Da Vinci Risk Adjustment Implementation Guide
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## : ra-measurereport01-with-annotation: Risk Adjustment Measure Report with Annotation - JSON Representation

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    {
      "resourceType" : "MeasureReport",
      "id" : "ra-measurereport01-with-annotation",
      "meta" : {
        "profile" : [
          "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-measurereport"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MeasureReport</b><a name=\"ra-measurereport01-with-annotation\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource MeasureReport &quot;ra-measurereport01-with-annotation&quot; </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ra-measurereport.html\">Risk Adjustment Coding Gap MeasureReport</a></p></div><p><b>Risk Adjustment Clinical Data Collection Deadline</b>: 2022-03-31</p><p><b>status</b>: complete</p><p><b>type</b>: individual</p><p><b>measure</b>: <a href=\"Measure-RAModelExample01.html\">Risk Adjustment Model Version 24 - CMS Hierarchical Category Condition (CMS-HCC)</a></p><p><b>subject</b>: <a href=\"Patient-ra-patient01.html\">Patient/ra-patient01</a> &quot; EVERYWOMAN&quot;</p><p><b>date</b>: 2021-10-18</p><p><b>reporter</b>: <a href=\"Organization-ra-payer01.html\">Organization/ra-payer01</a> &quot;ABC Payer&quot;</p><p><b>period</b>: 2021-01-01 --&gt; 2021-09-30</p><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-001</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-04-01</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><p><b>code</b>: HCC 18: Diabetes with Chronic Complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#18 &quot;Diabetes with Chronic Complications&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-002</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#pending)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-09-29</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><p><b>code</b>: HCC 111: Chronic Obstructive Pulmonary Disease <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#111 &quot;Chronic Obstructive Pulmonary Disease&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-003</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Open Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#open-gap)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2020-07-15</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><blockquote><p><b>Annotation</b></p><blockquote><p><b>url</b></p><code>annotator</code></blockquote><p><b>value</b>: <a href=\"Practitioner-ra-prac01pat01.html\">Practitioner/ra-prac01pat01</a> &quot; HIPPOCRATES&quot;</p><blockquote><p><b>url</b></p><code>annotated</code></blockquote><p><b>value</b>: 2021-11-01</p><blockquote><p><b>url</b></p><code>text</code></blockquote><p><b>value</b>: Diagnosis added</p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></blockquote><p><b>value</b>: Assessed and present <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-coding-gap-annotation.html\">Coding Gap Annotation CodeSystem</a>#assessed-present)</span></p><blockquote><p><b>url</b></p><code>relatedData</code></blockquote><p><b>value</b>: id:\u00a0CLM23333</p></blockquote><p><b>code</b>: HCC 59: Major Depressive, Bipolar, and Paranoid Disorders <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#59 &quot;Major Depressive, Bipolar, and Paranoid Disorders&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-004</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-04-27</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-superseded)</span></p><p><b>code</b>: HCC 112: Fibrosis of lung and other chronic lung disorders <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#112 &quot;Fibrosis of lung and other chronic lung disorders&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-005</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#pending)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-09-27</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-superseded)</span></p><p><b>code</b>: HCC 19: Diabetes without Complications <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#19 &quot;Diabetes without Complications&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-006</blockquote><p><b>Risk Adjustment Suspect Type</b>: Historic Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#historic)</span></p><p><b>Evidence Status</b>: Open Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#open-gap)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2020-12-15</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-superseded)</span></p><blockquote><p><b>Annotation</b></p><blockquote><p><b>url</b></p><code>annotator</code></blockquote><p><b>value</b>: <a href=\"Practitioner-ra-prac01pat01.html\">Practitioner/ra-prac01pat01</a> &quot; HIPPOCRATES&quot;</p><blockquote><p><b>url</b></p><code>annotated</code></blockquote><p><b>value</b>: 2021-11-01</p><blockquote><p><b>url</b></p><code>text</code></blockquote><p><b>value</b>: Continue evaluation</p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></blockquote><p><b>value</b>: Deferred <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-coding-gap-annotation.html\">Coding Gap Annotation CodeSystem</a>#deferred)</span></p></blockquote><p><b>code</b>: HCC 84: Cardio-Respiratory Failure and Shock <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#84 &quot;Cardio-Respiratory Failure and