davinci_pas_test_kit 0.14.1 → 0.15.1

data/config/presets/pas_server_v221_run_against_pas_client.json.erb

@@ -0,0 +1,104 @@
+{
+  "title": "Run Against the PAS Client Suite",
+  "id": "pas-server-v221-run-against-pas-client-tests",
+  "test_suite_id": "davinci_pas_server_suite_v221",
+  "inputs": [
+    {
+      "name": "server_endpoint",
+      "description": "Insert the FHIR server endpoint URL for PAS",
+      "title": "FHIR Server Endpoint URL",
+      "type": "text",
+      "value": "<%= Inferno::Application['base_url'] %>/custom/davinci_pas_client_suite_v221/demo_execution/fhir"
+    },
+    {
+      "name": "access_token",
+      "description": "An access token that the server under test will send to Inferno on notifications so that the request gets associated with this test session. The token must be provided as a `Bearer` token in the `Authorization` header of HTTP requests sent to Inferno.",
+      "title": "Notification Access Token",
+      "type": "text",
+      "value": "demo_execution"
+    },
+    {
+      "name": "subscription_resource",
+      "description": "A Subscription resource in JSON format that Inferno will send to the server under test so that it can demonstrate its ability to notify Inferno when pended prior authorization requests have been updated. The instance must be conformant to the R4/B Topic-Based Subscription profile. Inferno may modify the Subscription before submission, e.g., to point to Inferno's notification endpoint.",
+      "title": "Pended Prior Authorization Subscription",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Subscription\",\n  \"status\": \"requested\",\n  \"end\": \"2020-12-31T12:00:00Z\",\n  \"reason\": \"R4 Topic-Based Workflow Subscription for Patient Admission\",\n  \"criteria\": \"http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic\",\n  \"_criteria\": {\n    \"extension\": [\n      {\n        \"url\": \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-filter-criteria\",\n        \"valueString\": \"org-identifier=8189991234\"\n      }\n    ]\n  },\n  \"channel\": {\n    \"extension\": [\n      {\n        \"url\": \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-timeout\",\n        \"valueUnsignedInt\": 60\n      },\n      {\n        \"url\": \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-max-count\",\n        \"valuePositiveInt\": 20\n      }\n    ],\n    \"type\": \"rest-hook\",\n    \"header\": [\n      \"Authorization: Bearer demo_execution\"\n    ],\n    \"endpoint\": \"http://localhost:4567/custom/subscriptions_r5_backport_r4_server/subscription/channel/notification_listener\",\n    \"payload\": \"application/fhir+json\",\n    \"_payload\": {\n      \"extension\": [\n        {\n          \"url\": \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-payload-content\",\n          \"valueCode\": \"full-resource\"\n        }\n      ]\n    }\n  },\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-subscription\"\n    ]\n  }\n}"
+    },
+    {
+      "name": "approval_pa_submit_request_payload",
+      "description": "Insert Bundle to be sent for PAS Submit Request",
+      "optional": true,
+      "title": "PAS Submit Request Payload for Approval Response",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"ReferralAuthorizationBundleExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n            \"extension\": [\n              {\n                \"url\": \"applicationSenderCode\",\n                \"valueString\": \"SND-0001\"\n              },\n              {\n                \"url\": \"applicationReceiverCode\",\n                \"valueString\": \"RCV-0001\"\n              },\n              {\n                \"url\": \"interchangeSenderID\",\n                \"valueString\": \"INTER-SND-0001\"\n              },\n              {\n                \"url\": \"interchangeReceiverID\",\n                \"valueString\": \"INTER-RCV-0001\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode\",\n            \"extension\": [\n              {\n                \"url\": \"category\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1136\",\n                      \"code\": \"07\",\n                      \"display\": \"Encounter for Problem\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"indicator\",\n                \"valueBoolean\": true\n              },\n              {\n                \"url\": \"code\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1321\",\n                      \"code\": \"09\"\n                    }\n                  ]\n                }\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation\",\n            \"extension\": [\n              {\n                \"url\": \"prognosis\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/923\",\n                      \"code\": \"1\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-01\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n            \"valueString\": \"AUTH-0001\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n            \"valueString\": \"ADMIN-REF-0001\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1322\",\n                  \"code\": \"I\",\n                  \"display\": \"Initial\"\n                }\n              ]\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": false\n              }\n            ],\n            \"sequence\": 2,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"G0155\"\n                    }\n                  ]\n                }\n              }\n            ],\n            \"sequence\": 1,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            },\n            \"modifierExtension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                \"valueBoolean\": false\n              }\n            ]\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"G0155\"\n                    }\n                  ]\n                }\n              }\n            ],\n            \"sequence\": 2,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            },\n            \"modifierExtension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                \"valueBoolean\": false\n              }\n            ],\n            \"servicedPeriod\": {\n              \"start\": \"2016-08-10\",\n              \"end\": \"2016-08-12\"\n            }\n          }\n        ],\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"additionalInformation\",\n                  \"display\": \"Additional Information\"\n                }\n              ]\n            },\n            \"sequence\": 1,\n            \"valueReference\": {\n              \"reference\": \"DocumentReference/episode-summary\"\n            },\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                \"extension\": [\n                  {\n                    \"url\": \"reportTypeCode\",\n                    \"valueCodeableConcept\": {\n                      \"coding\": [\n                        {\n                          \"system\": \"https://codesystem.x12.org/005010/755\",\n                          \"code\": \"EB\",\n                          \"display\": \"Explaining Benefits\"\n                        }\n                      ]\n                    }\n                  }\n                ]\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"modifierExtension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                \"valueBoolean\": false\n              }\n            ]\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"freeFormMessage\",\n                  \"display\": \"Free Form Message\"\n                }\n              ]\n            },\n            \"sequence\": 2,\n            \"valueString\": \"Prior authorization inquiry details provided\"\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"patientEvent\",\n                  \"display\": \"Patient Event\"\n                }\n              ]\n            },\n            \"sequence\": 3,\n            \"timingPeriod\": {\n              \"start\": \"2021-09-01\",\n              \"end\": \"2021-09-03\"\n            }\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"admissionDates\",\n                  \"display\": \"Admission Dates\"\n                }\n              ]\n            },\n            \"sequence\": 4,\n            \"timingPeriod\": {\n              \"start\": \"2021-09-10\",\n              \"end\": \"2021-09-12\"\n            }\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"dischargeDates\",\n                  \"display\": \"Discharge Dates\"\n                }\n              ]\n            },\n            \"sequence\": 5,\n            \"timingDate\": \"2021-09-13\"\n          },\n          {\n            \"sequence\": 99,\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:inferno:pas-codes\",\n                  \"code\": \"default-profile-testing\",\n                  \"display\": \"Testing Profile Defaulting\"\n                }\n              ]\n            },\n            \"valueReference\": {\n              \"reference\": \"DocumentReference/episode-summary\"\n            },\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                \"extension\": [\n                  {\n                    \"url\": \"reportTypeCode\",\n                    \"valueCodeableConcept\": {\n                      \"coding\": [\n                        {\n                          \"system\": \"https://codesystem.x12.org/005010/755\",\n                          \"code\": \"EB\",\n                          \"display\": \"Explaining Benefits\"\n                        }\n                      ]\n                    }\n                  }\n                ]\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"modifierExtension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                \"valueBoolean\": false\n              }\n            ]\n          }\n        ],\n        \"accident\": {\n          \"date\": \"2016-03-09\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\n                \"code\": \"auto\",\n                \"display\": \"Automobile\"\n              }\n            ]\n          },\n          \"locationAddress\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"UMOExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"8189991234\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"8189948234\"\n          },\n          {\n            \"value\": \"PI-UMOExample\",\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-UMOExample\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"X3\"\n              }\n            ]\n          }\n        ],\n        \"name\": \"DR. JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"InsurerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"7239994834\"\n          },\n          {\n            \"value\": \"PI-InsurerExample\",\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-InsurerExample\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          },\n          {\n            \"system\": \"http://davinci-pas.org/MEMBERID\",\n            \"value\": \"MEM-1234567\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                  \"code\": \"MB\",\n                  \"display\": \"Member Number\"\n                }\n              ]\n            }\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            },\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1069\",\n              \"code\": \"18\",\n              \"display\": \"Self\"\n            }\n          ]\n        },\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n              \"code\": \"EHCPOL\",\n              \"display\": \"extended healthcare\"\n            }\n          ]\n        },\n        \"period\": {\n          \"start\": \"2020-01-01\",\n          \"end\": \"2025-12-31\"\n        },\n        \"class\": [\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                  \"code\": \"group\",\n                  \"display\": \"Group\"\n                }\n              ]\n            },\n            \"value\": \"GRP-001\",\n            \"name\": \"ACME GROUP\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                  \"code\": \"plan\",\n                  \"display\": \"Plan\"\n                }\n              ]\n            },\n            \"value\": \"PLAN-001\",\n            \"name\": \"PREMIER PLAN\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n      \"resource\": {\n        \"resourceType\": \"Patient\",\n        \"id\": \"SubscriberExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/584\",\n                  \"code\": \"RU\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2106-3\",\n                  \"display\": \"White\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Caucasian\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2135-2\",\n                  \"display\": \"Hispanic or Latino\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Filipino\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n            \"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"ServiceRequest\",\n        \"id\": \"ReferralRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"code\": {\n          \"coding\": [\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1365\",\n              \"code\": \"3\",\n              \"display\": \"Consultation\"\n            }\n          ]\n        },\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"4\",\n                  \"display\": \"Diagnostic\"\n                }\n              ]\n            }\n          }\n        ],\n        \"quantityQuantity\": {\n          \"value\": 1,\n          \"unit\": \"visit\",\n          \"system\": \"http://unitsofmeasure.org\",\n          \"code\": \"1\"\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ],\n        \"code\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                \"code\": \"doctor\",\n                \"display\": \"Doctor\"\n              }\n            ]\n          }\n        ],\n        \"specialty\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"408443003\",\n                \"display\": \"General medical practice\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"endpoint\": [\n          {\n            \"display\": \"Mock Endpoint\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n      \"resource\": {\n        \"resourceType\": \"Practitioner\",\n        \"id\": \"ReferralPractitionerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ],\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n          ],\n          \"lastUpdated\": \"2021-09-10T12:00:00Z\"\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1351\",\n                  \"code\": \"1\",\n                  \"display\": \"Admitted\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1345\",\n                  \"code\": \"2\",\n                  \"display\": \"Newly Admitted\"\n                }\n              ]\n            }\n          }\n        ],\n        \"reasonReference\": [\n          {\n            \"display\": \"Surgical encounter reason\"\n          }\n        ]\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "denial_pa_submit_request_payload",
