Currently, Support X12 as a baseline capability using the request model of LOINC attachment codes and the provider can submit a CCDA or PDF back.   We will align with DTR functionality and. provide the ability to address attachment data more precisely. CDex attachments will support the use of LOINC Document Type codes, particularly where X12 transactions are part of the interactions, and include the ability to use Questionnaire, CQL, and QuestionnaireResponse as supported by DTR when there is no transition into/out of X12 transactions in the interactions. This is achieved by including a URL to a FHIR Questionnaire in the request instead of a LOINC Document Type code. That approach will enable requests for very specific missing data, avoid a document format where not needed, yet still provides the ability to have a signature for the provider to attest to the content where that is required by a payer, which not all will require, nor require a document formatted attachment. Technically will add an element for a URL to a FHIR Questionnaire and the provider responds by submitting the completed QuestionnaireResponse. For Task-based queries it the same as above except the provider updates Task and references QuestionnaireResponse in the Task.output.   (Use the extension http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature for signed responses)   For high-level summary see attached