Shock&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-007</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Closed Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#closed-gap)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-03-15</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><p><b>code</b>: HCC 22: Morbid Obesity <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#22 &quot;Morbid Obesity&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-008</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#pending)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-09-27</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><p><b>code</b>: HCC 96: Specified Heart Arrhythmias <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#96 &quot;Specified Heart Arrhythmias&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-009</blockquote><p><b>Risk Adjustment Suspect Type</b>: Suspected Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#suspected)</span></p><p><b>Evidence Status</b>: Open Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#open-gap)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2020-07-15</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><p><b>Confidence Scale</b>: Medium <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT</a>#255508009)</span></p><blockquote><p><b>Annotation</b></p><blockquote><p><b>url</b></p><code>annotator</code></blockquote><p><b>value</b>: <a href=\"Practitioner-ra-prac01pat01.html\">Practitioner/ra-prac01pat01</a> &quot; HIPPOCRATES&quot;</p><blockquote><p><b>url</b></p><code>annotated</code></blockquote><p><b>value</b>: 2021-11-01</p><blockquote><p><b>url</b></p><code>text</code></blockquote><p><b>value</b>: Not diagnosed</p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#code\">code</a></blockquote><p><b>value</b>: Assessed and not present <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-coding-gap-annotation.html\">Coding Gap Annotation CodeSystem</a>#assessed-not-present)</span></p><blockquote><p><b>url</b></p><code>relatedData</code></blockquote><p><b>value</b>: id:\u00a0432203939</p></blockquote><p><b>code</b>: HCC 110: Cystic Fibrosis <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#110 &quot;Cystic Fibrosis&quot;)</span></p></blockquote><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-010</blockquote><p><b>Risk Adjustment Suspect Type</b>: Net-New Condition Category <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-suspect-type.html\">Risk Adjustment Suspect Type CodeSystem</a>#net-new)</span></p><p><b>Evidence Status</b>: Pending Condition Category Gap <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-evidence-status.html\">Risk Adjustment Evidence Status CodeSystem</a>#pending)</span></p><p><b>Risk Adjustment Evidence Status Date</b>: 2021-09-28</p><p><b>Hierarchical Status</b>: Hierarchies applied and Condition Category is not superseded <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-hierarchical-status.html\">Risk Adjustment Hierarchical Status CodeSystem</a>#applied-not-superseded)</span></p><p><b>code</b>: HCC 83: Respiratory Arrest <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (CMS Hierarchical Condition Categories[24]#83 &quot;Respiratory Arrest&quot;)</span></p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Condition-ra-condition02pat01.html\">Condition/ra-condition02pat01</a></li><li><a href=\"Condition-ra-condition03pat01.html\">Condition/ra-condition03pat01</a></li><li><a href=\"Condition-ra-condition08pat01.html\">Condition/ra-condition08pat01</a></li><li><a href=\"Condition-ra-condition09pat01.html\">Condition/ra-condition09pat01</a></li><li><a href=\"Condition-ra-condition10pat01.html\">Condition/ra-condition10pat01</a></li><li><a href=\"Condition-ra-condition11pat01.html\">Condition/ra-condition11pat01</a></li><li><a href=\"Condition-ra-condition17pat01.html\">Condition/ra-condition17pat01</a></li><li><a href=\"Condition-ra-condition18pat01.html\">Condition/ra-condition18pat01</a></li><li><a href=\"Condition-ra-condition33pat01.html\">Condition/ra-condition33pat01</a></li><li><a href=\"Condition-ra-condition43pat01.html\">Condition/ra-condition43pat01</a></li><li><a href=\"Condition-ra-condition44pat01.html\">Condition/ra-condition44pat01</a></li><li><a href=\"Encounter-ra-encounter02pat01.html\">Encounter/ra-encounter02pat01</a></li><li><a href=\"Encounter-ra-encounter03pat01.html\">Encounter/ra-encounter03pat01</a></li><li><a href=\"Encounter-ra-encounter08pat01.html\">Encounter/ra-encounter08pat01</a></li><li><a href=\"Encounter-ra-encounter09pat01.html\">Encounter/ra-encounter09pat01</a></li><li><a href=\"Encounter-ra-encounter11pat01.html\">Encounter/ra-encounter11pat01</a></li><li><a href=\"Encounter-ra-encounter43pat01.html\">Encounter/ra-encounter43pat01</a></li><li><a href=\"Encounter-ra-encounter44pat01.html\">Encounter/ra-encounter44pat01</a></li><li><a href=\"Observation-ra-obs21pat01.html\">Observation/ra-obs21pat01</a></li></ul></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-clinicalDataCollectionDeadline",
          "valueDate" : "2022-03-31"
        }
      ],
      "status" : "complete",
      "type" : "individual",
      "measure" : "https://build.fhir.org/ig/HL7/davinci-ra/Measure-RAModelExample01",
      "subject" : {
        "reference" : "Patient/ra-patient01"
      },
      "date" : "2021-10-18",
      "reporter" : {
        "reference" : "Organization/ra-payer01"
      },
      "period" : {
        "start" : "2021-01-01",
        "end" : "2021-09-30"
      },
      "group" : [
        {
          "id" : "group-001",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "closed-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-04-01"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "18",
