester._Practitioner.value",
                      "text": "Practitioner",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.requester._PractitionerRole",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "PractitionerRole"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.requester._PractitionerRole.value",
                      "text": "PractitionerRole",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.requester._Organization",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Organization"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.requester._Organization.value",
                      "text": "Organization",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "CodeableConcept"
            }
          ],
          "linkId": "DeviceRequest.performerType",
          "text": "Fille role",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Desired type of performer for doing the diagnostic testing.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.performerType.coding",
              "text": "code:",
              "type": "open-choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.performerType.text",
              "text": "text:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
              "valueInteger": 1
            }
          ],
          "linkId": "DeviceRequest.performer",
          "text": "Requested Filler",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "The desired perfomer for doing the diagnostic testing.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.performer._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs8"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._Practitioner",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Practitioner"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._Practitioner.value",
                      "text": "Practitioner",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._PractitionerRole",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "PractitionerRole"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._PractitionerRole.value",
                      "text": "PractitionerRole",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._Organization",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Organization"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._Organization.value",
                      "text": "Organization",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._CareTeam",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "CareTeam"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._CareTeam.value",
                      "text": "CareTeam",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._HealthcareService",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "HealthcareService"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._HealthcareService.value",
                      "text": "HealthcareService",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._Patient",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Patient"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._Patient.value",
                      "text": "Patient",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._Device",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Device"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._Device.value",
                      "text": "Device",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.performer._RelatedPerson",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "RelatedPerson"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.performer._RelatedPerson.value",
                      "text": "RelatedPerson",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "CodeableConcept"
            }
          ],
          "linkId": "DeviceRequest.reasonCode",
          "text": "Coded Reason for request",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Reason or justification for the use of this device.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.reasonCode.coding",
              "text": "code:",
              "type": "open-choice",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "DeviceRequest.reasonCode.text",
              "text": "text:",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "DeviceRequest.reasonReference",
          "text": "Linked Reason for request",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Reason or justification for the use of this device.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.reasonReference._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs9"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.reasonReference._Condition",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Condition"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.reasonReference._Condition.value",
                      "text": "Condition",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.reasonReference._Observation",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Observation"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.reasonReference._Observation.value",
                      "text": "Observation",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.reasonReference._DiagnosticReport",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "DiagnosticReport"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.reasonReference._DiagnosticReport.value",
                      "text": "DiagnosticReport",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.reasonReference._DocumentReference",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "DocumentReference"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.reasonReference._DocumentReference.value",
                      "text": "DocumentReference",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "linkId": "DeviceRequest.insurance",
          "text": "Associated insurance coverage",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Insurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be required for delivering the requested service.",
              "type": "display"
            },
            {
              "linkId": "DeviceRequest.insurance._type",
              "text": "type",
              "type": "choice",
              "required": false,
              "repeats": false,
              "options": {
                "reference": "#vs10"
              },
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.insurance._Coverage",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "Coverage"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.insurance._Coverage.value",
                      "text": "Coverage",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
                      "valueString": "Reference"
                    }
                  ],
                  "linkId": "DeviceRequest.insurance._ClaimResponse",
                  "type": "group",
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                          "valueCode": "ClaimResponse"
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                          "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                        }
                      ],
                      "linkId": "DeviceRequest.insurance._ClaimResponse.value",
                      "text": "ClaimResponse",
                      "type": "reference",
                      "required": false,
                      "repeats": false
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "DeviceRequest.supportingInfo",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Additional clinical information about the patient that may influence the request fulfilment.  For example, this may includes body where on the subject's the device will be used ( i.e. the target site).",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Resource"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "DeviceRequest.supportingInfo.value",
              "text": "Additional clinical information",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Annotation"
            }
          ],
          "linkId": "DeviceRequest.note",
          "text": "Notes or comments",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Details about this request that were not represented at all or sufficiently in one of the attributes provided in a class. These may include for example a comment, an instruction, or a note associated with the statement.",
              "type": "display"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-fhirType",
              "valueString": "Reference"
            }
          ],
          "linkId": "DeviceRequest.relevantHistory",
          "type": "group",
          "required": false,
          "repeats": true,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "flyover",
                        "display": "Fly-over"
                      }
                    ]
                  }
                }
              ],
              "text": "Key events in the history of the request. This might not include provenances for all versions of the request – only those deemed “relevant” or important.\rThis SHALL NOT include the Provenance associated with this current version of the resource.  (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update.  Until then, it can be queried directly as the Provenance that points to this version using _revinclude\rAll Provenances should have some historical version of this Request as their subject.",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-allowedResource",
                  "valueCode": "Provenance"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceFilter",
                  "valueString": "subject=$subj&patient=$subj&encounter=$encounter"
                }
              ],
              "linkId": "DeviceRequest.relevantHistory.value",
              "text": "Request provenance",
              "type": "reference",
              "required": false,
              "repeats": false
            }
          ]
        }
      ]
    }
  ]
}

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.