@prefix fhir: <http://hl7.org/fhir/> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/sct/> .

# - resource -------------------------------------------------------------------

[] a fhir:CodeSystem;
  fhir:Resource.id [ fhir:value "v3-AmericanIndianAlaskaNativeLanguages"];
  fhir:Resource.language [ fhir:value "en"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ]
  ];
  fhir:CodeSystem.url [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-AmericanIndianAlaskaNativeLanguages"];
  fhir:CodeSystem.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ];
     fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.5.1054" ]
  ];
  fhir:CodeSystem.version [ fhir:value "3.0.0"];
  fhir:CodeSystem.name [ fhir:value "AmericanIndianAlaskaNativeLanguages"];
  fhir:CodeSystem.title [ fhir:value "AmericanIndianAlaskaNativeLanguages"];
  fhir:CodeSystem.status [ fhir:value "active"];
  fhir:CodeSystem.experimental [ fhir:value "false"];
  fhir:CodeSystem.date [ fhir:value "2019-03-20"];
  fhir:CodeSystem.publisher [ fhir:value "Health Level Seven International"];
  fhir:CodeSystem.contact [
     fhir:index 0;
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://hl7.org" ]
     ], [
       fhir:index 1;
       fhir:ContactPoint.system [ fhir:value "email" ];
       fhir:ContactPoint.value [ fhir:value "hq@HL7.org" ]
     ]
  ];
  fhir:CodeSystem.description [ fhir:value "American Indian and Alaska Native languages currently being used in the United States."];
  fhir:CodeSystem.copyright [ fhir:value "This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license"];
  fhir:CodeSystem.caseSensitive [ fhir:value "true"];
  fhir:CodeSystem.hierarchyMeaning [ fhir:value "is-a"];
  fhir:CodeSystem.content [ fhir:value "complete"];
  fhir:CodeSystem.property [
     fhir:index 0;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-symmetry" ];
       fhir:Extension.value [ fhir:value "antisymmetric" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-transitivity" ];
       fhir:Extension.value [ fhir:value "transitive" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-reflexivity" ];
       fhir:Extension.value [ fhir:value "irreflexive" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-isNavigable" ];
       fhir:Extension.value [ fhir:value "true" ]
     ], [
       fhir:index 4;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-relationshipKind" ];
       fhir:Extension.value [ fhir:value "Specializes" ]
     ], [
       fhir:index 5;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-inverseName" ];
       fhir:Extension.value [ fhir:value "Generalizes" ]
     ];
     fhir:CodeSystem.code [ fhir:value "Specializes" ];
     fhir:CodeSystem.description [ fhir:value "The child code is a more narrow version of the concept represented by the parent code.  I.e. Every child concept is also a valid parent concept.  Used to allow determination of subsumption.  Must be transitive, irreflexive, antisymmetric." ];
     fhir:CodeSystem.type [ fhir:value "Coding" ]
  ], [
     fhir:index 1;
     fhir:Element.extension [
       fhir:index 0;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-symmetry" ];
       fhir:Extension.value [ fhir:value "antisymmetric" ]
     ], [
       fhir:index 1;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-transitivity" ];
       fhir:Extension.value [ fhir:value "transitive" ]
     ], [
       fhir:index 2;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-reflexivity" ];
       fhir:Extension.value [ fhir:value "irreflexive" ]
     ], [
       fhir:index 3;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-isNavigable" ];
       fhir:Extension.value [ fhir:value "true" ]
     ], [
       fhir:index 4;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-relationshipKind" ];
       fhir:Extension.value [ fhir:value "Generalizes" ]
     ], [
       fhir:index 5;
       fhir:Extension.url [ fhir:value "http://terminology.hl7.org/StructureDefinition/ext-mif-relationship-inverseName" ];
       fhir:Extension.value [ fhir:value "Specializes" ]
     ];
     fhir:CodeSystem.code [ fhir:value "Generalizes" ];
     fhir:CodeSystem.description [ fhir:value "Inverse of Specializes.  Only included as a derived relationship." ];
     fhir:CodeSystem.type [ fhir:value "Coding" ]
  ], [
     fhir:index 2;
     fhir:CodeSystem.code [ fhir:value "internalId" ];
     fhir:CodeSystem.uri [ fhir:value "http://terminology.hl7.org/CodeSystem/utg-concept-properties#v3-internal-id" ];
     fhir:CodeSystem.description [ fhir:value "The internal identifier for the concept in the HL7 Access database repository." ];
     fhir:CodeSystem.type [ fhir:value "code" ]
  ], [
     fhir:index 3;
     fhir:CodeSystem.code [ fhir:value "notSelectable" ];
     fhir:CodeSystem.uri [ fhir:value "http://hl7.org/fhir/concept-properties#notSelectable" ];
     fhir:CodeSystem.description [ fhir:value "Indicates that the code is abstract - only intended to be used as a selector for other concepts" ];
     fhir:CodeSystem.type [ fhir:value "boolean" ]
  ], [
     fhir:index 4;
     fhir:CodeSystem.code [ fhir:value "status" ];
     fhir:CodeSystem.uri [ fhir:value "http://hl7.org/fhir/concept-properties#status" ];
     fhir:CodeSystem.description [ fhir:value "Designation of a concept's state. Normally is not populated unless the state is retired." ];
     fhir:CodeSystem.type [ fhir:value "code" ]
  ];
  fhir:CodeSystem.concept [
     fhir:index 0;
     fhir:CodeSystem.code [ fhir:value "_Algic" ];
     fhir:CodeSystem.display [ fhir:value "Algic" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Algic" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Algic" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20952" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Algonquian" ];
       fhir:CodeSystem.display [ fhir:value "Algonquian" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Algonquian" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Algonquian" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Algonquian" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20953" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Arapahoan" ];
         fhir:CodeSystem.display [ fhir:value "Arapahoan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arapahoan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arapahoan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arapahoan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arapahoan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20955" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_ArapahoGrosVentre" ];
           fhir:CodeSystem.display [ fhir:value "ArapahoGrosVentre" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ArapahoGrosVentre" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ArapahoGrosVentre" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ArapahoGrosVentre" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ArapahoGrosVentre" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ArapahoGrosVentre" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20956" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-ARP" ];
             fhir:CodeSystem.display [ fhir:value "Arapaho" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arrapahoe" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arapaho" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arapaho" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arapaho" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arapaho" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arapaho" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18151" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-ATS" ];
             fhir:CodeSystem.display [ fhir:value "Gros Ventre" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "A'ananin" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahahnelin" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahe" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Atsina" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Fall Indians" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "White Clay People" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Gros Ventre" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Gros Ventre" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Gros Ventre" ]
             ], [
               fhir:index 9;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Gros Ventre" ]
             ], [
               fhir:index 10;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Gros Ventre" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18144" ]
             ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "_CreeMontagnais" ];
         fhir:CodeSystem.display [ fhir:value "CreeMontagnais" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CreeMontagnais" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CreeMontagnais" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CreeMontagnais" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CreeMontagnais" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20972" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_Cree" ];
           fhir:CodeSystem.display [ fhir:value "Cree" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cree" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cree" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cree" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cree" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cree" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20971" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-CRP" ];
             fhir:CodeSystem.display [ fhir:value "Western Cree" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mitchif" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Plains Cree" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Swampy Cree" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Woods Cree" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Cree" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Cree" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Cree" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Cree" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Cree" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18137" ]
             ]
           ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "_EasternAlgonquin" ];
         fhir:CodeSystem.display [ fhir:value "EasternAlgonquin" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "EasternAlgonquin" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "EasternAlgonquin" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "EasternAlgonquin" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "EasternAlgonquin" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20979" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_Abenakian" ];
           fhir:CodeSystem.display [ fhir:value "Abenakian" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Abenakian" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Abenakian" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Abenakian" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Abenakian" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Abenakian" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20950" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-AAQ" ];
             fhir:CodeSystem.display [ fhir:value "Eastern Abenaki" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Eastern Abnaki" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Penobscot" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Eastern Abenaki" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Eastern Abenaki" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Eastern Abenaki" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Eastern Abenaki" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Eastern Abenaki" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18177" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-ABE" ];
             fhir:CodeSystem.display [ fhir:value "Western Abenaki" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Abenaki" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Abenaqui" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "St. Francis" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Abenaki" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Abenaki" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Abenaki" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Abenaki" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Western Abenaki" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18180" ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "x-MAC" ];
             fhir:CodeSystem.display [ fhir:value "Maliseet-Passamaquoddy" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Malecite-Passamaquoddy" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maliseet-Passamaquoddy" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maliseet-Passamaquoddy" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maliseet-Passamaquoddy" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maliseet-Passamaquoddy" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maliseet-Passamaquoddy" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18175" ]
             ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "_Delawaran" ];
           fhir:CodeSystem.display [ fhir:value "Delawaran" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Delawaran" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Delawaran" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Delawaran" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Delawaran" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Delawaran" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20975" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-DEL" ];
             fhir:CodeSystem.display [ fhir:value "Unami Delaware" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Delaware" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lenape" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lenni-Lenape" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Unami Delaware" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Unami Delaware" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Unami Delaware" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Unami Delaware" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Unami Delaware" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18185" ]
             ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "x-MIC" ];
           fhir:CodeSystem.display [ fhir:value "Micmac" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Restigouche" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Micmac" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Micmac" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Micmac" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Micmac" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18172" ]
           ]
         ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.code [ fhir:value "_Ojibwayan" ];
         fhir:CodeSystem.display [ fhir:value "Ojibwayan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ojibwayan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ojibwayan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ojibwayan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ojibwayan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21003" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-OJB" ];
           fhir:CodeSystem.display [ fhir:value "Southern Ojibwa" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Chippewa" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mississippi Ojibwa" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Saulteaux" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Western Ojibwa" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Southern Ojibwa" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Southern Ojibwa" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Southern Ojibwa" ]
           ], [
             fhir:index 7;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Southern Ojibwa" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18157" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-POT" ];
           fhir:CodeSystem.display [ fhir:value "Potawatami" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pottawotomi" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Potawatami" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Potawatami" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Potawatami" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Potawatami" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18162" ]
           ]
         ]
       ], [
         fhir:index 4;
         fhir:CodeSystem.code [ fhir:value "_SaukFoxKickapoo" ];
         fhir:CodeSystem.display [ fhir:value "SaukFoxKickapoo" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SaukFoxKickapoo" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SaukFoxKickapoo" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SaukFoxKickapoo" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SaukFoxKickapoo" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21016" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-KIC" ];
           fhir:CodeSystem.display [ fhir:value "Kickapoo" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kikapu" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kickapoo" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kickapoo" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kickapoo" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kickapoo" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18168" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-SAC" ];