+      "description": "Insert Bundle to be sent for PAS Submit Request",
+      "optional": true,
+      "title": "PAS Submit Request Payload for Denial Response",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"ReferralAuthorizationBundleExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n            \"extension\": [\n              {\n                \"url\": \"applicationSenderCode\",\n                \"valueString\": \"SND-0001\"\n              },\n              {\n                \"url\": \"applicationReceiverCode\",\n                \"valueString\": \"RCV-0001\"\n              },\n              {\n                \"url\": \"interchangeSenderID\",\n                \"valueString\": \"INTER-SND-0001\"\n              },\n              {\n                \"url\": \"interchangeReceiverID\",\n                \"valueString\": \"INTER-RCV-0001\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode\",\n            \"extension\": [\n              {\n                \"url\": \"category\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1136\",\n                      \"code\": \"07\",\n                      \"display\": \"Encounter for Problem\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"indicator\",\n                \"valueBoolean\": true\n              },\n              {\n                \"url\": \"code\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1321\",\n                      \"code\": \"09\"\n                    }\n                  ]\n                }\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation\",\n            \"extension\": [\n              {\n                \"url\": \"prognosis\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/923\",\n                      \"code\": \"1\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-01\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n            \"valueString\": \"AUTH-0001\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n            \"valueString\": \"ADMIN-REF-0001\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1322\",\n                  \"code\": \"I\",\n                  \"display\": \"Initial\"\n                }\n              ]\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": 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}\n            ],\n            \"sequence\": 2,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n 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\"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            },\n            \"modifierExtension\": [\n              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JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"InsurerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"7239994834\"\n          },\n          {\n            \"value\": \"PI-InsurerExample\",\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-InsurerExample\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          },\n          {\n            \"system\": \"http://davinci-pas.org/MEMBERID\",\n            \"value\": \"MEM-1234567\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                  \"code\": \"MB\",\n                  \"display\": \"Member Number\"\n                }\n              ]\n            }\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            },\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1069\",\n              \"code\": \"18\",\n              \"display\": \"Self\"\n            }\n          ]\n        },\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n              \"code\": \"EHCPOL\",\n              \"display\": \"extended healthcare\"\n            }\n          ]\n        },\n        \"period\": {\n          \"start\": \"2020-01-01\",\n          \"end\": \"2025-12-31\"\n        },\n        \"class\": [\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                  \"code\": \"group\",\n                  \"display\": \"Group\"\n                }\n              ]\n            },\n            \"value\": \"GRP-001\",\n            \"name\": \"ACME GROUP\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                  \"code\": \"plan\",\n                  \"display\": \"Plan\"\n                }\n              ]\n            },\n            \"value\": \"PLAN-001\",\n            \"name\": \"PREMIER PLAN\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n      \"resource\": {\n        \"resourceType\": \"Patient\",\n        \"id\": \"SubscriberExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/584\",\n                  \"code\": \"RU\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2106-3\",\n                  \"display\": \"White\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Caucasian\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2135-2\",\n                  \"display\": \"Hispanic or Latino\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Filipino\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n            \"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"ServiceRequest\",\n        \"id\": \"ReferralRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"code\": {\n          \"coding\": [\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1365\",\n              \"code\": \"3\",\n              \"display\": \"Consultation\"\n            }\n          ]\n        },\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"4\",\n                  \"display\": \"Diagnostic\"\n                }\n              ]\n            }\n          }\n        ],\n        \"quantityQuantity\": {\n          \"value\": 1,\n          \"unit\": \"visit\",\n          \"system\": \"http://unitsofmeasure.org\",\n          \"code\": \"1\"\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ],\n        \"code\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                \"code\": \"doctor\",\n                \"display\": \"Doctor\"\n              }\n            ]\n          }\n        ],\n        \"specialty\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"408443003\",\n                \"display\": \"General medical practice\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"endpoint\": [\n          {\n            \"display\": \"Mock Endpoint\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n      \"resource\": {\n        \"resourceType\": \"Practitioner\",\n        \"id\": \"ReferralPractitionerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ],\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n          ],\n          \"lastUpdated\": \"2021-09-10T12:00:00Z\"\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1351\",\n                  \"code\": \"1\",\n                  \"display\": \"Admitted\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1345\",\n                  \"code\": \"2\",\n                  \"display\": \"Newly Admitted\"\n                }\n              ]\n            }\n          }\n        ],\n        \"reasonReference\": [\n          {\n            \"display\": \"Surgical encounter reason\"\n          }\n        ]\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "pended_pa_submit_request_payload",
+      "description": "Insert Bundle to be sent for PAS Submit Request",
+      "optional": true,
+      "title": "PAS Submit Request Payload for Pended Response",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"DeviceAuthorizationBundleExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n            \"extension\": [\n              {\n                \"url\": \"applicationSenderCode\",\n                \"valueString\": \"SND-0001\"\n              },\n              {\n                \"url\": \"applicationReceiverCode\",\n                \"valueString\": \"RCV-0001\"\n              },\n              {\n                \"url\": \"interchangeSenderID\",\n                \"valueString\": \"INTER-SND-0001\"\n              },\n              {\n                \"url\": \"interchangeReceiverID\",\n                \"valueString\": \"INTER-RCV-0001\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode\",\n            \"extension\": [\n              {\n                \"url\": \"category\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1136\",\n                      \"code\": \"07\",\n                      \"display\": \"Encounter for Problem\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"indicator\",\n                \"valueBoolean\": true\n              },\n              {\n                \"url\": \"code\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1321\",\n                      \"code\": \"09\"\n                    }\n                  ]\n                }\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation\",\n            \"extension\": [\n              {\n                \"url\": \"prognosis\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/923\",\n                      \"code\": \"1\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-01\"\n              }\n            ]\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n            \"valueString\": \"AUTH-0001\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n            \"valueString\": \"ADMIN-REF-0001\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1322\",\n                  \"code\": \"I\",\n                  \"display\": \"Initial\"\n                }\n              ]\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": false\n              }\n            ],\n            \"sequence\": 2,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": 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JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n   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\"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            },\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1069\",\n              \"code\": \"18\",\n              \"display\": \"Self\"\n            }\n          ]\n        },\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n              \"code\": \"EHCPOL\",\n              \"display\": \"extended healthcare\"\n            }\n          ]\n        },\n        \"period\": {\n          \"start\": \"2020-01-01\",\n          \"end\": \"2025-12-31\"\n        },\n        \"class\": [\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                  \"code\": \"group\",\n                  \"display\": \"Group\"\n                }\n              ]\n            },\n            \"value\": \"GRP-001\",\n            \"name\": \"ACME GROUP\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                  \"code\": \"plan\",\n                  \"display\": \"Plan\"\n                }\n              ]\n            },\n            \"value\": \"PLAN-001\",\n            \"name\": \"PREMIER PLAN\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n      \"resource\": {\n        \"resourceType\": \"Patient\",\n        \"id\": \"SubscriberExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/584\",\n                  \"code\": \"RU\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2106-3\",\n                  \"display\": \"White\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Caucasian\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2135-2\",\n                  \"display\": \"Hispanic or Latino\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Filipino\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n            \"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DeviceRequest/DeviceRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"DeviceRequest\",\n        \"id\": \"DeviceRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"codeCodeableConcept\": {\n          \"coding\": [\n            {\n              \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n              \"code\": \"E1223\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          }\n        ],\n        \"authoredOn\": \"2005-06-02\",\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"requester\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ],\n        \"code\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                \"code\": \"doctor\",\n                \"display\": \"Doctor\"\n              }\n            ]\n          }\n        ],\n        \"specialty\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"408443003\",\n                \"display\": \"General medical practice\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"endpoint\": [\n          {\n            \"display\": \"Mock Endpoint\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n      \"resource\": {\n        \"resourceType\": \"Practitioner\",\n        \"id\": \"ReferralPractitionerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ],\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n          ],\n          \"lastUpdated\": \"2021-09-10T12:00:00Z\"\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1351\",\n                  \"code\": \"1\",\n                  \"display\": \"Admitted\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1345\",\n                  \"code\": \"2\",\n                  \"display\": \"Newly Admitted\"\n                }\n              ]\n            }\n          }\n        ],\n        \"reasonReference\": [\n          {\n            \"display\": \"Surgical encounter reason\"\n          }\n        ]\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "pended_pa_inquire_request_payload",
