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Source1

{
  "resourceType": "Parameters",
  "id": "QuestionnairePackageInputParamsExample",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-input-parameters"
    ]
  },
  "parameter": [
    {
      "name": "coverage",
      "resource": {
        "resourceType": "Coverage",
        "id": "CoverageExample",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage|2.1.0"
          ]
        },
        "contained": [
          {
            "resourceType": "Organization",
            "id": "OrgExample",
            "meta": {
              "profile": [
                "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-organization|2.1.0"
              ]
            },
            "identifier": [
              {
                "system": "urn:oid:2.16.840.1.113883.4.7",
                "value": "10D0202020"
              }
            ],
            "active": true,
            "type": [
              {
                "coding": [
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/organization-type",
                    "code": "pay",
                    "display": "Payer"
                  }
                ]
              }
            ],
            "name": "Insurance Company",
            "telecom": [
              {
                "system": "phone",
                "value": "860-547-5001",
                "use": "work"
              }
            ],
            "address": [
              {
                "line": [
                  "680 Asylum Street"
                ],
                "city": "Hartford",
                "state": "CT",
                "postalCode": "06155",
                "country": "US"
              }
            ]
          }
        ],
        "status": "active",
        "subscriber": {
          "reference": "Patient/examplepatient"
        },
        "subscriberId": "PFP123450000",
        "beneficiary": {
          "reference": "Patient/examplepatient"
        },
        "relationship": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
              "code": "self",
              "display": "Self"
            }
          ]
        },
        "period": {
          "start": "2022-01-01",
          "end": "2023-01-01"
        },
        "payor": [
          {
            "reference": "#OrgExample"
          }
        ],
        "class": [
          {
            "type": {
              "coding": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/coverage-class",
                  "code": "plan",
                  "display": "Plan"
                }
              ]
            },
            "value": "Premim Family Plus",
            "name": "Premim Family Plus Plan"
          }
        ]
      }
    },
    {
      "name": "order",
      "resource": {
        "resourceType": "ServiceRequest",
        "id": "ServiceRequestExample",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest|2.1.0"
          ]
        },
        "status": "active",
        "intent": "original-order",
        "code": {
          "coding": [
            {
              "system": "http://loinc.org",
              "code": "24338-6"
            }
          ],
          "text": "Gas panel - Blood"
        },
        "subject": {
          "reference": "Patient/examplepatient"
        },
        "occurrenceDateTime": "2019-05-08T09:33:27+07:00",
        "authoredOn": "2019-09-18T07:53:21+07:00",
        "requester": {
          "reference": "Practitioner/PractitionerExample"
        },
        "reasonCode": [
          {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "4565000"
              }
            ],
            "text": "Decreased oxygen affinity"
          }
        ]
      }
    },
    {
      "name": "questionnaire",
      "valueCanonical": "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire|2.1.0"
    }
  ]
}