           fhir:CodeSystem.display [ fhir:value "Mesquakie" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Sac and Fox" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Sauk-Fox" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mesquakie" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mesquakie" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mesquakie" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mesquakie" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18165" ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "x-SJW" ];
           fhir:CodeSystem.display [ fhir:value "Shawnee" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shawnee" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shawnee" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shawnee" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shawnee" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18170" ]
           ]
         ]
       ], [
         fhir:index 5;
         fhir:CodeSystem.code [ fhir:value "x-BLC" ];
         fhir:CodeSystem.display [ fhir:value "Blackfoot" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Pikanii" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Blackfoot" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Blackfoot" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Blackfoot" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18133" ]
         ]
       ], [
         fhir:index 6;
         fhir:CodeSystem.code [ fhir:value "x-CHY" ];
         fhir:CodeSystem.display [ fhir:value "Cheyenne" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cheyenne" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cheyenne" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cheyenne" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18153" ]
         ]
       ], [
         fhir:index 7;
         fhir:CodeSystem.code [ fhir:value "x-MEZ" ];
         fhir:CodeSystem.display [ fhir:value "Menominee" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Menomini" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Menominee" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Menominee" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Menominee" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18154" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_Ritwan" ];
       fhir:CodeSystem.display [ fhir:value "Ritwan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Ritwan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Ritwan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Ritwan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21012" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-YUR" ];
         fhir:CodeSystem.display [ fhir:value "Yurok" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yurok" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yurok" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yurok" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18190" ]
         ]
       ]
     ]
  ], [
     fhir:index 1;
     fhir:CodeSystem.code [ fhir:value "_Caddoan" ];
     fhir:CodeSystem.display [ fhir:value "Caddoan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Caddoan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Caddoan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20959" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_NorthernCaddoan" ];
       fhir:CodeSystem.display [ fhir:value "NorthernCaddoan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "NorthernCaddoan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "NorthernCaddoan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "NorthernCaddoan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21000" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-ARI" ];
         fhir:CodeSystem.display [ fhir:value "Arikara" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arikaree" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arikari" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arikaris" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ree" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ris" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arikara" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arikara" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Arikara" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18225" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-PAW" ];
         fhir:CodeSystem.display [ fhir:value "Pawnee" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Pawnee" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Pawnee" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Pawnee" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18231" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-WIC" ];
         fhir:CodeSystem.display [ fhir:value "Wichita" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wichita" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wichita" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wichita" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18232" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_SouthernCaddoan" ];
       fhir:CodeSystem.display [ fhir:value "SouthernCaddoan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "SouthernCaddoan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "SouthernCaddoan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "SouthernCaddoan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21023" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-CAD" ];
         fhir:CodeSystem.display [ fhir:value "Caddo" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Caddoe" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kado" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kadohadacho" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Caddo" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Caddo" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Caddo" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18234" ]
         ]
       ]
     ]
  ], [
     fhir:index 2;
     fhir:CodeSystem.code [ fhir:value "_Chimakuan" ];
     fhir:CodeSystem.display [ fhir:value "Chimakuan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Chimakuan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Chimakuan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20966" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "x-QUI" ];
       fhir:CodeSystem.display [ fhir:value "Quileute" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Quileute" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Quileute" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18239" ]
       ]
     ]
  ], [
     fhir:index 3;
     fhir:CodeSystem.code [ fhir:value "_EskimoAleut" ];
     fhir:CodeSystem.display [ fhir:value "EskimoAleut" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "EskimoAleut" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "EskimoAleut" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20982" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Aleut" ];
       fhir:CodeSystem.display [ fhir:value "Aleut" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Aleut" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Aleut" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Aleut" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20951" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-ALW" ];
         fhir:CodeSystem.display [ fhir:value "Aleut" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Aleut" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Aleut" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Aleut" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18222" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_Eskimoan" ];
       fhir:CodeSystem.display [ fhir:value "Eskimoan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Eskimoan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Eskimoan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Eskimoan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20983" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_InuitInupiaq" ];
         fhir:CodeSystem.display [ fhir:value "InuitInupiaq" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "InuitInupiaq" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "InuitInupiaq" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "InuitInupiaq" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "InuitInupiaq" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20986" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-ESI" ];
           fhir:CodeSystem.display [ fhir:value "North Alaskan Inuktitut" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Inupiaq" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Inupiat Eskimo" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Inupik" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "North Alaskan Eskimo" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "North Alaskan Inupiaq" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "North Alaskan Inuktitut" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "North Alaskan Inuktitut" ]
           ], [
             fhir:index 7;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "North Alaskan Inuktitut" ]
           ], [
             fhir:index 8;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "North Alaskan Inuktitut" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18211" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-ESK" ];
           fhir:CodeSystem.display [ fhir:value "Northwest Alaska Inuktitut" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Inupiatun" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northwest Alaska Inupiat Eskimo" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Seward Peninsula Inupiaq" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northwest Alaska Inuktitut" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northwest Alaska Inuktitut" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northwest Alaska Inuktitut" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northwest Alaska Inuktitut" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18217" ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "_SirenikskiYupik" ];
         fhir:CodeSystem.display [ fhir:value "SirenikskiYupik" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SirenikskiYupik" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SirenikskiYupik" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SirenikskiYupik" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SirenikskiYupik" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21021" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-EMS" ];
           fhir:CodeSystem.display [ fhir:value "Pacific Yupik Gulf" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Aleut" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Alutiiq" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Chugach Eskimo" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Koniag-Chugach" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pacific Yupik" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "South Alaska Eskimo" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Sugcestun" ]
           ], [
             fhir:index 7;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Sugpiak Eskimo" ]
           ], [
             fhir:index 8;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Sugpiaq Eskimo" ]
           ], [
             fhir:index 9;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Suk" ]
           ], [
             fhir:index 10;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pacific Yupik Gulf" ]
           ], [
             fhir:index 11;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pacific Yupik Gulf" ]
           ], [
             fhir:index 12;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pacific Yupik Gulf" ]
           ], [
             fhir:index 13;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pacific Yupik Gulf" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18199" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-ESS" ];
           fhir:CodeSystem.display [ fhir:value "Central Siberian Yupik" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "St. Lawrence Island Eskimo" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Siberian Yupik" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Siberian Yupik" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Siberian Yupik" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Siberian Yupik" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18194" ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "x-ESU" ];
           fhir:CodeSystem.display [ fhir:value "Central Alaskan Yupik" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Yupik" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "West Alaska Eskimo" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Alaskan Yupik" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Alaskan Yupik" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Alaskan Yupik" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Alaskan Yupik" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18196" ]
           ]
         ]
       ]
     ]
  ], [
     fhir:index 4;
     fhir:CodeSystem.code [ fhir:value "_Hokan" ];
     fhir:CodeSystem.display [ fhir:value "Hokan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Hokan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Hokan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20984" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_CochimiYuman" ];
       fhir:CodeSystem.display [ fhir:value "CochimiYuman" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CochimiYuman" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CochimiYuman" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CochimiYuman" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20969" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Yuman" ];
         fhir:CodeSystem.display [ fhir:value "Yuman" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yuman" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yuman" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yuman" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yuman" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21045" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_DeltaCalifornia" ];
           fhir:CodeSystem.display [ fhir:value "DeltaCalifornia" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "DeltaCalifornia" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "DeltaCalifornia" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "DeltaCalifornia" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "DeltaCalifornia" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "DeltaCalifornia" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20976" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "_Diegueno" ];
             fhir:CodeSystem.display [ fhir:value "Diegueno" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Diegueno" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Diegueno" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Diegueno" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Diegueno" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Diegueno" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Diegueno" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "20978" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-DIH" ];
               fhir:CodeSystem.display [ fhir:value "Kumeyaay" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Campo" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Diegueño" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kamia" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumiái" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumeyaay" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumeyaay" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumeyaay" ]
               ], [
                 fhir:index 7;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumeyaay" ]
               ], [
                 fhir:index 8;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumeyaay" ]
               ], [
                 fhir:index 9;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kumeyaay" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18293" ]
               ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-COC" ];
             fhir:CodeSystem.display [ fhir:value "Cocopa" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocopah" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cucapá" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Delta River Yuman" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kikima" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kwikapa" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocopa" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocopa" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocopa" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocopa" ]
             ], [
               fhir:index 9;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocopa" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18298" ]
             ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "_Pai" ];
           fhir:CodeSystem.display [ fhir:value "Pai" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pai" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pai" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pai" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pai" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Pai" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "21006" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-YUF" ];