+      "description": "Insert Bundle to be sent for PAS Inquire Request",
+      "optional": true,
+      "title": "PAS Inquire Request Payload",
+      "type": "textarea",
+      "value": "[\n  {\n    \"resourceType\": \"Bundle\",\n    \"id\": \"PASBundleInquiryExample\",\n    \"meta\": {\n      \"profile\": [\n        \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n      ]\n    },\n    \"identifier\": {\n      \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n      \"value\": \"A12345\"\n    },\n    \"type\": \"collection\",\n    \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n    \"entry\": [\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"PASClaimInquiryExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1322\",\n                    \"code\": \"I\",\n                    \"display\": \"Initial\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n              \"extension\": [\n                {\n                  \"url\": \"traceNumber\",\n                  \"valueString\": \"TRN-12345\"\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1325\",\n                    \"code\": \"AA\",\n                    \"display\": \"Authorized\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/service-type\",\n                    \"code\": \"1\",\n                    \"display\": \"Adoption/Permanent Care Info/Support\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n              \"valueString\": \"AUTH-0001\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n              \"valueString\": \"ADMIN-REF-0001\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://www.usps.com/\",\n                        \"code\": \"MA\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                  \"valueString\": \"223412\"\n                }\n              ],\n              \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n              \"value\": \"111099\",\n              \"assigner\": {\n                \"identifier\": {\n                  \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                  \"value\": \"9012345678\"\n                }\n              }\n            }\n          ],\n          \"status\": \"active\",\n          \"billablePeriod\": {\n            \"start\": \"2016-12-06\",\n            \"end\": \"2020-07-22\"\n          },\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n                \"code\": \"professional\"\n              }\n            ]\n          },\n          \"use\": \"preauthorization\",\n          \"patient\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2005-05-02T11:01:00+05:00\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"careTeam\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": true\n                }\n              ],\n              \"sequence\": 1,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": false\n                }\n              ],\n              \"sequence\": 2,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"diagnosis\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                  \"valueDate\": \"2021-05-10\"\n                }\n              ],\n              \"sequence\": 1,\n              \"diagnosisCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                    \"code\": \"G89.4\"\n                  }\n                ]\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                      \"code\": \"patientreasonforvisit\"\n                    }\n                  ]\n                }\n              ]\n            }\n          ],\n          \"insurance\": [\n            {\n              \"sequence\": 1,\n              \"focal\": true,\n              \"coverage\": {\n                \"reference\": \"Coverage/InsuranceExample\"\n              }\n            }\n          ],\n          \"item\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                  \"valueIdentifier\": {\n                    \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                    \"value\": \"1122334\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                  \"valueString\": \"1122445\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                  \"valueString\": \"9988311\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"HS\",\n                        \"display\": \"Health Services Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n                  \"valueDate\": \"2022-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/306\",\n                        \"code\": \"A1\",\n                        \"display\": \"Certified in total\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                  \"valueCode\": \"changed\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                        \"code\": \"G0155\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                  \"valueReference\": {\n                    \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                  }\n                }\n              ],\n              \"sequence\": 1,\n              \"careTeamSequence\": [\n                1\n              ],\n              \"diagnosisSequence\": [\n                1\n              ],\n              \"informationSequence\": [\n                1\n              ],\n              \"revenue\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.nubc.org/revenue-code\",\n                    \"code\": \"0105\"\n                  }\n                ]\n              },\n              \"modifier\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"E0110\"\n                    }\n                  ]\n                }\n              ],\n              \"servicedDate\": \"2016-08-09\",\n              \"quantity\": {\n                \"value\": 1\n              },\n              \"locationCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                    \"code\": \"11\"\n                  }\n                ]\n              },\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"G0154\"\n                  }\n                ]\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"unitPrice\": {\n                \"value\": 1000,\n                \"currency\": \"USD\"\n              },\n              \"modifierExtension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                  \"valueBoolean\": false\n                }\n              ]\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"HS\",\n                        \"display\": \"Health Services Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                }\n              ],\n              \"sequence\": 2,\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"B4185\"\n                  }\n                ]\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                  \"valueIdentifier\": {\n                    \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                    \"value\": \"1122334\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                  \"valueString\": \"1122445\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                  \"valueString\": \"9988311\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"HS\",\n                        \"display\": \"Health Services Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n                  \"valueDate\": \"2022-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/306\",\n                        \"code\": \"A1\",\n                        \"display\": \"Certified in total\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                  \"valueCode\": \"changed\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                        \"code\": \"G0155\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                  \"valueReference\": {\n                    \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                  }\n                }\n              ],\n              \"sequence\": 3,\n              \"careTeamSequence\": [\n                1\n              ],\n              \"diagnosisSequence\": [\n                1\n              ],\n              \"informationSequence\": [\n                1\n              ],\n              \"revenue\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.nubc.org/revenue-code\",\n                    \"code\": \"0105\"\n                  }\n                ]\n              },\n              \"modifier\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"E0110\"\n                    }\n                  ]\n                }\n              ],\n              \"quantity\": {\n                \"value\": 1\n              },\n              \"locationCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                    \"code\": \"11\"\n                  }\n                ]\n              },\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"G0154\"\n                  }\n                ]\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"unitPrice\": {\n                \"value\": 1000,\n                \"currency\": \"USD\"\n              },\n              \"modifierExtension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                  \"valueBoolean\": false\n                }\n              ],\n              \"servicedPeriod\": {\n                \"start\": \"2016-08-10\",\n                \"end\": \"2016-08-12\"\n              }\n            }\n          ],\n          \"accident\": {\n            \"date\": \"2016-03-09\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\n                  \"code\": \"auto\",\n                  \"display\": \"Automobile\"\n                }\n              ]\n            },\n            \"locationAddress\": {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          },\n          \"related\": [\n            {\n              \"claim\": {\n                \"reference\": \"Claim/PreviousAuthorizationExample\"\n              },\n              \"relationship\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship\",\n                    \"code\": \"prior\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"supportingInfo\": [\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"additionalInformation\",\n                    \"display\": \"Additional Information\"\n                  }\n                ]\n              },\n              \"sequence\": 1,\n              \"valueReference\": {\n                \"reference\": \"DocumentReference/episode-summary\"\n              },\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                  \"extension\": [\n                    {\n                      \"url\": \"type\",\n                      \"valueString\": \"summary\"\n                    }\n                  ]\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                  \"valueCode\": \"changed\"\n                }\n              ],\n              \"modifierExtension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                  \"valueBoolean\": false\n                }\n              ]\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"freeFormMessage\",\n                    \"display\": \"Free Form Message\"\n                  }\n                ]\n              },\n              \"sequence\": 2,\n              \"valueString\": \"Prior authorization inquiry details provided\"\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientEvent\",\n                    \"display\": \"Patient Event\"\n                  }\n                ]\n              },\n              \"sequence\": 3,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-01\",\n                \"end\": \"2021-09-03\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"admissionDates\",\n                    \"display\": \"Admission Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 4,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-10\",\n                \"end\": \"2021-09-12\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"dischargeDates\",\n                    \"display\": \"Discharge Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 5,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-13\",\n                \"end\": \"2021-09-15\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"UMOExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"8189991234\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"8189948234\"\n            },\n            {\n              \"value\": \"PI-UMOExample\",\n              \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n            },\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                    \"code\": \"payerid\"\n                  }\n                ]\n              },\n              \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n              \"value\": \"PI-UMOExample\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"X3\"\n                }\n              ]\n            }\n          ],\n          \"name\": \"DR. JOE SMITH CORPORATION\",\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"contact\": [\n            {\n              \"telecom\": [\n                {\n                  \"system\": \"other\",\n                  \"value\": \"http://hl7.org/fhir\"\n                }\n              ],\n              \"name\": {\n                \"family\": \"WATSON\",\n                \"given\": [\n                  \"SUSAN\"\n                ]\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"InsurerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"789312\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"7239994834\"\n            },\n            {\n              \"value\": \"PI-InsurerExample\",\n              \"system\": \"http://davinci-pas.org/fhir/payer-id\"\n            },\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                    \"code\": \"payerid\"\n                  }\n                ]\n              },\n              \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n              \"value\": \"PI-InsurerExample\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"PR\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"3029993456\"\n            }\n          ],\n          \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\",\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            },\n            {\n              \"system\": \"http://davinci-pas.org/MEMBERID\",\n              \"value\": \"MEM-1234567\",\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                    \"code\": \"MB\",\n                    \"display\": \"Member Number\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"beneficiary\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"payor\": [\n            {\n              \"reference\": \"Organization/InsurerExample\"\n            }\n          ],\n          \"subscriber\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"subscriberId\": \"12345678901\",\n          \"relationship\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n                \"code\": \"self\"\n              },\n              {\n                \"system\": \"https://codesystem.x12.org/005010/1069\",\n                \"code\": \"18\",\n                \"display\": \"Self\"\n              }\n            ]\n          },\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n                \"code\": \"EHCPOL\",\n                \"display\": \"extended healthcare\"\n              }\n            ]\n          },\n          \"period\": {\n            \"start\": \"2020-01-01\",\n            \"end\": \"2025-12-31\"\n          },\n          \"class\": [\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"group\",\n                    \"display\": \"Group\"\n                  }\n                ]\n              },\n              \"value\": \"GRP-001\",\n              \"name\": \"ACME GROUP\"\n            },\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"plan\",\n                    \"display\": \"Plan\"\n                  }\n                ]\n              },\n              \"value\": \"PLAN-001\",\n              \"name\": \"PREMIER PLAN\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n        \"resource\": {\n          \"resourceType\": \"Patient\",\n          \"id\": \"SubscriberExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/584\",\n                    \"code\": \"RU\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2106-3\",\n                    \"display\": \"White\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Caucasian\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2135-2\",\n                    \"display\": \"Hispanic or Latino\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Filipino\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n              \"valueCode\": \"M\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"12345678901\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"SMITH\",\n              \"given\": [\n                \"JOE\"\n              ],\n              \"prefix\": [\n                \"Mr\"\n              ],\n              \"suffix\": [\n                \"PharmD\"\n              ]\n            }\n          ],\n          \"gender\": \"male\",\n          \"birthDate\": \"1987-02-20\",\n          \"multipleBirthInteger\": 1,\n          \"communication\": [\n            {\n              \"language\": {\n                \"coding\": [\n                  {\n                    \"system\": \"urn:ietf:bcp:47\",\n                    \"code\": \"nl-NL\",\n                    \"display\": \"Dutch (Netherlands)\"\n                  }\n                ]\n              },\n              \"preferred\": true\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"555-555-5555\",\n              \"use\": \"home\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"49 Meadow St\"\n              ],\n              \"city\": \"Mounds\",\n              \"state\": \"OK\",\n              \"district\": \"Meadow\",\n              \"postalCode\": \"74047\",\n              \"country\": \"US\",\n              \"period\": {\n                \"start\": \"2016-12-06\",\n                \"end\": \"2020-07-22\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"location\": [\n            {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          ],\n          \"code\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                  \"code\": \"doctor\",\n                  \"display\": \"Doctor\"\n                }\n              ]\n            }\n          ],\n          \"specialty\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://snomed.info/sct\",\n                  \"code\": \"408443003\",\n                  \"display\": \"General medical practice\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"endpoint\": [\n            {\n              \"reference\": \"Endpoint/ReferralEndpointExample\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"987654321\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      }\n    ]\n  }\n]"
+    },
+    {
+      "name": "must_support_pa_submit_request_payload",
+      "description": "Insert an additional request bundle or a list of bundles (e.g. [bundle_1, bundle_2])",
+      "optional": true,
+      "title": "Additional PAS Submit Request Payloads",
+      "type": "textarea",
+      "value": "[\n  {\n    \"resourceType\": \"Bundle\",\n    \"id\": \"DeviceAuthorizationBundleExample\",\n    \"meta\": {\n      \"profile\": [\n        \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n      ]\n    },\n    \"identifier\": {\n      \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n      \"value\": \"A12345\"\n    },\n    \"type\": \"collection\",\n    \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n    \"entry\": [\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"ReferralAuthorizationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n              \"valueReference\": {\n                \"reference\": \"Encounter/SurgicalEncounterExample\"\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n              \"extension\": [\n                {\n                  \"url\": \"applicationSenderCode\",\n                  \"valueString\": \"SND-0001\"\n                },\n                {\n                  \"url\": \"applicationReceiverCode\",\n                  \"valueString\": \"RCV-0001\"\n                },\n                {\n                  \"url\": \"interchangeSenderID\",\n                  \"valueString\": \"INTER-SND-0001\"\n                },\n                {\n                  \"url\": \"interchangeReceiverID\",\n                  \"valueString\": \"INTER-RCV-0001\"\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode\",\n              \"extension\": [\n                {\n                  \"url\": \"category\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1136\",\n                        \"code\": \"07\",\n                        \"display\": \"Encounter for Problem\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"indicator\",\n                  \"valueBoolean\": true\n                },\n                {\n                  \"url\": \"code\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1321\",\n                        \"code\": \"09\"\n                      }\n                    ]\n                  }\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation\",\n              \"extension\": [\n                {\n                  \"url\": \"prognosis\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/923\",\n                        \"code\": \"1\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"date\",\n                  \"valueDate\": \"2021-09-01\"\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n              \"valueString\": \"AUTH-0001\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n              \"valueString\": \"ADMIN-REF-0001\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1322\",\n                  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]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1337\",\n                        \"code\": \"2\",\n                        \"display\": \"Intermediate Care Facility (ICF)\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                  \"valueDecimal\": 100\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                  \"valueCode\": \"changed\"\n                },\n                {\n          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\"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            },\n            {\n              \"system\": \"http://davinci-pas.org/MEMBERID\",\n              \"value\": \"MEM-1234567\",\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                    \"code\": \"MB\",\n                    \"display\": \"Member 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\"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n                \"code\": \"EHCPOL\",\n                \"display\": \"extended healthcare\"\n              }\n            ]\n          },\n          \"period\": {\n            \"start\": \"2020-01-01\",\n            \"end\": \"2025-12-31\"\n          },\n          \"class\": [\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"group\",\n                    \"display\": \"Group\"\n                  }\n                ]\n              },\n              \"value\": \"GRP-001\",\n              \"name\": \"ACME GROUP\"\n            },\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"plan\",\n     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\"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n              \"extension\": [\n                {\n                  \"url\": \"coverage\",\n                  \"valueReference\": {\n                    \"reference\": \"Coverage/InsuranceExample\"\n                  }\n                },\n                {\n                  \"url\": \"covered\",\n                  \"valueCode\": \"covered\"\n                },\n                {\n                  \"url\": \"pa-needed\",\n                  \"valueCode\": \"auth-needed\"\n                },\n                {\n                  \"url\": \"date\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"coverage-assertion-id\",\n                  \"valueString\": \"1122445\"\n                }\n              ]\n            }\n          ],\n          \"authoredOn\": \"2005-06-02\",\n          \"occurrenceTiming\": {\n            \"repeat\": {\n              \"duration\": 15,\n              \"durationMax\": 25,\n              \"durationUnit\": \"min\",\n              \"frequency\": 1,\n              \"frequencyMax\": 4,\n              \"period\": 1,\n              \"periodUnit\": \"d\"\n            }\n          },\n          \"requester\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n  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],\n          \"endpoint\": [\n            {\n              \"display\": \"Mock Endpoint\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"1234567893\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n        \"resource\": {\n          \"resourceType\": \"DocumentReference\",\n          \"id\": \"episode-summary\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"urn:ietf:rfc:3986\",\n              \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n            }\n          ],\n          \"status\": \"current\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://loinc.org\",\n                \"code\": \"34133-9\",\n                \"display\": \"Summary of episode note\"\n              }\n            ],\n            \"text\": \"CCD Document\"\n 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}\n          ],\n          \"status\": \"planned\",\n          \"class\": {\n            \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n            \"code\": \"AMB\",\n            \"display\": \"ambulatory\"\n          },\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://snomed.info/sct\",\n                  \"code\": \"11429006\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            }\n          ],\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"17621005\",\n                \"display\": \"Normal\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"participant\": [\n            {\n              \"individual\": {\n                \"reference\": \"Practitioner/ReferralPractitionerExample\"\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                      \"code\": \"REF\"\n                    }\n                  ]\n                }\n              ],\n              \"period\": {\n                \"start\": \"2020-07-02\",\n                \"end\": \"2020-07-09\"\n              }\n            }\n          ],\n          \"reasonCode\": [\n            {\n              \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n            }\n          ],\n          \"period\": {\n            \"start\": \"2020-07-02\",\n            \"end\": \"2020-07-09\"\n          },\n          \"serviceProvider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"hospitalization\": {\n            \"admitSource\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                  \"code\": \"5\"\n                }\n              ]\n            },\n            \"dischargeDisposition\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                  \"code\": \"oth\"\n                }\n              ]\n            }\n          },\n          \"location\": [\n            {\n              \"location\": {\n                \"reference\": \"Location/ReferralLocationExample\"\n              }\n            }\n          ],\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n            ],\n            \"lastUpdated\": \"2021-09-10T12:00:00Z\"\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1351\",\n                    \"code\": \"1\",\n                    \"display\": \"Admitted\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                 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{\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2021-01-01\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"insurance\": [\n            {\n              \"sequence\": 1,\n              \"focal\": true,\n              \"coverage\": {\n                \"reference\": \"Coverage/InsuranceExample\"\n              }\n            }\n          ],\n          \"item\": [\n            {\n              \"sequence\": 1,\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/data-absent-reason\",\n                    \"code\": 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       \"resourceType\": \"Condition\",\n          \"id\": \"EncounterDiagnosisExample\",\n          \"clinicalStatus\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/condition-clinical\",\n                \"code\": \"active\"\n              }\n            ]\n          },\n          \"code\": {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"category\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/condition-category\",\n                  \"code\": \"problem-list-item\",\n                  \"display\": \"Problem List Item\"\n             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{\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n              \"valueReference\": {\n                \"reference\": \"Encounter/SurgicalEncounterExample\"\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n              \"extension\": [\n                {\n                  \"url\": \"applicationSenderCode\",\n                  \"valueString\": \"SND-0001\"\n              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 ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1337\",\n                        \"code\": \"2\",\n                        \"display\": \"Intermediate Care Facility (ICF)\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                  \"valueDecimal\": 100\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                  \"valueCode\": \"changed\"\n                },\n                {\n         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                 \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"X3\"\n                }\n              ]\n            }\n          ],\n          \"name\": \"DR. 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\"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            },\n            {\n              \"system\": \"http://davinci-pas.org/MEMBERID\",\n              \"value\": \"MEM-1234567\",\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                    \"code\": \"MB\",\n                    \"display\": \"Member 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\"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n                \"code\": \"EHCPOL\",\n                \"display\": \"extended healthcare\"\n              }\n            ]\n          },\n          \"period\": {\n            \"start\": \"2020-01-01\",\n            \"end\": \"2025-12-31\"\n          },\n          \"class\": [\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"group\",\n                    \"display\": \"Group\"\n                  }\n                ]\n              },\n              \"value\": \"GRP-001\",\n              \"name\": \"ACME GROUP\"\n            },\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"plan\",\n                    \"display\": \"Plan\"\n                  }\n                ]\n              },\n              \"value\": \"PLAN-001\",\n              \"name\": \"PREMIER PLAN\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n        \"resource\": {\n          \"resourceType\": \"Patient\",\n          \"id\": \"SubscriberExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/584\",\n                    \"code\": \"RU\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2106-3\",\n                    \"display\": \"White\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Caucasian\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2135-2\",\n                    \"display\": \"Hispanic or Latino\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Filipino\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n              \"valueCode\": \"M\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"12345678901\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"SMITH\",\n              \"given\": [\n                \"JOE\"\n              ],\n              \"prefix\": [\n                \"Mr\"\n              ],\n              \"suffix\": [\n                \"PharmD\"\n              ]\n            }\n          ],\n          \"gender\": \"male\",\n          \"birthDate\": \"1987-02-20\",\n          \"multipleBirthInteger\": 1,\n          \"communication\": [\n            {\n              \"language\": {\n                \"coding\": [\n                  {\n                    \"system\": \"urn:ietf:bcp:47\",\n                    \"code\": \"nl-NL\",\n                    \"display\": \"Dutch (Netherlands)\"\n                  }\n                ]\n              },\n              \"preferred\": true\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"555-555-5555\",\n              \"use\": \"home\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"49 Meadow St\"\n              ],\n              \"city\": \"Mounds\",\n              \"state\": \"OK\",\n              \"district\": \"Meadow\",\n              \"postalCode\": \"74047\",\n              \"country\": \"US\",\n              \"period\": {\n                \"start\": \"2016-12-06\",\n                \"end\": \"2020-07-22\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n        \"resource\": {\n          \"resourceType\": \"ServiceRequest\",\n          \"id\": \"ReferralRequestExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n            ]\n          },\n          \"status\": \"active\",\n          \"intent\": \"order\",\n          \"code\": {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/1365\",\n                \"code\": \"3\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          },\n          \"occurrenceTiming\": {\n            \"repeat\": {\n              \"duration\": 15,\n              \"durationMax\": 25,\n              \"durationUnit\": \"min\",\n              \"frequency\": 1,\n              \"frequencyMax\": 4,\n              \"period\": 1,\n              \"periodUnit\": \"d\"\n            }\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n              \"extension\": [\n                {\n                  \"url\": \"coverage\",\n                  \"valueReference\": {\n                    \"reference\": \"Coverage/InsuranceExample\"\n                  }\n                },\n                {\n                  \"url\": \"covered\",\n                  \"valueCode\": \"covered\"\n                },\n                {\n                  \"url\": \"pa-needed\",\n                  \"valueCode\": \"auth-needed\"\n                },\n                {\n                  \"url\": \"date\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"coverage-assertion-id\",\n                  \"valueString\": \"1122445\"\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"4\",\n                    \"display\": \"Diagnostic\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"quantityQuantity\": {\n            \"value\": 1,\n            \"unit\": \"visit\",\n            \"system\": \"http://unitsofmeasure.org\",\n            \"code\": \"1\"\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"location\": [\n            {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          ],\n          \"code\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                  \"code\": \"doctor\",\n                  \"display\": \"Doctor\"\n                }\n              ]\n            }\n          ],\n          \"specialty\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://snomed.info/sct\",\n                  \"code\": \"408443003\",\n                  \"display\": \"General medical practice\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"endpoint\": [\n            {\n              \"display\": \"Mock Endpoint\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"1234567893\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n        \"resource\": {\n          \"resourceType\": \"DocumentReference\",\n          \"id\": \"episode-summary\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"urn:ietf:rfc:3986\",\n              \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n            }\n          ],\n          \"status\": \"current\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://loinc.org\",\n                \"code\": \"34133-9\",\n                \"display\": \"Summary of episode note\"\n              }\n            ],\n            \"text\": \"CCD Document\"\n          },\n          \"category\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                  \"code\": \"clinical-note\",\n                  \"display\": \"Clinical Note\"\n                }\n              ],\n              \"text\": \"Clinical Note\"\n            }\n          ],\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"date\": \"2016-03-09T15:29:46Z\",\n          \"author\": [\n            {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            }\n          ],\n          \"description\": \"Pulmonology clinic acute visit\",\n          \"content\": [\n            {\n              \"attachment\": {\n                \"contentType\": \"text/plain\",\n                \"url\": \"/Binary/1-note\",\n                \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n              },\n              \"format\": {\n                \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n                \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n                \"display\": \"Documents following C-CDA constraints using a structured body\"\n              }\n            }\n          ],\n          \"context\": {\n            \"period\": {\n              \"start\": \"2004-12-23T08:00:00+11:00\",\n              \"end\": \"2004-12-23T08:01:00+11:00\"\n            }\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n        \"resource\": {\n          \"resourceType\": \"Encounter\",\n          \"id\": \"SurgicalEncounterExample\",\n          \"identifier\": [\n            {\n              \"use\": \"temp\",\n              \"system\": \"http://www.temp.com\",\n              \"value\": \"Encounter_SubscriberExample_20130404\"\n            }\n          ],\n          \"status\": \"planned\",\n          \"class\": {\n            \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n            \"code\": \"AMB\",\n            \"display\": \"ambulatory\"\n          },\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://snomed.info/sct\",\n                  \"code\": \"11429006\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            }\n          ],\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"17621005\",\n                \"display\": \"Normal\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"participant\": [\n            {\n              \"individual\": {\n                \"reference\": \"Practitioner/ReferralPractitionerExample\"\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                      \"code\": \"REF\"\n                    }\n                  ]\n                }\n              ],\n              \"period\": {\n                \"start\": \"2020-07-02\",\n                \"end\": \"2020-07-09\"\n              }\n            }\n          ],\n          \"reasonCode\": [\n            {\n              \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n            }\n          ],\n          \"period\": {\n            \"start\": \"2020-07-02\",\n            \"end\": \"2020-07-09\"\n          },\n          \"serviceProvider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"hospitalization\": {\n            \"admitSource\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                  \"code\": \"5\"\n                }\n              ]\n            },\n            \"dischargeDisposition\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                  \"code\": \"oth\"\n                }\n              ]\n            }\n          },\n          \"location\": [\n            {\n              \"location\": {\n                \"reference\": \"Location/ReferralLocationExample\"\n              }\n            }\n          ],\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n            ],\n            \"lastUpdated\": \"2021-09-10T12:00:00Z\"\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1351\",\n                    \"code\": \"1\",\n                    \"display\": \"Admitted\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1345\",\n                    \"code\": \"2\",\n                    \"display\": \"Newly Admitted\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"reasonReference\": [\n            {\n              \"reference\": \"Condition/EncounterDiagnosisExample\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PriorAuthorizationExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"PriorAuthorizationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-jurisdiction\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://www.usps.com/\",\n                        \"code\": \"MA\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-subDepartment\",\n                  \"valueString\": \"223412\"\n                }\n              ],\n              \"system\": \"http://utilization-management.com/identifiers\",\n              \"value\": \"AUTH-PRIOR-0001\"\n            }\n          ],\n          \"status\": \"active\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n                \"code\": \"professional\"\n              }\n            ]\n          },\n          \"use\": \"preauthorization\",\n          \"patient\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2021-01-01\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"insurance\": [\n            {\n              \"sequence\": 1,\n              \"focal\": true,\n              \"coverage\": {\n                \"reference\": \"Coverage/InsuranceExample\"\n              }\n            }\n          ],\n          \"item\": [\n            {\n              \"sequence\": 1,\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/data-absent-reason\",\n                    \"code\": \"not-applicable\"\n                  }\n                ]\n              },\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"HS\",\n                        \"display\": \"Health Services Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                }\n              ],\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"1\",\n                    \"display\": \"Medical Care\"\n                  }\n                ]\n              },\n              \"locationCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                    \"code\": \"11\",\n                    \"display\": \"Office\"\n                  }\n                ]\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Condition/EncounterDiagnosisExample\",\n        \"resource\": {\n          \"resourceType\": \"Condition\",\n          \"id\": \"EncounterDiagnosisExample\",\n          \"clinicalStatus\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/condition-clinical\",\n                \"code\": \"active\"\n              }\n            ]\n          },\n          \"code\": {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"category\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/condition-category\",\n                  \"code\": \"problem-list-item\",\n                  \"display\": \"Problem List Item\"\n                }\n              ]\n            }\n          ]\n        }\n      }\n    ]\n  }\n]"
+    },
+    {
+      "name": "must_support_pa_inquire_request_payload",
+      "description": "Insert an additional request bundle or a list of bundles (e.g. [bundle_1, bundle_2])",
+      "optional": true,
+      "title": "Additional PAS Inquire Request Payloads",
+      "type": "textarea",
+      "value": "[\n  {\n    \"resourceType\": \"Bundle\",\n    \"id\": \"PASBundleInquiryExample\",\n    \"meta\": {\n      \"profile\": [\n        \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n      ]\n    },\n    \"identifier\": {\n      \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n      \"value\": \"A12345\"\n    },\n    \"type\": \"collection\",\n    \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n    \"entry\": [\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"PASClaimInquiryExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-inquiry\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1322\",\n                    \"code\": \"I\",\n                    \"display\": \"Initial\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-TransmissionIdentifiers\",\n              \"extension\": [\n                {\n                  \"url\": \"applicationSenderCode\",\n                  \"valueString\": \"SND-0001\"\n                },\n                {\n                  \"url\": \"applicationReceiverCode\",\n                  \"valueString\": \"RCV-0001\"\n                },\n                {\n                  \"url\": \"interchangeSenderID\",\n                  \"valueString\": \"INTER-SND-0001\"\n                },\n                {\n                  \"url\": \"interchangeReceiverID\",\n                  \"valueString\": \"INTER-RCV-0001\"\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-conditionCode\",\n              \"extension\": [\n                {\n                  \"url\": \"category\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1136\",\n                        \"code\": \"07\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"indicator\",\n                  \"valueBoolean\": true\n                },\n                {\n                  \"url\": \"code\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1321\",\n                        \"code\": \"09\"\n                      }\n                    ]\n                  }\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-homeHealthCareInformation\",\n              \"extension\": [\n                {\n                  \"url\": \"prognosis\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/923\",\n                        \"code\": \"1\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"date\",\n                  \"valueDate\": \"2021-09-01\"\n                }\n              ]\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n              \"valueString\": \"AUTH-0001\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n              \"valueString\": \"ADMIN-REF-0001\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://www.usps.com/\",\n                        \"code\": \"MA\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                  \"valueString\": \"223412\"\n                }\n              ],\n              \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n              \"value\": \"111099\",\n              \"assigner\": {\n                \"identifier\": {\n                  \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                  \"value\": \"9012345678\"\n                }\n              }\n            }\n          ],\n          \"status\": \"active\",\n          \"billablePeriod\": {\n            \"start\": \"2016-12-06\",\n            \"end\": \"2020-07-22\"\n          },\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n                \"code\": \"professional\"\n              }\n            ]\n          },\n          \"use\": \"preauthorization\",\n          \"patient\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2005-05-02T11:01:00+05:00\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"careTeam\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": true\n                }\n              ],\n              \"sequence\": 1,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": 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\"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"diagnosis\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                  \"valueDate\": \"2021-05-10\"\n                }\n              ],\n              \"sequence\": 1,\n              \"diagnosisCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                    \"code\": \"G89.4\"\n                  }\n                ]\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": 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]\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"unitPrice\": {\n                \"value\": 1000,\n                \"currency\": \"USD\"\n              },\n              \"modifierExtension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                  \"valueBoolean\": false\n                }\n              ]\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n       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\"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n                  \"valueDate\": \"2022-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/306\",\n                        \"code\": \"A1\",\n                        \"display\": \"Certified in total\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": 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}\n            }\n          ],\n          \"supportingInfo\": [\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"freeFormMessage\",\n                    \"display\": \"Free Form Message\"\n                  }\n                ]\n              },\n              \"sequence\": 2,\n              \"valueString\": \"Prior authorization inquiry details provided\"\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"additionalInformation\",\n                    \"display\": \"Additional Information\"\n                  }\n                ]\n              },\n              \"sequence\": 1,\n              \"valueReference\": {\n     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\"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            },\n            {\n              \"system\": \"http://davinci-pas.org/MEMBERID\",\n              \"value\": \"MEM-1234567\",\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                    \"code\": \"MB\",\n                    \"display\": \"Member 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\"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n                \"code\": \"EHCPOL\",\n                \"display\": \"extended healthcare\"\n              }\n            ]\n          },\n          \"period\": {\n            \"start\": \"2020-01-01\",\n            \"end\": \"2025-12-31\"\n          },\n          \"class\": [\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"group\",\n                    \"display\": \"Group\"\n                  }\n                ]\n              },\n              \"value\": \"GRP-001\",\n              \"name\": \"ACME GROUP\"\n            },\n            {\n              \"type\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/coverage-class\",\n                    \"code\": \"plan\",\n     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             }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2106-3\",\n                    \"display\": \"White\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Caucasian\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2135-2\",\n                    \"display\": \"Hispanic or Latino\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Filipino\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n              \"valueCode\": \"M\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"12345678901\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"SMITH\",\n              \"given\": [\n                \"JOE\"\n              ],\n              \"prefix\": [\n                \"Mr\"\n              ],\n              \"suffix\": [\n                \"PharmD\"\n              ]\n            }\n          ],\n          \"gender\": \"male\",\n          \"birthDate\": \"1987-02-20\",\n          \"multipleBirthInteger\": 1,\n          \"communication\": [\n            {\n              \"language\": {\n                \"coding\": [\n                  {\n                    \"system\": \"urn:ietf:bcp:47\",\n                    \"code\": \"nl-NL\",\n                    \"display\": \"Dutch (Netherlands)\"\n                  }\n                ]\n              },\n              \"preferred\": true\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"555-555-5555\",\n              \"use\": \"home\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"49 Meadow St\"\n              ],\n              \"city\": \"Mounds\",\n              \"state\": \"OK\",\n              \"district\": \"Meadow\",\n              \"postalCode\": \"74047\",\n              \"country\": \"US\",\n              \"period\": {\n                \"start\": \"2016-12-06\",\n                \"end\": \"2020-07-22\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"location\": [\n            {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          ],\n          \"code\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                  \"code\": \"doctor\",\n                  \"display\": \"Doctor\"\n                }\n              ]\n            }\n          ],\n          \"specialty\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://snomed.info/sct\",\n                  \"code\": \"408443003\",\n                  \"display\": \"General medical practice\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"endpoint\": [\n            {\n              \"display\": \"Mock Endpoint\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"1234567893\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n        \"resource\": {\n          \"resourceType\": \"DocumentReference\",\n          \"id\": \"episode-summary\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"urn:ietf:rfc:3986\",\n              \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n            }\n          ],\n          \"status\": \"current\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://loinc.org\",\n                \"code\": \"34133-9\",\n                \"display\": \"Summary of episode note\"\n              }\n            ],\n            \"text\": \"CCD Document\"\n          },\n          \"category\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                  \"code\": \"clinical-note\",\n                  \"display\": \"Clinical Note\"\n                }\n              ],\n              \"text\": \"Clinical Note\"\n            }\n          ],\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"date\": \"2016-03-09T15:29:46Z\",\n          \"author\": [\n            {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            }\n          ],\n          \"description\": \"Pulmonology clinic acute visit\",\n          \"content\": [\n            {\n              \"attachment\": {\n                \"contentType\": \"text/plain\",\n                \"url\": \"/Binary/1-note\",\n                \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n              },\n              \"format\": {\n                \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n                \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n                \"display\": \"Documents following C-CDA constraints using a structured body\"\n              }\n            }\n          ],\n          \"context\": {\n            \"period\": {\n              \"start\": \"2004-12-23T08:00:00+11:00\",\n              \"end\": \"2004-12-23T08:01:00+11:00\"\n            }\n          }\n        }\n      }\n    ]\n  }\n]"