                "display" : "Diabetes with Chronic Complications"
              }
            ],
            "text" : "HCC 18: Diabetes with Chronic Complications"
          }
        },
        {
          "id" : "group-002",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "pending"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-09-29"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "111",
                "display" : "Chronic Obstructive Pulmonary Disease"
              }
            ],
            "text" : "HCC 111: Chronic Obstructive Pulmonary Disease"
          }
        },
        {
          "id" : "group-003",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "open-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2020-07-15"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            },
            {
              "extension" : [
                {
                  "url" : "annotator",
                  "valueReference" : {
                    "reference" : "Practitioner/ra-prac01pat01"
                  }
                },
                {
                  "url" : "annotated",
                  "valueDateTime" : "2021-11-01"
                },
                {
                  "url" : "text",
                  "valueString" : "Diagnosis added"
                },
                {
                  "url" : "code",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/coding-gap-annotation",
                        "code" : "assessed-present",
                        "display" : "Assessed and present"
                      }
                    ]
                  }
                },
                {
                  "url" : "relatedData",
                  "valueIdentifier" : {
                    "system" : "http://example.org/fhir/myclaimno",
                    "value" : "CLM23333"
                  }
                }
              ],
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "59",
                "display" : "Major Depressive, Bipolar, and Paranoid Disorders"
              }
            ],
            "text" : "HCC 59: Major Depressive, Bipolar, and Paranoid Disorders"
          }
        },
        {
          "id" : "group-004",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "closed-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-04-27"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "112",
                "display" : "Fibrosis of lung and other chronic lung disorders"
              }
            ],
            "text" : "HCC 112: Fibrosis of lung and other chronic lung disorders"
          }
        },
        {
          "id" : "group-005",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "pending"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-09-27"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "19",
                "display" : "Diabetes without Complications"
              }
            ],
            "text" : "HCC 19: Diabetes without Complications"
          }
        },
        {
          "id" : "group-006",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "historic"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "open-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2020-12-15"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-superseded"
                  }
                ]
              }
            },
            {
              "extension" : [
                {
                  "url" : "annotator",
                  "valueReference" : {
                    "reference" : "Practitioner/ra-prac01pat01"
                  }
                },
                {
                  "url" : "annotated",
                  "valueDateTime" : "2021-11-01"
                },
                {
                  "url" : "text",
                  "valueString" : "Continue evaluation"
                },
                {
                  "url" : "code",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/coding-gap-annotation",
                        "code" : "deferred",
                        "display" : "Deferred"
                      }
                    ]
                  }
                }
              ],
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "84",
                "display" : "Cardio-Respiratory Failure and Shock"
              }
            ],
            "text" : "HCC 84: Cardio-Respiratory Failure and Shock"
          }
        },
        {
          "id" : "group-007",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "suspected"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "closed-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-03-15"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "22",
                "display" : "Morbid Obesity"
              }
            ],
            "text" : "HCC 22: Morbid Obesity"
          }
        },
        {
          "id" : "group-008",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "suspected"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "pending"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-09-27"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "96",
                "display" : "Specified Heart Arrhythmias"
              }
            ],
            "text" : "HCC 96: Specified Heart Arrhythmias"
          }
        },
        {
          "id" : "group-009",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "suspected"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "open-gap"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2020-07-15"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-confidenceScale",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://snomed.info/sct",