             fhir:CodeSystem.display [ fhir:value "Havasupai" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Upland Yuman" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Upper Colorado River Yuman" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Walapai" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Yavapai" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Havasupai" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Havasupai" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Havasupai" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Havasupai" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Havasupai" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18277" ]
             ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "_River" ];
           fhir:CodeSystem.display [ fhir:value "River" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "River" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "River" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "River" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "River" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "River" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "21013" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-MOV" ];
             fhir:CodeSystem.display [ fhir:value "Mohave" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mojave" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mohave" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mohave" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mohave" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mohave" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mohave" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18289" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-MRC" ];
             fhir:CodeSystem.display [ fhir:value "Maricopa" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Cocomaricopa" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maricopa" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maricopa" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maricopa" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maricopa" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Maricopa" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18287" ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "x-YUM" ];
             fhir:CodeSystem.display [ fhir:value "Quechan" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kechan" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quecl" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Yuma" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quechan" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quechan" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quechan" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quechan" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quechan" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18283" ]
             ]
           ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_Palaihnihan" ];
       fhir:CodeSystem.display [ fhir:value "Palaihnihan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Palaihnihan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Palaihnihan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Palaihnihan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21007" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-ACH" ];
         fhir:CodeSystem.display [ fhir:value "Achumawi" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Achomawi" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Pitt River" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Achumawi" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Achumawi" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Achumawi" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18249" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-ATW" ];
         fhir:CodeSystem.display [ fhir:value "Atsugewi" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Atsugewi" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Atsugewi" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Atsugewi" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18252" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "_Pomoan" ];
       fhir:CodeSystem.display [ fhir:value "Pomoan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Pomoan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Pomoan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Pomoan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21011" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-KJU" ];
         fhir:CodeSystem.display [ fhir:value "Kashaya" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southwestern Pomo" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kashaya" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kashaya" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kashaya" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18272" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-PEF" ];
         fhir:CodeSystem.display [ fhir:value "Northeastern Pomo" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Salt Pomo" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northeastern Pomo" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northeastern Pomo" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northeastern Pomo" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18254" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-PEO" ];
         fhir:CodeSystem.display [ fhir:value "Southeastern Pomo" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southeastern Pomo" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southeastern Pomo" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southeastern Pomo" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18256" ]
         ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.code [ fhir:value "x-PEQ" ];
         fhir:CodeSystem.display [ fhir:value "Southern Pomo" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lower Lake Pomo" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Pomo" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Pomo" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Pomo" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18270" ]
         ]
       ], [
         fhir:index 4;
         fhir:CodeSystem.code [ fhir:value "x-POO" ];
         fhir:CodeSystem.display [ fhir:value "Central Pomo" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Ballo-Kai-Pomo" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cabanapo" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Habenapo" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "H'hana" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kábinapek" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Khabenapo" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Khana" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kulanapan" ]
         ], [
           fhir:index 8;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kulanapo" ]
         ], [
           fhir:index 9;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Venaambakaia" ]
         ], [
           fhir:index 10;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Venambakaiia" ]
         ], [
           fhir:index 11;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yokaia" ]
         ], [
           fhir:index 12;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Central Pomo" ]
         ], [
           fhir:index 13;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Central Pomo" ]
         ], [
           fhir:index 14;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Central Pomo" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18257" ]
         ]
       ]
     ], [
       fhir:index 3;
       fhir:CodeSystem.code [ fhir:value "_Shasta" ];
       fhir:CodeSystem.display [ fhir:value "Shasta" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Shasta" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Shasta" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Shasta" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21018" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-SHT" ];
         fhir:CodeSystem.display [ fhir:value "Shasta" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sastean" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Shastan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Shasta" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Shasta" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Shasta" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18245" ]
         ]
       ]
     ], [
       fhir:index 4;
       fhir:CodeSystem.code [ fhir:value "x-KYH" ];
       fhir:CodeSystem.display [ fhir:value "Karok" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Karuk" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Karok" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Karok" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18242" ]
       ]
     ], [
       fhir:index 5;
       fhir:CodeSystem.code [ fhir:value "x-WAS" ];
       fhir:CodeSystem.display [ fhir:value "Washoe" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Washo" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Washoe" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Washoe" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18304" ]
       ]
     ]
  ], [
     fhir:index 5;
     fhir:CodeSystem.code [ fhir:value "_Iroquoian" ];
     fhir:CodeSystem.display [ fhir:value "Iroquoian" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Iroquoian" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Iroquoian" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20987" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_NorthernIroquoian" ];
       fhir:CodeSystem.display [ fhir:value "NorthernIroquoian" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "NorthernIroquoian" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "NorthernIroquoian" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "NorthernIroquoian" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21001" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-CAY" ];
         fhir:CodeSystem.display [ fhir:value "Cayuga" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cayuga" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cayuga" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cayuga" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18310" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-MOH" ];
         fhir:CodeSystem.display [ fhir:value "Mohawk" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kanien'kehaka" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mohawk" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mohawk" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mohawk" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18313" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-ONE" ];
         fhir:CodeSystem.display [ fhir:value "Oneida" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Oneida" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Oneida" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Oneida" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18315" ]
         ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.code [ fhir:value "x-ONO" ];
         fhir:CodeSystem.display [ fhir:value "Onondaga" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Onandaga" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Onondaga" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Onondaga" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Onondaga" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18311" ]
         ]
       ], [
         fhir:index 4;
         fhir:CodeSystem.code [ fhir:value "x-SEE" ];
         fhir:CodeSystem.display [ fhir:value "Seneca" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Seneca" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Seneca" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Seneca" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18309" ]
         ]
       ], [
         fhir:index 5;
         fhir:CodeSystem.code [ fhir:value "x-TUS" ];
         fhir:CodeSystem.display [ fhir:value "Tuscarora" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tuscarora" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tuscarora" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tuscarora" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18308" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "x-CER" ];
       fhir:CodeSystem.display [ fhir:value "Cherokee" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsalagi" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tslagi" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Cherokee" ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Cherokee" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18316" ]
       ]
     ]
  ], [
     fhir:index 6;
     fhir:CodeSystem.code [ fhir:value "_Keresan" ];
     fhir:CodeSystem.display [ fhir:value "Keresan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Keresan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Keresan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20989" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "x-KEE" ];
       fhir:CodeSystem.display [ fhir:value "Rio Grande Keresan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Eastern Keres Pueblo" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Eastern Keresan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Rio Grande Keresan" ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Rio Grande Keresan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18324" ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "x-KJQ" ];
       fhir:CodeSystem.display [ fhir:value "Acoma-Laguna" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Western Keres" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Western Keres Pueblo" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Western Keresan" ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Acoma-Laguna" ]
       ], [
         fhir:index 4;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Acoma-Laguna" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18320" ]
       ]
     ]
  ], [
     fhir:index 7;
     fhir:CodeSystem.code [ fhir:value "_KiowaTanoan" ];
     fhir:CodeSystem.display [ fhir:value "KiowaTanoan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "KiowaTanoan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "KiowaTanoan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20990" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Tiwa" ];
       fhir:CodeSystem.display [ fhir:value "Tiwa" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tiwa" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tiwa" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tiwa" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21031" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-TAO" ];
         fhir:CodeSystem.display [ fhir:value "Northern Tiwa" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northern Tiwa" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northern Tiwa" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northern Tiwa" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18332" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-TIX" ];
         fhir:CodeSystem.display [ fhir:value "Southern Tiwa" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Tiwa" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Tiwa" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Tiwa" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18333" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "x-KIO" ];
       fhir:CodeSystem.display [ fhir:value "Kiowa" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Kiowa" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Kiowa" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18328" ]
       ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "x-TEW" ];
       fhir:CodeSystem.display [ fhir:value "Tewa" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tewa" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tewa" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18334" ]
       ]
     ], [
       fhir:index 3;
       fhir:CodeSystem.code [ fhir:value "x-TOW" ];
       fhir:CodeSystem.display [ fhir:value "Jemez" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Towa" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Jemez" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Jemez" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18329" ]
       ]
     ]
  ], [
     fhir:index 8;
     fhir:CodeSystem.code [ fhir:value "_Muskogean" ];
     fhir:CodeSystem.display [ fhir:value "Muskogean" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Muskogean" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Muskogean" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20997" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_CentralMuskogean" ];
       fhir:CodeSystem.display [ fhir:value "CentralMuskogean" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CentralMuskogean" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CentralMuskogean" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CentralMuskogean" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20963" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-AKZ" ];
         fhir:CodeSystem.display [ fhir:value "Alabama" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Alabama" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Alabama" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Alabama" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18343" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-CKU" ];