+    },
+    {
+      "name": "claim_update_initial_submit_payload",
+      "description": "An example PAS Claim Update $submit request Bundle that Inferno will send to the server under test during the Claim Updates workflow.",
+      "title": "PAS $submit Payload: Initial Claim",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"ClaimUpdateInitialExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              }\n            ],\n            \"sequence\": 1,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            }\n          }\n        ],\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"additionalInformation\",\n                  \"display\": \"Additional Information\"\n                }\n              ]\n            },\n            \"sequence\": 1,\n            \"valueReference\": {\n              \"reference\": \"DocumentReference/episode-summary\"\n            },\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                \"extension\": [\n                  {\n                    \"url\": \"reportTypeCode\",\n                    \"valueCodeableConcept\": {\n                      \"coding\": [\n                        {\n                          \"system\": \"https://codesystem.x12.org/005010/755\",\n                          \"code\": \"EB\"\n                        }\n                      ]\n                    }\n                  }\n                ]\n              }\n            ]\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"freeFormMessage\",\n                  \"display\": \"Free Form Message\"\n                }\n              ]\n            },\n            \"sequence\": 2,\n            \"valueString\": \"1\"\n          }\n        ],\n        \"accident\": {\n          \"date\": \"2016-03-09\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"UMOExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"8189991234\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"8189948234\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-UMO\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"X3\"\n              }\n            ]\n          }\n        ],\n        \"name\": \"DR. JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"InsurerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"7893120007\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"7239994834\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-Insurer\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          },\n          {\n            \"system\": \"http://davinci-pas.org/MEMBERID\",\n            \"value\": \"MEM-1234567\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                  \"code\": \"MB\",\n                  \"display\": \"Member Number\"\n                }\n              ]\n            }\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            }\n          ]\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n      \"resource\": {\n        \"resourceType\": \"Patient\",\n        \"id\": \"SubscriberExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/584\",\n                  \"code\": \"RU\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2106-3\",\n                  \"display\": \"White\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Caucasian\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2135-2\",\n                  \"display\": \"Hispanic or Latino\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Filipino\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n            \"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"ServiceRequest\",\n        \"id\": \"ReferralRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"code\": {\n          \"coding\": [\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1365\",\n              \"code\": \"3\",\n              \"display\": \"Consultation\"\n            }\n          ]\n        },\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          }\n        ],\n        \"quantityQuantity\": {\n          \"value\": 1,\n          \"unit\": \"visit\",\n          \"system\": \"http://unitsofmeasure.org\",\n          \"code\": \"1\"\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ],\n        \"code\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                \"code\": \"doctor\",\n                \"display\": \"Doctor\"\n              }\n            ]\n          }\n        ],\n        \"specialty\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"408443003\",\n                \"display\": \"General medical practice\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"endpoint\": [\n          {\n            \"display\": \"Mock Endpoint\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n      \"resource\": {\n        \"resourceType\": \"Practitioner\",\n        \"id\": \"ReferralPractitionerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ]\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "claim_update_add_item_submit_payload",
+      "description": "An example PAS Claim Update $submit request Bundle that Inferno will send to the server under test during the Claim Updates workflow.",
+      "title": "PAS $submit Payload: Update Adding an Item",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"ClaimUpdateAddItemExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate1\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationUpdate1\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              }\n            ],\n            \"sequence\": 1,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122335\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"added\"\n              }\n            ],\n            \"sequence\": 2,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            }\n          }\n        ],\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"additionalInformation\",\n                  \"display\": \"Additional Information\"\n                }\n              ]\n            },\n            \"sequence\": 1,\n            \"valueReference\": {\n              \"reference\": \"DocumentReference/episode-summary\"\n            },\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                \"extension\": [\n                  {\n                    \"url\": \"reportTypeCode\",\n                    \"valueCodeableConcept\": {\n                      \"coding\": [\n                        {\n                          \"system\": \"https://codesystem.x12.org/005010/755\",\n                          \"code\": \"EB\"\n                        }\n                      ]\n                    }\n                  }\n                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{\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          },\n          {\n            \"system\": \"http://davinci-pas.org/MEMBERID\",\n            \"value\": \"MEM-1234567\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                  \"code\": \"MB\",\n                  \"display\": \"Member Number\"\n                }\n              ]\n            }\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            }\n          ]\n        }\n      }\n    },\n    {\n      \"fullUrl\": 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\"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"ServiceRequest\",\n        \"id\": \"ReferralRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"code\": {\n          \"coding\": [\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1365\",\n              \"code\": \"3\",\n              \"display\": \"Consultation\"\n            }\n          ]\n        },\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          }\n        ],\n        \"quantityQuantity\": {\n          \"value\": 1,\n          \"unit\": \"visit\",\n          \"system\": \"http://unitsofmeasure.org\",\n          \"code\": \"1\"\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": 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   \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ]\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "claim_update_modify_cancel_submit_payload",
+      "description": "An example PAS Claim Update $submit request Bundle that Inferno will send to the server under test during the Claim Updates workflow.",
+      "title": "PAS $submit Payload: Update Modifying and Canceling Items",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"ClaimUpdateModifyCancelExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate2\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationUpdate2\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"sequence\": 1,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-09-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122335\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"3\",\n                      \"display\": \"Cancel\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"sequence\": 2,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            },\n            \"modifierExtension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                \"valueBoolean\": true\n              }\n            ]\n          }\n        ],\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"additionalInformation\",\n                  \"display\": \"Additional Information\"\n                }\n              ]\n            },\n            \"sequence\": 1,\n            \"valueReference\": {\n              \"reference\": \"DocumentReference/episode-summary\"\n            },\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                \"extension\": [\n                  {\n                    \"url\": \"reportTypeCode\",\n                    \"valueCodeableConcept\": {\n                      \"coding\": [\n                        {\n                          \"system\": \"https://codesystem.x12.org/005010/755\",\n                          \"code\": \"EB\"\n                        }\n                      ]\n                    }\n                  }\n                ]\n              }\n            ]\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"freeFormMessage\",\n                  \"display\": \"Free Form Message\"\n                }\n              ]\n            },\n            \"sequence\": 2,\n            \"valueString\": \"1\"\n          }\n        ],\n        \"accident\": {\n          \"date\": \"2016-03-09\"\n        },\n        \"related\": [\n          {\n            \"claim\": {\n              \"reference\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate1\"\n            },\n            \"relationship\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship\",\n                  \"code\": \"prior\"\n                }\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate1\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationUpdate1\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n        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{\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122335\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": 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            \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"added\"\n              }\n            ],\n            \"sequence\": 2,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": 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\"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            }\n          }\n        ],\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"additionalInformation\",\n                  \"display\": \"Additional Information\"\n                }\n              ]\n            },\n            \"sequence\": 1,\n            \"valueReference\": {\n              \"reference\": 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\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"8189991234\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"8189948234\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-UMO\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"X3\"\n              }\n            ]\n          }\n        ],\n        \"name\": \"DR. JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"InsurerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"7893120007\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"7239994834\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-Insurer\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          },\n          {\n            \"system\": \"http://davinci-pas.org/MEMBERID\",\n            \"value\": \"MEM-1234567\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                  \"code\": \"MB\",\n                  \"display\": \"Member Number\"\n                }\n              ]\n            }\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            }\n          ]\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n      \"resource\": {\n        \"resourceType\": \"Patient\",\n        \"id\": \"SubscriberExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/584\",\n                  \"code\": \"RU\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2106-3\",\n                 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\"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"ServiceRequest\",\n        \"id\": \"ReferralRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"code\": {\n          \"coding\": [\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1365\",\n              \"code\": \"3\",\n              \"display\": \"Consultation\"\n            }\n          ]\n        },\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          }\n        ],\n        \"quantityQuantity\": {\n          \"value\": 1,\n          \"unit\": \"visit\",\n          \"system\": \"http://unitsofmeasure.org\",\n          \"code\": \"1\"\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ],\n        \"code\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                \"code\": \"doctor\",\n                \"display\": \"Doctor\"\n              }\n            ]\n          }\n        ],\n        \"specialty\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"408443003\",\n                \"display\": \"General medical practice\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"endpoint\": [\n          {\n            \"display\": \"Mock Endpoint\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n      \"resource\": {\n        \"resourceType\": \"Practitioner\",\n        \"id\": \"ReferralPractitionerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"1234567893\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ]\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "claim_update_cancel_all_submit_payload",