                    "code" : "255508009",
                    "display" : "Medium"
                  }
                ]
              }
            },
            {
              "extension" : [
                {
                  "url" : "annotator",
                  "valueReference" : {
                    "reference" : "Practitioner/ra-prac01pat01"
                  }
                },
                {
                  "url" : "annotated",
                  "valueDateTime" : "2021-11-01"
                },
                {
                  "url" : "text",
                  "valueString" : "Not diagnosed"
                },
                {
                  "url" : "code",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/coding-gap-annotation",
                        "code" : "assessed-not-present"
                      }
                    ]
                  }
                },
                {
                  "url" : "relatedData",
                  "valueIdentifier" : {
                    "system" : "http://example.org/fhir/mychart",
                    "value" : "432203939"
                  }
                }
              ],
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-annotation"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "110",
                "display" : "Cystic Fibrosis"
              }
            ],
            "text" : "HCC 110: Cystic Fibrosis"
          }
        },
        {
          "id" : "group-010",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-suspectType",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/suspect-type",
                    "code" : "net-new"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/evidence-status",
                    "code" : "pending"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-evidenceStatusDate",
              "valueDate" : "2021-09-28"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-hierarchicalStatus",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/us/davinci-ra/CodeSystem/hierarchical-status",
                    "code" : "applied-not-superseded"
                  }
                ]
              }
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/cmshcc",
                "version" : "24",
                "code" : "83",
                "display" : "Respiratory Arrest"
              }
            ],
            "text" : "HCC 83: Respiratory Arrest"
          }
        }
      ],
      "evaluatedResource" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-001"
            }
          ],
          "reference" : "Condition/ra-condition02pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-002"
            }
          ],
          "reference" : "Condition/ra-condition03pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-003"
            }
          ],
          "reference" : "Condition/ra-condition08pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-004"
            }
          ],
          "reference" : "Condition/ra-condition09pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-005"
            }
          ],
          "reference" : "Condition/ra-condition10pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-006"
            }
          ],
          "reference" : "Condition/ra-condition11pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-007"
            }
          ],
          "reference" : "Condition/ra-condition17pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-008"
            }
          ],
          "reference" : "Condition/ra-condition18pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-010"
            }
          ],
          "reference" : "Condition/ra-condition33pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-001"
            }
          ],
          "reference" : "Condition/ra-condition43pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-004"
            }
          ],
          "reference" : "Condition/ra-condition44pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-001"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-007"
            }
          ],
          "reference" : "Encounter/ra-encounter02pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-002"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-005"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-008"
            },
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-010"
            }
          ],
          "reference" : "Encounter/ra-encounter03pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-003"
            }
          ],
          "reference" : "Encounter/ra-encounter08pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-004"
            }
          ],
          "reference" : "Encounter/ra-encounter09pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-006"
            }
          ],
          "reference" : "Encounter/ra-encounter11pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-001"
            }
          ],
          "reference" : "Encounter/ra-encounter43pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-004"
            }
          ],
          "reference" : "Encounter/ra-encounter44pat01"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/davinci-ra/StructureDefinition/ra-groupReference",
              "valueString" : "group-009"
            }
          ],
          "reference" : "Observation/ra-obs21pat01"
        }
      ]
    }