         fhir:CodeSystem.display [ fhir:value "Koasati" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coushatta" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Koasati" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Koasati" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Koasati" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18348" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-MIK" ];
         fhir:CodeSystem.display [ fhir:value "Mikasuki" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Hitchiti" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Miccosukee" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mikasuki Seminole" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mikasuki" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mikasuki" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mikasuki" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18344" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_WesternMuskogean" ];
       fhir:CodeSystem.display [ fhir:value "WesternMuskogean" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "WesternMuskogean" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "WesternMuskogean" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "WesternMuskogean" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21040" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-CCT" ];
         fhir:CodeSystem.display [ fhir:value "Choctaw" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Choctaw" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Choctaw" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Choctaw" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18341" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-CIC" ];
         fhir:CodeSystem.display [ fhir:value "Chickasaw" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Chickasaw" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Chickasaw" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Chickasaw" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18340" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "x-CRK" ];
       fhir:CodeSystem.display [ fhir:value "Creek" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Muskogee" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Creek" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Creek" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18350" ]
       ]
     ]
  ], [
     fhir:index 9;
     fhir:CodeSystem.code [ fhir:value "_Nadene" ];
     fhir:CodeSystem.display [ fhir:value "Nadene" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Nadene" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Nadene" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "20998" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_AthapaskanEyak" ];
       fhir:CodeSystem.display [ fhir:value "AthapaskanEyak" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "AthapaskanEyak" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "AthapaskanEyak" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "AthapaskanEyak" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20958" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Athapaskan" ];
         fhir:CodeSystem.display [ fhir:value "Athapaskan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Athapaskan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Athapaskan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Athapaskan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Athapaskan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20957" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_Apachean" ];
           fhir:CodeSystem.display [ fhir:value "Apachean" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Apachean" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Apachean" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Apachean" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Apachean" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Apachean" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20954" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "_EasternApachean" ];
             fhir:CodeSystem.display [ fhir:value "EasternApachean" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "EasternApachean" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "EasternApachean" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "EasternApachean" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "EasternApachean" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "EasternApachean" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "EasternApachean" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "20980" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-APJ" ];
               fhir:CodeSystem.display [ fhir:value "Jicarilla" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla Apache" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Jicarilla" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18408" ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-APL" ];
               fhir:CodeSystem.display [ fhir:value "Lipan" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan Apache" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Lipan" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18410" ]
               ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "_WesternApachean" ];
             fhir:CodeSystem.display [ fhir:value "WesternApachean" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "WesternApachean" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "WesternApachean" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "WesternApachean" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "WesternApachean" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "WesternApachean" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "WesternApachean" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "21038" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-APM" ];
               fhir:CodeSystem.display [ fhir:value "Mescalero-Chiricahua" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mescalero-Chiricahua" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mescalero-Chiricahua" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mescalero-Chiricahua" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mescalero-Chiricahua" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mescalero-Chiricahua" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mescalero-Chiricahua" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18406" ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-APW" ];
               fhir:CodeSystem.display [ fhir:value "Western Apache" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Coyotero" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Western Apache" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Western Apache" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Western Apache" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Western Apache" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Western Apache" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Western Apache" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18404" ]
               ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "x-NAV" ];
               fhir:CodeSystem.display [ fhir:value "Dine" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Navajo" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dine" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dine" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dine" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dine" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dine" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dine" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18401" ]
               ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "x-APK" ];
             fhir:CodeSystem.display [ fhir:value "Kiowa Apache" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kiowa Apache" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kiowa Apache" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kiowa Apache" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kiowa Apache" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kiowa Apache" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18412" ]
             ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "_CentralAlaskaYukon" ];
           fhir:CodeSystem.display [ fhir:value "CentralAlaskaYukon" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "CentralAlaskaYukon" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "CentralAlaskaYukon" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "CentralAlaskaYukon" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "CentralAlaskaYukon" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "CentralAlaskaYukon" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20962" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "_KoyukonIngalik" ];
             fhir:CodeSystem.display [ fhir:value "KoyukonIngalik" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KoyukonIngalik" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KoyukonIngalik" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KoyukonIngalik" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KoyukonIngalik" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KoyukonIngalik" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KoyukonIngalik" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "20991" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-HOI" ];
               fhir:CodeSystem.display [ fhir:value "Holikachuk" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Holikachuk" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Holikachuk" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Holikachuk" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Holikachuk" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Holikachuk" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Holikachuk" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18368" ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-ING" ];
               fhir:CodeSystem.display [ fhir:value "Degexit'an" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Degexit'an" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Degexit'an" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Degexit'an" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Degexit'an" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Degexit'an" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Degexit'an" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18367" ]
               ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "x-KOY" ];
               fhir:CodeSystem.display [ fhir:value "Koyukon" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Koyukon" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Koyukon" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Koyukon" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Koyukon" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Koyukon" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Koyukon" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18369" ]
               ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "_KutchinHan" ];
             fhir:CodeSystem.display [ fhir:value "KutchinHan" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KutchinHan" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KutchinHan" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KutchinHan" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KutchinHan" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KutchinHan" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "KutchinHan" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "20992" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-HAA" ];
               fhir:CodeSystem.display [ fhir:value "Han" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Dawson" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han-Kutchin" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Moosehide" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han" ]
               ], [
                 fhir:index 7;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han" ]
               ], [
                 fhir:index 8;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Han" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18382" ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-KUC" ];
               fhir:CodeSystem.display [ fhir:value "Kutchin" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Gwich'in" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kutchin" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kutchin" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kutchin" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kutchin" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kutchin" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kutchin" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18380" ]
               ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "_TananaTutchone" ];
             fhir:CodeSystem.display [ fhir:value "TananaTutchone" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "TananaTutchone" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "TananaTutchone" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "TananaTutchone" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "TananaTutchone" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "TananaTutchone" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "TananaTutchone" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "21028" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "_Tanana" ];
               fhir:CodeSystem.display [ fhir:value "Tanana" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tanana" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "notSelectable" ];
                 fhir:CodeSystem.value [ fhir:value "true" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "21027" ]
               ];
               fhir:CodeSystem.concept [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "x-TAA" ];
                 fhir:CodeSystem.display [ fhir:value "Lower Tanana" ];
                 fhir:CodeSystem.designation [
                   fhir:index 0;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ], [
                   fhir:index 1;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ], [
                   fhir:index 2;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ], [
                   fhir:index 3;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ], [
                   fhir:index 4;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ], [
                   fhir:index 5;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ], [
                   fhir:index 6;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Lower Tanana" ]
                 ];
                 fhir:CodeSystem.property [
                   fhir:index 0;
                   fhir:CodeSystem.code [ fhir:value "status" ];
                   fhir:CodeSystem.value [ fhir:value "active" ]
                 ], [
                   fhir:index 1;
                   fhir:CodeSystem.code [ fhir:value "internalId" ];
                   fhir:CodeSystem.value [ fhir:value "18375" ]
                 ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "x-TAU" ];
                 fhir:CodeSystem.display [ fhir:value "Upper Tanana" ];
                 fhir:CodeSystem.designation [
                   fhir:index 0;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     a sct:900000000000013009;
                     fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                     fhir:Coding.code [ fhir:value "900000000000013009" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Nabesna" ]
                 ], [
                   fhir:index 1;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ], [
                   fhir:index 2;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ], [
                   fhir:index 3;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ], [
                   fhir:index 4;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ], [
                   fhir:index 5;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ], [
                   fhir:index 6;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ], [
                   fhir:index 7;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Upper Tanana" ]
                 ];
                 fhir:CodeSystem.property [
                   fhir:index 0;
                   fhir:CodeSystem.code [ fhir:value "status" ];
                   fhir:CodeSystem.value [ fhir:value "active" ]
                 ], [
                   fhir:index 1;
                   fhir:CodeSystem.code [ fhir:value "internalId" ];
                   fhir:CodeSystem.value [ fhir:value "18377" ]
                 ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.code [ fhir:value "x-TCB" ];
                 fhir:CodeSystem.display [ fhir:value "Tanacross" ];
                 fhir:CodeSystem.designation [
                   fhir:index 0;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ], [
                   fhir:index 1;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ], [
                   fhir:index 2;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ], [
                   fhir:index 3;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ], [
                   fhir:index 4;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ], [
                   fhir:index 5;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ], [
