Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1

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## : $questionnaire-package Input Parameters Example - JSON Representation

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    {
      "resourceType" : "Parameters",
      "id" : "QuestionnairePackageInputParamsExample",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-input-parameters"
        ]
      },
      "parameter" : [
        {
          "name" : "coverage",
          "resource" : {
            "resourceType" : "Coverage",
            "id" : "CoverageExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage"
              ]
            },
            "contained" : [
              {
                "resourceType" : "Organization",
                "id" : "OrgExample",
                "meta" : {
                  "profile" : [
                    🔗 "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization"
                  ]
                },
                "identifier" : [
                  {
                    "system" : "urn:oid:2.16.840.1.113883.4.7",
                    "value" : "10D0202020"
                  }
                ],
                "active" : true,
                "type" : [
                  {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/organization-type",
                        "code" : "pay",
                        "display" : "Payer"
                      }
                    ]
                  }
                ],
                "name" : "Insurance Company",
                "telecom" : [
                  {
                    "system" : "phone",
                    "value" : "860-547-5001",
                    "use" : "work"
                  }
                ],
                "address" : [
                  {
                    "line" : [
                      "680 Asylum Street"
                    ],
                    "city" : "Hartford",
                    "state" : "CT",
                    "postalCode" : "06155",
                    "country" : "US"
                  }
                ]
              }
            ],
            "status" : "active",
            "subscriber" : {
              🔗 "reference" : "Patient/examplepatient"
            },
            "subscriberId" : "PFP123450000",
            "beneficiary" : {
              🔗 "reference" : "Patient/examplepatient"
            },
            "relationship" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                  "code" : "self",
                  "display" : "Self"
                }
              ]
            },
            "period" : {
              "start" : "2022-01-01",
              "end" : "2023-01-01"
            },
            "payor" : [
              {
                "reference" : "#OrgExample"
              }
            ],
            "class" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code" : "plan",
                      "display" : "Plan"
                    }
                  ]
                },
                "value" : "Premim Family Plus",
                "name" : "Premim Family Plus Plan"
              }
            ]
          }
        },
        {
          "name" : "order",
          "resource" : {
            "resourceType" : "ServiceRequest",
            "id" : "ServiceRequestExample",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest"
              ]
            },
            "status" : "active",
            "intent" : "original-order",
            "code" : {
              "coding" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "24338-6"
                }
              ],
              "text" : "Gas panel - Blood"
            },
            "subject" : {
              🔗 "reference" : "Patient/examplepatient"
            },
            "occurrenceDateTime" : "2019-05-08T09:33:27+07:00",
            "authoredOn" : "2019-09-18T07:53:21+07:00",
            "requester" : {
              🔗 "reference" : "Practitioner/PractitionerExample"
            },
            "reasonCode" : [
              {
                "coding" : [
                  {
                    "system" : "http://snomed.info/sct",
                    "code" : "4565000"
                  }
                ],
                "text" : "Decreased oxygen affinity"
              }
            ]
          }
        },
        {
          "name" : "questionnaire",
          "valueCanonical" : "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire"
        }
      ]
    }