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Source1

{
  "resourceType": "Parameters",
  "id": "cdex-parameters-example5",
  "parameter": [
    {
      "name": "TrackingId",
      "valueIdentifier": {
        "system": "http://example.org/payer-acns",
        "value": "trackingid1012"
      }
    },
    {
      "name": "AdminRefNumber",
      "valueIdentifier": {
        "system": "http://example.org/payer-refnos",
        "value": "adminrefnumber4657"
      }
    },
    {
      "name": "AttachTo",
      "valueCode": "preauthorization"
    },
    {
      "name": "PayerId",
      "valueIdentifier": {
        "system": "http://example.org/cdex/payer/payer-ids",
        "value": "payer123"
      }
    },
    {
      "name": "OrganizationId",
      "valueIdentifier": {
        "system": "http://hl7.org/fhir/sid/us-npi",
        "value": "1234567893"
      }
    },
    {
      "name": "ProviderId",
      "valueIdentifier": {
        "system": "http://hl7.org/fhir/sid/us-npi",
        "value": "9941339100"
      }
    },
    {
      "name": "MemberId",
      "valueIdentifier": {
        "system": "http://example.org/cdex/payer/member-ids",
        "value": "Member123"
      }
    },
    {
      "name": "Attachment",
      "part": [
        {
          "name": "LineItem",
          "valueString": "1"
        },
        {
          "name": "Content",
          "resource": {
            "resourceType": "QuestionnaireResponse",
            "id": "cdex-questionnaireresponse-example1",
            "questionnaire": "http://example.org/cdex-questionnaire-example1",
            "status": "completed",
            "subject": {
              "identifier": {
                "use": "usual",
                "type": {
                  "coding": [
                    {
                      "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code": "MB",
                      "display": "Member Number"
                    }
                  ],
                  "text": "Member Number"
                },
                "system": "http://example.org/cdex/payer/member-ids",
                "value": "Member123"
              },
              "display": "Amy Shaw"
            },
            "authored": "2022-06-17",
            "author": {
              "identifier": {
                "system": "http://hl7.org/fhir/sid/us-npi",
                "value": "9941339100"
              }
            },
            "item": [
              {
                "linkId": "1",
                "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
                "answer": [
                  {
                    "valueString": "Examplitis"
                  }
                ]
              },
              {
                "linkId": "2",
                "text": "Order Reason",
                "answer": [
                  {
                    "valueCoding": {
                      "system": "http://example.org",
                      "code": "4",
                      "display": "Replacement"
                    }
                  }
                ]
              }
            ]
          }
        }
      ]
    }
  ]
}