                   fhir:index 6;
                   fhir:CodeSystem.language [ fhir:value "en" ];
                   fhir:CodeSystem.use [
                     fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                     fhir:Coding.code [ fhir:value "display" ]
                   ];
                   fhir:CodeSystem.value [ fhir:value "Tanacross" ]
                 ];
                 fhir:CodeSystem.property [
                   fhir:index 0;
                   fhir:CodeSystem.code [ fhir:value "status" ];
                   fhir:CodeSystem.value [ fhir:value "active" ]
                 ], [
                   fhir:index 1;
                   fhir:CodeSystem.code [ fhir:value "internalId" ];
                   fhir:CodeSystem.value [ fhir:value "18376" ]
                 ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-KUU" ];
               fhir:CodeSystem.display [ fhir:value "Upper Kuskokwim" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Mcgrath Ingalik" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Upper Kuskokwim" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Upper Kuskokwim" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Upper Kuskokwim" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Upper Kuskokwim" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Upper Kuskokwim" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Upper Kuskokwim" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18372" ]
               ]
             ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "_PacificCoastAthapaskan" ];
           fhir:CodeSystem.display [ fhir:value "PacificCoastAthapaskan" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "PacificCoastAthapaskan" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "PacificCoastAthapaskan" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "PacificCoastAthapaskan" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "PacificCoastAthapaskan" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "PacificCoastAthapaskan" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "21005" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "_CaliforniaAthapaskan" ];
             fhir:CodeSystem.display [ fhir:value "CaliforniaAthapaskan" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "CaliforniaAthapaskan" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "CaliforniaAthapaskan" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "CaliforniaAthapaskan" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "CaliforniaAthapaskan" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "CaliforniaAthapaskan" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "CaliforniaAthapaskan" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "20961" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-HUP" ];
               fhir:CodeSystem.display [ fhir:value "Hupa" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hoopa" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hupa" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hupa" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hupa" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hupa" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hupa" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Hupa" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18392" ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-KTW" ];
               fhir:CodeSystem.display [ fhir:value "Cahto" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Batem-da-kai-ee" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kai Po-mo" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Kato" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tlokeang" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Cahto" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Cahto" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Cahto" ]
               ], [
                 fhir:index 7;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Cahto" ]
               ], [
                 fhir:index 8;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Cahto" ]
               ], [
                 fhir:index 9;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Cahto" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18394" ]
               ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "_OregonAthapaskan" ];
             fhir:CodeSystem.display [ fhir:value "OregonAthapaskan" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "OregonAthapaskan" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "OregonAthapaskan" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "OregonAthapaskan" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "OregonAthapaskan" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "OregonAthapaskan" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "OregonAthapaskan" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "notSelectable" ];
               fhir:CodeSystem.value [ fhir:value "true" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "21004" ]
             ];
             fhir:CodeSystem.concept [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "x-TOL" ];
               fhir:CodeSystem.display [ fhir:value "Tolowa" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   a sct:900000000000013009;
                   fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                   fhir:Coding.code [ fhir:value "900000000000013009" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Smith River" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tolowa" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tolowa" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tolowa" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tolowa" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tolowa" ]
               ], [
                 fhir:index 6;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tolowa" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18389" ]
               ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "x-TUU" ];
               fhir:CodeSystem.display [ fhir:value "Tututni" ];
               fhir:CodeSystem.designation [
                 fhir:index 0;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tututni" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tututni" ]
               ], [
                 fhir:index 2;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tututni" ]
               ], [
                 fhir:index 3;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tututni" ]
               ], [
                 fhir:index 4;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tututni" ]
               ], [
                 fhir:index 5;
                 fhir:CodeSystem.language [ fhir:value "en" ];
                 fhir:CodeSystem.use [
                   fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                   fhir:Coding.code [ fhir:value "display" ]
                 ];
                 fhir:CodeSystem.value [ fhir:value "Tututni" ]
               ];
               fhir:CodeSystem.property [
                 fhir:index 0;
                 fhir:CodeSystem.code [ fhir:value "status" ];
                 fhir:CodeSystem.value [ fhir:value "active" ]
               ], [
                 fhir:index 1;
                 fhir:CodeSystem.code [ fhir:value "internalId" ];
                 fhir:CodeSystem.value [ fhir:value "18388" ]
               ]
             ]
           ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.code [ fhir:value "_SouthernAlaska" ];
           fhir:CodeSystem.display [ fhir:value "SouthernAlaska" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "SouthernAlaska" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "SouthernAlaska" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "SouthernAlaska" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "SouthernAlaska" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "SouthernAlaska" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "21022" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-AHT" ];
             fhir:CodeSystem.display [ fhir:value "Ahtna" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahtena" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Atna" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Copper River" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahtna" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahtna" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahtna" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahtna" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ahtna" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18360" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-TFN" ];
             fhir:CodeSystem.display [ fhir:value "Tanaina" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Tanaina" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Tanaina" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Tanaina" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Tanaina" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Tanaina" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18364" ]
             ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-EYA" ];
         fhir:CodeSystem.display [ fhir:value "Eyak" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Eyak" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Eyak" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Eyak" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18357" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "x-TLI" ];
       fhir:CodeSystem.display [ fhir:value "Tlingit" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Thlinget" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tlinkit" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tlingit" ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tlingit" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18353" ]
       ]
     ]
  ], [
     fhir:index 10;
     fhir:CodeSystem.code [ fhir:value "_Penutian" ];
     fhir:CodeSystem.display [ fhir:value "Penutian" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Penutian" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Penutian" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21008" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Chinookan" ];
       fhir:CodeSystem.display [ fhir:value "Chinookan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinookan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinookan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinookan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20967" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_UpperChinook" ];
         fhir:CodeSystem.display [ fhir:value "UpperChinook" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "UpperChinook" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "UpperChinook" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "UpperChinook" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "UpperChinook" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21034" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-WAC" ];
           fhir:CodeSystem.display [ fhir:value "Kiksht" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cascades-Wasco-Wishram" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Multnomah-Clackamas" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Upper Chinook" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Wasco-Wishram" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kiksht" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kiksht" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kiksht" ]
           ], [
             fhir:index 7;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kiksht" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18416" ]
           ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_Coosan" ];
       fhir:CodeSystem.display [ fhir:value "Coosan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Coosan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Coosan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Coosan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20970" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-COS" ];
         fhir:CodeSystem.display [ fhir:value "Hanis" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coos" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Hanis" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Hanis" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Hanis" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18422" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "_Maiduan" ];
       fhir:CodeSystem.display [ fhir:value "Maiduan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Maiduan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Maiduan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Maiduan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20993" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-MAI" ];
         fhir:CodeSystem.display [ fhir:value "Northwest Maidu" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Concow" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Digger" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Holólupai" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Konkau" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Konkow" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Maiduan" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Meidoo" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Michopdo" ]
         ], [
           fhir:index 8;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nákum" ]
         ], [
           fhir:index 9;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Secumne" ]
         ], [
           fhir:index 10;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sekumne" ]
         ], [
           fhir:index 11;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tsamak" ]
         ], [
           fhir:index 12;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yuba" ]
         ], [
           fhir:index 13;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northwest Maidu" ]
         ], [
           fhir:index 14;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northwest Maidu" ]
         ], [
           fhir:index 15;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northwest Maidu" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18438" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-NMU" ];
         fhir:CodeSystem.display [ fhir:value "Northeast Maidu" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mountain Maidu" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northeast Maidu" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northeast Maidu" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northeast Maidu" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18436" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-NSZ" ];
         fhir:CodeSystem.display [ fhir:value "Nisenan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Neeshenam" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nishinam" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Pujuni" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Southern Maidu" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wapumni" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nisenan" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nisenan" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nisenan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18452" ]
         ]
       ]
     ], [
       fhir:index 3;
       fhir:CodeSystem.code [ fhir:value "_PlateauPenutian" ];
       fhir:CodeSystem.display [ fhir:value "PlateauPenutian" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "PlateauPenutian" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "PlateauPenutian" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "PlateauPenutian" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21010" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Sahaptian" ];
         fhir:CodeSystem.display [ fhir:value "Sahaptian" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sahaptian" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sahaptian" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sahaptian" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sahaptian" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21014" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-UMA" ];
           fhir:CodeSystem.display [ fhir:value "Umatilla" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Columbia River Sahaptin" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Umatilla" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Umatilla" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Umatilla" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Umatilla" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18503" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-WAA" ];
           fhir:CodeSystem.display [ fhir:value "Walla Walla" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northeast Sahaptin" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Walla Walla" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Walla Walla" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Walla Walla" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Walla Walla" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18505" ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "x-WAR" ];