+      "description": "An example PAS Claim Update $submit request Bundle that Inferno will send to the server under test during the Claim Updates workflow.",
+      "title": "PAS $submit Payload: Update Canceling the Entire Request",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"ClaimUpdateCancelAllExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate3\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationUpdate3\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1322\",\n                  \"code\": \"3\",\n                  \"display\": \"Cancel\"\n                }\n              ]\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"additionalInformation\",\n                  \"display\": \"Additional Information\"\n                }\n              ]\n            },\n            \"sequence\": 1,\n            \"valueReference\": {\n              \"reference\": \"DocumentReference/episode-summary\"\n            },\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-documentInformation\",\n                \"extension\": [\n                  {\n                    \"url\": \"reportTypeCode\",\n                    \"valueCodeableConcept\": {\n                      \"coding\": [\n                        {\n                          \"system\": \"https://codesystem.x12.org/005010/755\",\n                          \"code\": \"EB\"\n                        }\n                      ]\n                    }\n                  }\n                ]\n              }\n            ]\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"freeFormMessage\",\n                  \"display\": \"Free Form Message\"\n                }\n              ]\n            },\n            \"sequence\": 2,\n            \"valueString\": \"1\"\n          }\n        ],\n        \"accident\": {\n          \"date\": \"2016-03-09\"\n        },\n        \"related\": [\n          {\n            \"claim\": {\n              \"reference\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate2\"\n            },\n            \"relationship\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship\",\n                  \"code\": \"prior\"\n                }\n              ]\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"sequence\": 1,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-09-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122335\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"3\",\n                      \"display\": \"Cancel\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"sequence\": 2,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            },\n            \"modifierExtension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/modifierextension-infoCancelled\",\n                \"valueBoolean\": true\n              }\n            ]\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationUpdate2\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"ReferralAuthorizationUpdate2\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim-update\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n            \"valueReference\": {\n              \"reference\": \"Encounter/SurgicalEncounterExample\"\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"SC\",\n                      \"display\": \"Specialty Care Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n        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\"code\": \"3\",\n                      \"display\": \"Cancel\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                \"valueReference\": {\n                  \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                \"valueBoolean\": false\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1345\",\n                      \"code\": \"2\",\n                      \"display\": \"Newly Admitted\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1337\",\n                      \"code\": \"2\",\n                      \"display\": \"Intermediate Care Facility (ICF)\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                \"valueDecimal\": 100\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-infoChanged\",\n                \"valueCode\": \"changed\"\n              }\n            ],\n            \"sequence\": 2,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"unitPrice\": {\n              \"value\": 1000,\n              \"currency\": \"USD\"\n            },\n            \"quantity\": {\n     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\"value\": \"8189948234\"\n          },\n          {\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType\",\n                  \"code\": \"payerid\"\n                }\n              ]\n            },\n            \"system\": \"http://davinci-pas.org/fhir/payer-id\",\n            \"value\": \"PI-UMO\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"X3\"\n              }\n            ]\n          }\n        ],\n        \"name\": \"DR. JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n   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{\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          },\n          {\n            \"system\": \"http://davinci-pas.org/MEMBERID\",\n            \"value\": \"MEM-1234567\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/v2-0203\",\n                  \"code\": \"MB\",\n                  \"display\": \"Member Number\"\n                }\n              ]\n            }\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            }\n          ]\n        }\n      }\n    },\n    {\n      \"fullUrl\": 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\"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n      \"resource\": {\n        \"resourceType\": \"ServiceRequest\",\n        \"id\": \"ReferralRequestExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n          ]\n        },\n        \"status\": \"active\",\n        \"intent\": \"order\",\n        \"code\": {\n          \"coding\": [\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1365\",\n              \"code\": \"3\",\n              \"display\": \"Consultation\"\n            }\n          ]\n        },\n        \"occurrenceTiming\": {\n          \"repeat\": {\n            \"duration\": 15,\n            \"durationMax\": 25,\n            \"durationUnit\": \"min\",\n            \"frequency\": 1,\n            \"frequencyMax\": 4,\n            \"period\": 1,\n            \"periodUnit\": \"d\"\n          }\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n            \"extension\": [\n              {\n                \"url\": \"coverage\",\n                \"valueReference\": {\n                  \"reference\": \"Coverage/InsuranceExample\"\n                }\n              },\n              {\n                \"url\": \"covered\",\n                \"valueCode\": \"covered\"\n              },\n              {\n                \"url\": \"pa-needed\",\n                \"valueCode\": \"auth-needed\"\n              },\n              {\n                \"url\": \"date\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"coverage-assertion-id\",\n                \"valueString\": \"1122445\"\n              }\n            ]\n          }\n        ],\n        \"quantityQuantity\": {\n          \"value\": 1,\n          \"unit\": \"visit\",\n          \"system\": \"http://unitsofmeasure.org\",\n          \"code\": \"1\"\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ],\n        \"code\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/practitioner-role\",\n                \"code\": \"doctor\",\n                \"display\": \"Doctor\"\n              }\n            ]\n          }\n        ],\n        \"specialty\": [\n          {\n            \"coding\": [\n              {\n                \"system\": 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   \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n      \"resource\": {\n        \"resourceType\": \"DocumentReference\",\n        \"id\": \"episode-summary\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"urn:ietf:rfc:3986\",\n            \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n          }\n        ],\n        \"status\": \"current\",\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://loinc.org\",\n              \"code\": \"34133-9\",\n              \"display\": \"Summary of episode note\"\n            }\n          ],\n          \"text\": \"CCD Document\"\n        },\n        \"category\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                \"code\": \"clinical-note\",\n                \"display\": \"Clinical Note\"\n              }\n            ],\n            \"text\": \"Clinical Note\"\n          }\n        ],\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"date\": \"2016-03-09T15:29:46Z\",\n        \"author\": [\n          {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        ],\n        \"description\": \"Pulmonology clinic acute visit\",\n        \"content\": [\n          {\n            \"attachment\": {\n              \"contentType\": \"text/plain\",\n              \"url\": \"/Binary/1-note\",\n              \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n            },\n            \"format\": {\n              \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n              \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n              \"display\": \"Documents following C-CDA constraints using a structured body\"\n            }\n          }\n        ],\n        \"context\": {\n          \"period\": {\n            \"start\": \"2004-12-23T08:00:00+11:00\",\n            \"end\": \"2004-12-23T08:01:00+11:00\"\n          }\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n      \"resource\": {\n        \"resourceType\": \"Encounter\",\n        \"id\": \"SurgicalEncounterExample\",\n        \"identifier\": [\n          {\n            \"use\": \"temp\",\n            \"system\": \"http://www.temp.com\",\n            \"value\": \"Encounter_SubscriberExample_20130404\"\n          }\n        ],\n        \"status\": \"planned\",\n        \"class\": {\n          \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n          \"code\": \"AMB\",\n          \"display\": \"ambulatory\"\n        },\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"11429006\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          }\n        ],\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://snomed.info/sct\",\n              \"code\": \"17621005\",\n              \"display\": \"Normal\"\n            }\n          ]\n        },\n        \"subject\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"participant\": [\n          {\n            \"individual\": {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                    \"code\": \"REF\"\n                  }\n                ]\n              }\n            ],\n            \"period\": {\n              \"start\": \"2020-07-02\",\n              \"end\": \"2020-07-09\"\n            }\n          }\n        ],\n        \"reasonCode\": [\n          {\n            \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n          }\n        ],\n        \"period\": {\n          \"start\": \"2020-07-02\",\n          \"end\": \"2020-07-09\"\n        },\n        \"serviceProvider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"hospitalization\": {\n          \"admitSource\": {\n            \"coding\": [\n              {\n                \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                \"code\": \"5\"\n              }\n            ]\n          },\n          \"dischargeDisposition\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                \"code\": \"oth\"\n              }\n            ]\n          }\n        },\n        \"location\": [\n          {\n            \"location\": {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          }\n        ]\n      }\n    }\n  ]\n}"
+    }
+  ]
+}