           fhir:CodeSystem.display [ fhir:value "Tenino" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Warm Springs" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Tenino" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Tenino" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Tenino" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Tenino" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18501" ]
           ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.code [ fhir:value "x-YAK" ];
           fhir:CodeSystem.display [ fhir:value "Yakima" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northwest Sahaptin" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yakima And Klikitat" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yakima" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yakima" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yakima" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yakima" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18507" ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-KLA" ];
         fhir:CodeSystem.display [ fhir:value "Klamath-Modoc" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Klamath-Modoc" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Klamath-Modoc" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Klamath-Modoc" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18499" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-NEZ" ];
         fhir:CodeSystem.display [ fhir:value "Nez Perce" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nez Perce" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nez Perce" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nez Perce" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18510" ]
         ]
       ]
     ], [
       fhir:index 4;
       fhir:CodeSystem.code [ fhir:value "_Takelman" ];
       fhir:CodeSystem.display [ fhir:value "Takelman" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Takelman" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Takelman" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Takelman" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21025" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Kalapuyan" ];
         fhir:CodeSystem.display [ fhir:value "Kalapuyan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalapuyan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalapuyan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalapuyan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalapuyan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20988" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-KAL" ];
           fhir:CodeSystem.display [ fhir:value "Central Kalapuyan" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kalapuya" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Lukamiute" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Santiam" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Wapatu" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Kalapuyan" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Kalapuyan" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Kalapuyan" ]
           ], [
             fhir:index 7;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Central Kalapuyan" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18426" ]
           ]
         ]
       ]
     ], [
       fhir:index 5;
       fhir:CodeSystem.code [ fhir:value "_Tsimshianic" ];
       fhir:CodeSystem.display [ fhir:value "Tsimshianic" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsimshianic" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsimshianic" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsimshianic" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21033" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-TSI" ];
         fhir:CodeSystem.display [ fhir:value "Coast Tsimshain" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Chimmezyan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coast And Southern Tsimshian" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Sm'algyax" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tsimpshean" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Zimshian" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coast Tsimshain" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coast Tsimshain" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coast Tsimshain" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18512" ]
         ]
       ]
     ], [
       fhir:index 6;
       fhir:CodeSystem.code [ fhir:value "_Utian" ];
       fhir:CodeSystem.display [ fhir:value "Utian" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Utian" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Utian" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Utian" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21035" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Miwokan" ];
         fhir:CodeSystem.display [ fhir:value "Miwokan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Miwokan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Miwokan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Miwokan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Miwokan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20996" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_EasternMiwok" ];
           fhir:CodeSystem.display [ fhir:value "EasternMiwok" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "EasternMiwok" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "EasternMiwok" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "EasternMiwok" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "EasternMiwok" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "EasternMiwok" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20981" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-CSM" ];
             fhir:CodeSystem.display [ fhir:value "Central Sierra Miwok" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Central Sierra Miwok" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Central Sierra Miwok" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Central Sierra Miwok" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Central Sierra Miwok" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Central Sierra Miwok" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18467" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-NSQ" ];
             fhir:CodeSystem.display [ fhir:value "Northern Sierra Miwok" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Northern Sierra Miwok" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Northern Sierra Miwok" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Northern Sierra Miwok" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Northern Sierra Miwok" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Northern Sierra Miwok" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18466" ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "x-PMW" ];
             fhir:CodeSystem.display [ fhir:value "Plains Miwok" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Valley Miwok" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Plains Miwok" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Plains Miwok" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Plains Miwok" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Plains Miwok" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Plains Miwok" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18464" ]
             ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.code [ fhir:value "x-SKD" ];
             fhir:CodeSystem.display [ fhir:value "Southern Sierra Miwok" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Meewoc" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mewoc" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Me-Wuk" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Miwoc" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Miwokan" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Mokélumne" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Moquelumnan" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "San Raphael" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Talatui" ]
             ], [
               fhir:index 9;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Talutui" ]
             ], [
               fhir:index 10;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Southern Sierra Miwok" ]
             ], [
               fhir:index 11;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Southern Sierra Miwok" ]
             ], [
               fhir:index 12;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Southern Sierra Miwok" ]
             ], [
               fhir:index 13;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Southern Sierra Miwok" ]
             ], [
               fhir:index 14;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Southern Sierra Miwok" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18468" ]
             ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "_WesternMiwok" ];
           fhir:CodeSystem.display [ fhir:value "WesternMiwok" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "WesternMiwok" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "WesternMiwok" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "WesternMiwok" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "WesternMiwok" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "WesternMiwok" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "21039" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-CSI" ];
             fhir:CodeSystem.display [ fhir:value "Coast Miwok" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Coast Miwok" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Coast Miwok" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Coast Miwok" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Coast Miwok" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Coast Miwok" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18461" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-LMW" ];
             fhir:CodeSystem.display [ fhir:value "Lake Miwok" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lake Miwok" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lake Miwok" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lake Miwok" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lake Miwok" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lake Miwok" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18462" ]
             ]
           ]
         ]
       ]
     ], [
       fhir:index 7;
       fhir:CodeSystem.code [ fhir:value "_Wintuan" ];
       fhir:CodeSystem.display [ fhir:value "Wintuan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Wintuan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Wintuan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Wintuan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21042" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-WIT" ];
         fhir:CodeSystem.display [ fhir:value "Wintu-Nomlaki" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wintu" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wintun" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wintu-Nomlaki" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wintu-Nomlaki" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wintu-Nomlaki" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18432" ]
         ]
       ]
     ], [
       fhir:index 8;
       fhir:CodeSystem.code [ fhir:value "_Yokutsan" ];
       fhir:CodeSystem.display [ fhir:value "Yokutsan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Yokutsan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Yokutsan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Yokutsan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21043" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-ENH" ];
         fhir:CodeSystem.display [ fhir:value "Kings River" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Aiticha" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Choinimni" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Chukaimina" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Entimbich" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kocheyali" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kings River" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kings River" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kings River" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18489" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-GSH" ];
         fhir:CodeSystem.display [ fhir:value "Gashowu" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Goshowi" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Gashowu" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Gashowu" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Gashowu" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18480" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-PYL" ];
         fhir:CodeSystem.display [ fhir:value "Poso Creek" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kumachisi" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Paleuyami" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Poso Creek" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Poso Creek" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Poso Creek" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18495" ]
         ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.code [ fhir:value "x-TKH" ];
         fhir:CodeSystem.display [ fhir:value "Tule-Kaweah" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Bokninuwad" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kawia" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wükchamni" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yawdanchi" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Yokod" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tule-Kaweah" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tule-Kaweah" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Tule-Kaweah" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18483" ]
         ]
       ]
     ]
  ], [
     fhir:index 11;
     fhir:CodeSystem.code [ fhir:value "_Pidgin" ];
     fhir:CodeSystem.display [ fhir:value "Pidgin" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Pidgin" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Pidgin" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21009" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "x-CHH" ];
       fhir:CodeSystem.display [ fhir:value "Chinook Wawa" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinook Jargon" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinook Pidgin" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           a sct:900000000000013009;
           fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
           fhir:Coding.code [ fhir:value "900000000000013009" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tshinuk Wawa" ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinook Wawa" ]
       ], [
         fhir:index 4;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Chinook Wawa" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18519" ]
       ]
     ]
  ], [
     fhir:index 12;
     fhir:CodeSystem.code [ fhir:value "_Salishan" ];
     fhir:CodeSystem.display [ fhir:value "Salishan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Salishan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Salishan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21015" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_CentralSalish" ];
       fhir:CodeSystem.display [ fhir:value "CentralSalish" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CentralSalish" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CentralSalish" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "CentralSalish" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20965" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-CLM" ];
         fhir:CodeSystem.display [ fhir:value "Clallam" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Klallam" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Na'klallam" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "S'klallam" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Clallam" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Clallam" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Clallam" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18528" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-LUT" ];
         fhir:CodeSystem.display [ fhir:value "Lushootseed" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lushootseed" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lushootseed" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lushootseed" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18532" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-STR" ];
         fhir:CodeSystem.display [ fhir:value "Northern Straits" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Straits" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Straits Salish" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northern Straits" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northern Straits" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Northern Straits" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18525" ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_InteriorSalish" ];
       fhir:CodeSystem.display [ fhir:value "InteriorSalish" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "InteriorSalish" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "InteriorSalish" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "InteriorSalish" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20985" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-COL" ];
         fhir:CodeSystem.display [ fhir:value "Columbian" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Columbia-Wenatchi" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Wenatchee-Columbia" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Columbian" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Columbian" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Columbian" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18545" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-CRD" ];
         fhir:CodeSystem.display [ fhir:value "Coeur D'alene" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coeur D'alene" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coeur D'alene" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Coeur D'alene" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18544" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-FLA" ];
         fhir:CodeSystem.display [ fhir:value "Kalispel" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Flathead-Kalispel" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalispel-Flathead" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalispel" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalispel" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kalispel" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18541" ]
         ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.code [ fhir:value "x-OKA" ];
         fhir:CodeSystem.display [ fhir:value "Okanagan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Okanagan-Colville" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Okanagon" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Okanogan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Okanagan" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Okanagan" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Okanagan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18548" ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "_Tsamosan" ];
       fhir:CodeSystem.display [ fhir:value "Tsamosan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsamosan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsamosan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tsamosan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21032" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-CEA" ];
         fhir:CodeSystem.display [ fhir:value "Lower Chehalis" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lower Chehalis" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lower Chehalis" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lower Chehalis" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18535" ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "x-CJH" ];
         fhir:CodeSystem.display [ fhir:value "Upper Chehalis" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Chehalis" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Upper Chehalis" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Upper Chehalis" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Upper Chehalis" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18536" ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-COW" ];
         fhir:CodeSystem.display [ fhir:value "Cowlitz" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Lower Cowlitz" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cowlitz" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cowlitz" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cowlitz" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18538" ]
         ]
       ], [
         fhir:index 3;
         fhir:CodeSystem.code [ fhir:value "x-QUN" ];
         fhir:CodeSystem.display [ fhir:value "Quinault" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Quinault" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Quinault" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Quinault" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18534" ]
         ]
       ]
     ]
  ], [
     fhir:index 13;
     fhir:CodeSystem.code [ fhir:value "_SiouanCatawba" ];
     fhir:CodeSystem.display [ fhir:value "SiouanCatawba" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "SiouanCatawba" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "SiouanCatawba" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21020" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Siouan" ];
       fhir:CodeSystem.display [ fhir:value "Siouan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Siouan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Siouan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Siouan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21019" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_MississippiValley" ];
         fhir:CodeSystem.display [ fhir:value "MississippiValley" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MississippiValley" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MississippiValley" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MississippiValley" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MississippiValley" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20994" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "_ChiwereWinnebago" ];
           fhir:CodeSystem.display [ fhir:value "ChiwereWinnebago" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ChiwereWinnebago" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ChiwereWinnebago" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ChiwereWinnebago" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ChiwereWinnebago" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "ChiwereWinnebago" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20968" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-IOW" ];
             fhir:CodeSystem.display [ fhir:value "Chiwere" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Iowa-Oto" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Iowa-Otoe" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Chiwere" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Chiwere" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Chiwere" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Chiwere" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Chiwere" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18594" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-WIN" ];
             fhir:CodeSystem.display [ fhir:value "Hocak" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocak Wazijaci" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocank" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hochank" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hochunk" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Winnebago" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocak" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocak" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocak" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocak" ]
             ], [
               fhir:index 9;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hocak" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18597" ]
             ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "_Dakotan" ];
           fhir:CodeSystem.display [ fhir:value "Dakotan" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dakotan" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dakotan" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dakotan" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dakotan" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dakotan" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20974" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-ASB" ];
             fhir:CodeSystem.display [ fhir:value "Assiniboine" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Assiniboin" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Hohe" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Assiniboine" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Assiniboine" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Assiniboine" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Assiniboine" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Assiniboine" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18577" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-DHG" ];
             fhir:CodeSystem.display [ fhir:value "Dakota" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Dakhota" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Santee" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Santee-Sisseton" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Sioux" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Dakota" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Dakota" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Dakota" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Dakota" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Dakota" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18568" ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "x-LKT" ];
             fhir:CodeSystem.display [ fhir:value "Lakota" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Teton" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lakhota" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lakota" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lakota" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lakota" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lakota" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Lakota" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18564" ]
             ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.code [ fhir:value "x-NKT" ];
             fhir:CodeSystem.display [ fhir:value "Nakota" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Nakoda" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Yankton" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Yankton-Yanktonais" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Nakota" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Nakota" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Nakota" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Nakota" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Nakota" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18573" ]
             ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "_Dhegiha" ];
           fhir:CodeSystem.display [ fhir:value "Dhegiha" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dhegiha" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dhegiha" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dhegiha" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dhegiha" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Dhegiha" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "notSelectable" ];
             fhir:CodeSystem.value [ fhir:value "true" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "20977" ]
           ];
           fhir:CodeSystem.concept [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "x-KAA" ];
             fhir:CodeSystem.display [ fhir:value "Kansa" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kanze" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kaw" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Konze" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kansa" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kansa" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kansa" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kansa" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Kansa" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18584" ]
             ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "x-OMA" ];
             fhir:CodeSystem.display [ fhir:value "Omaha-Ponca" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Omaha-Ponca" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Omaha-Ponca" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Omaha-Ponca" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Omaha-Ponca" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Omaha-Ponca" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18581" ]
             ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.code [ fhir:value "x-OSA" ];
             fhir:CodeSystem.display [ fhir:value "Osage" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Wazhazhe" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Osage" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Osage" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Osage" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Osage" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Osage" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18582" ]
             ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.code [ fhir:value "x-QUA" ];
             fhir:CodeSystem.display [ fhir:value "Quapaw" ];
             fhir:CodeSystem.designation [
               fhir:index 0;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Alkansea" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Arkansas" ]
             ], [
               fhir:index 2;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Capa" ]
             ], [
               fhir:index 3;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 a sct:900000000000013009;
                 fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
                 fhir:Coding.code [ fhir:value "900000000000013009" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Ogaxpa" ]
             ], [
               fhir:index 4;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quapaw" ]
             ], [
               fhir:index 5;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quapaw" ]
             ], [
               fhir:index 6;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quapaw" ]
             ], [
               fhir:index 7;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quapaw" ]
             ], [
               fhir:index 8;
               fhir:CodeSystem.language [ fhir:value "en" ];
               fhir:CodeSystem.use [
                 fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
                 fhir:Coding.code [ fhir:value "display" ]
               ];
               fhir:CodeSystem.value [ fhir:value "Quapaw" ]
             ];
             fhir:CodeSystem.property [
               fhir:index 0;
               fhir:CodeSystem.code [ fhir:value "status" ];
               fhir:CodeSystem.value [ fhir:value "active" ]
             ], [
               fhir:index 1;
               fhir:CodeSystem.code [ fhir:value "internalId" ];
               fhir:CodeSystem.value [ fhir:value "18588" ]
             ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "_MissouriRiver" ];
         fhir:CodeSystem.display [ fhir:value "MissouriRiver" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MissouriRiver" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MissouriRiver" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MissouriRiver" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "MissouriRiver" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20995" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-CRO" ];
           fhir:CodeSystem.display [ fhir:value "Crow" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Apsaaloke" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Crow" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Crow" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Crow" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Crow" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18559" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-HID" ];
           fhir:CodeSystem.display [ fhir:value "Hidatsa" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Hinatsa" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Hiraca" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Minitari" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Hidatsa" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Hidatsa" ]
           ], [
             fhir:index 5;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Hidatsa" ]
           ], [
             fhir:index 6;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Hidatsa" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18555" ]
           ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "x-MHQ" ];
         fhir:CodeSystem.display [ fhir:value "Mandan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mandan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mandan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Mandan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18561" ]
         ]
       ]
     ]
  ], [
     fhir:index 14;
     fhir:CodeSystem.code [ fhir:value "_UtoAztecan" ];
     fhir:CodeSystem.display [ fhir:value "UtoAztecan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "UtoAztecan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "UtoAztecan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21036" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Numic" ];
       fhir:CodeSystem.display [ fhir:value "Numic" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Numic" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Numic" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Numic" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21002" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_CentralNumic" ];
         fhir:CodeSystem.display [ fhir:value "CentralNumic" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CentralNumic" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CentralNumic" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CentralNumic" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "CentralNumic" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20964" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-COM" ];
           fhir:CodeSystem.display [ fhir:value "Comanche" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Comanche" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Comanche" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Comanche" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Comanche" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18616" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-PAR" ];
           fhir:CodeSystem.display [ fhir:value "Panamint" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Koso" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Panamint" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Panamint" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Panamint" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Panamint" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18612" ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "x-SHH" ];
           fhir:CodeSystem.display [ fhir:value "Shoshone" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shoshoni" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shoshone" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shoshone" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shoshone" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Shoshone" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18614" ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "_SouthernNumic" ];
         fhir:CodeSystem.display [ fhir:value "SouthernNumic" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SouthernNumic" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SouthernNumic" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SouthernNumic" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SouthernNumic" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21024" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-KAW" ];
           fhir:CodeSystem.display [ fhir:value "Kawaiisu" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kawaiisu" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kawaiisu" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kawaiisu" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Kawaiisu" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18618" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-UTE" ];
           fhir:CodeSystem.display [ fhir:value "Ute-Southern Paiute" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Ute-Southern Paiute" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Ute-Southern Paiute" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Ute-Southern Paiute" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Ute-Southern Paiute" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18619" ]
           ]
         ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "_WesternNumic" ];
         fhir:CodeSystem.display [ fhir:value "WesternNumic" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "WesternNumic" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "WesternNumic" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "WesternNumic" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "WesternNumic" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21041" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-MON" ];
           fhir:CodeSystem.display [ fhir:value "Mono" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               a sct:900000000000013009;
               fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
               fhir:Coding.code [ fhir:value "900000000000013009" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Paviotso" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mono" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mono" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mono" ]
           ], [
             fhir:index 4;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Mono" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18608" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-PAO" ];
           fhir:CodeSystem.display [ fhir:value "Northern Paiute-Bannock" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northern Paiute-Bannock" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northern Paiute-Bannock" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northern Paiute-Bannock" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Northern Paiute-Bannock" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18609" ]
           ]
         ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "_Takic" ];
       fhir:CodeSystem.display [ fhir:value "Takic" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Takic" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Takic" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Takic" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21026" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Cupan" ];
         fhir:CodeSystem.display [ fhir:value "Cupan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cupan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cupan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cupan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cupan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20973" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-CHL" ];
           fhir:CodeSystem.display [ fhir:value "Cahuilla" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cahuilla" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cahuilla" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cahuilla" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cahuilla" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18625" ]
           ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "x-CUP" ];
           fhir:CodeSystem.display [ fhir:value "Cupeno" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cupeno" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cupeno" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cupeno" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Cupeno" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18626" ]
           ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "x-LUI" ];
           fhir:CodeSystem.display [ fhir:value "Luiseno" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Luiseno" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Luiseno" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Luiseno" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Luiseno" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18627" ]
           ]
         ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "_SerranoGabrielino" ];
         fhir:CodeSystem.display [ fhir:value "SerranoGabrielino" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SerranoGabrielino" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SerranoGabrielino" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SerranoGabrielino" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "SerranoGabrielino" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "21017" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-SER" ];
           fhir:CodeSystem.display [ fhir:value "Serrano" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Serrano" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Serrano" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Serrano" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Serrano" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18623" ]
           ]
         ]
       ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "_Taracahitan" ];
       fhir:CodeSystem.display [ fhir:value "Taracahitan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Taracahitan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Taracahitan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Taracahitan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21029" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "_Cahitan" ];
         fhir:CodeSystem.display [ fhir:value "Cahitan" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cahitan" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cahitan" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cahitan" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Cahitan" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "notSelectable" ];
           fhir:CodeSystem.value [ fhir:value "true" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "20960" ]
         ];
         fhir:CodeSystem.concept [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "x-YAQ" ];
           fhir:CodeSystem.display [ fhir:value "Yaqui" ];
           fhir:CodeSystem.designation [
             fhir:index 0;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yaqui" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yaqui" ]
           ], [
             fhir:index 2;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yaqui" ]
           ], [
             fhir:index 3;
             fhir:CodeSystem.language [ fhir:value "en" ];
             fhir:CodeSystem.use [
               fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
               fhir:Coding.code [ fhir:value "display" ]
             ];
             fhir:CodeSystem.value [ fhir:value "Yaqui" ]
           ];
           fhir:CodeSystem.property [
             fhir:index 0;
             fhir:CodeSystem.code [ fhir:value "status" ];
             fhir:CodeSystem.value [ fhir:value "active" ]
           ], [
             fhir:index 1;
             fhir:CodeSystem.code [ fhir:value "internalId" ];
             fhir:CodeSystem.value [ fhir:value "18638" ]
           ]
         ]
       ]
     ], [
       fhir:index 3;
       fhir:CodeSystem.code [ fhir:value "_Tepiman" ];
       fhir:CodeSystem.display [ fhir:value "Tepiman" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tepiman" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tepiman" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tepiman" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "21030" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-PAP" ];
         fhir:CodeSystem.display [ fhir:value "Papago-Pima" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nebome" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Nevome" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "O'odham" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "O'othham" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Upper Piman" ]
         ], [
           fhir:index 5;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Papago-Pima" ]
         ], [
           fhir:index 6;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Papago-Pima" ]
         ], [
           fhir:index 7;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Papago-Pima" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18630" ]
         ]
       ]
     ], [
       fhir:index 4;
       fhir:CodeSystem.code [ fhir:value "x-HOP" ];
       fhir:CodeSystem.display [ fhir:value "Hopi" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Hopi" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Hopi" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18628" ]
       ]
     ], [
       fhir:index 5;
       fhir:CodeSystem.code [ fhir:value "x-TUB" ];
       fhir:CodeSystem.display [ fhir:value "Tubatululabal" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tubatululabal" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Tubatululabal" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18620" ]
       ]
     ]
  ], [
     fhir:index 15;
     fhir:CodeSystem.code [ fhir:value "_Wakashan" ];
     fhir:CodeSystem.display [ fhir:value "Wakashan" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Wakashan" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Wakashan" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21037" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "_Nootkan" ];
       fhir:CodeSystem.display [ fhir:value "Nootkan" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Nootkan" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Nootkan" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Nootkan" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "notSelectable" ];
         fhir:CodeSystem.value [ fhir:value "true" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 2;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "20999" ]
       ];
       fhir:CodeSystem.concept [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "x-MYH" ];
         fhir:CodeSystem.display [ fhir:value "Makah" ];
         fhir:CodeSystem.designation [
           fhir:index 0;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kweedishchaaht" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             a sct:900000000000013009;
             fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
             fhir:Coding.code [ fhir:value "900000000000013009" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Kwe-Nee-Chee-Aht" ]
         ], [
           fhir:index 2;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Makah" ]
         ], [
           fhir:index 3;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Makah" ]
         ], [
           fhir:index 4;
           fhir:CodeSystem.language [ fhir:value "en" ];
           fhir:CodeSystem.use [
             fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
             fhir:Coding.code [ fhir:value "display" ]
           ];
           fhir:CodeSystem.value [ fhir:value "Makah" ]
         ];
         fhir:CodeSystem.property [
           fhir:index 0;
           fhir:CodeSystem.code [ fhir:value "status" ];
           fhir:CodeSystem.value [ fhir:value "active" ]
         ], [
           fhir:index 1;
           fhir:CodeSystem.code [ fhir:value "internalId" ];
           fhir:CodeSystem.value [ fhir:value "18643" ]
         ]
       ]
     ]
  ], [
     fhir:index 16;
     fhir:CodeSystem.code [ fhir:value "_Yukian" ];
     fhir:CodeSystem.display [ fhir:value "Yukian" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Yukian" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
         fhir:Coding.code [ fhir:value "display" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Yukian" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "notSelectable" ];
       fhir:CodeSystem.value [ fhir:value "true" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 2;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "21044" ]
     ];
     fhir:CodeSystem.concept [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "x-WAO" ];
       fhir:CodeSystem.display [ fhir:value "Wappo" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Wappo" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Wappo" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18648" ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "x-YUK" ];
       fhir:CodeSystem.display [ fhir:value "Yuki" ];
       fhir:CodeSystem.designation [
         fhir:index 0;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Yuki" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.language [ fhir:value "en" ];
         fhir:CodeSystem.use [
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/designation-usage" ];
           fhir:Coding.code [ fhir:value "display" ]
         ];
         fhir:CodeSystem.value [ fhir:value "Yuki" ]
       ];
       fhir:CodeSystem.property [
         fhir:index 0;
         fhir:CodeSystem.code [ fhir:value "status" ];
         fhir:CodeSystem.value [ fhir:value "active" ]
       ], [
         fhir:index 1;
         fhir:CodeSystem.code [ fhir:value "internalId" ];
         fhir:CodeSystem.value [ fhir:value "18647" ]
       ]
     ]
  ], [
     fhir:index 17;
     fhir:CodeSystem.code [ fhir:value "x-HAI" ];
     fhir:CodeSystem.display [ fhir:value "Haida" ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "18240" ]
     ]
  ], [
     fhir:index 18;
     fhir:CodeSystem.code [ fhir:value "x-KUN" ];
     fhir:CodeSystem.display [ fhir:value "Kootenai" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         a sct:900000000000013009;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "900000000000013009" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Ktunaxa" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         a sct:900000000000013009;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "900000000000013009" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Kutenai" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "18335" ]
     ]
  ], [
     fhir:index 19;
     fhir:CodeSystem.code [ fhir:value "x-PSD" ];
     fhir:CodeSystem.display [ fhir:value "Plains Indian Sign Language" ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "18651" ]
     ]
  ], [
     fhir:index 20;
     fhir:CodeSystem.code [ fhir:value "x-YUC" ];
     fhir:CodeSystem.display [ fhir:value "Yuchi" ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "18639" ]
     ]
  ], [
     fhir:index 21;
     fhir:CodeSystem.code [ fhir:value "x-ZUN" ];
     fhir:CodeSystem.display [ fhir:value "Zuni" ];
     fhir:CodeSystem.designation [
       fhir:index 0;
       fhir:CodeSystem.language [ fhir:value "en" ];
       fhir:CodeSystem.use [
         a sct:900000000000013009;
         fhir:Coding.system [ fhir:value "http://snomed.info/sct" ];
         fhir:Coding.code [ fhir:value "900000000000013009" ]
       ];
       fhir:CodeSystem.value [ fhir:value "Zuñi" ]
     ];
     fhir:CodeSystem.property [
       fhir:index 0;
       fhir:CodeSystem.code [ fhir:value "status" ];
       fhir:CodeSystem.value [ fhir:value "active" ]
     ], [
       fhir:index 1;
       fhir:CodeSystem.code [ fhir:value "internalId" ];
       fhir:CodeSystem.value [ fhir:value "18649" ]
     ]
  ] .

# -------------------------------------------------------------------------------------

