Da Vinci - Documentation Templates and Rules
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Da Vinci - Documentation Templates and Rules, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-dtr/ and changes regularly. See the Directory of published versions

Example QuestionnaireResponse: home-o2-questionnaireresponse

Page standards status: Informative
LinkIDTextDefinitionAnswerdoco
.. home-o2-questionnaireresponseQuestionnaire:http://example.com/Questionnaire/referred-questionnaire
... 1Patient Information
.... 1.1Last Name but Different This TimeQuinton
.... 1.2First NameVlad
.... 1.3Middle InitialA, N
.... 1.4Date Of Birth1956-12-01
.... 1.5GenderAdministrativeGender male: Male
.... 1.6Medicare ID10A3D58WH22
... 2Provider who is performing face-to-face evaluation
.... 2.1Last NameDoe
.... 2.2First NameJane
.... 2.3Middle InitialB
.... 2.4NPI1122334455
.... 2.5Date of Face-To-Face Evaluation2019-07-18
... 3Coverage Requirements
.... 3.1Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)
.... 3.2Arterial oxygen saturation (Patient on room air while at rest and awake when tested)95 mm[Hg]
.... 3.3Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)83 mm[Hg]
.... 3.4Arterial oxygen saturation (Patient tested during exercise)95 mm[Hg]
.... 3.5Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)78 mm[Hg]
.... 3.6Is there a documented improvement of hypoxemia during exercise with oxygen?true
... 4Prescribed Use
.... 4.1Start date2019-07-18
.... 4.2Length of need: (months) (99 = lifetime)99
.... 4.3Peak Flow Rate
..... 4.3.1LPM2
..... 4.3.2oxygen %98
.... 4.4Average Flow Rate
..... 4.4.1LPM2
..... 4.4.2oxygen %97
.... 4.5Frequency of use (choose all that apply)example.org 2112: At rest and awake
... 5Oxygen Supply Order Details
.... 5.1Current Order DescriptionHCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental
.... 5.1bCurrent Order Is For A Portable Device
.... 5.2Typeexample.org 122: Compressed Gas
.... 5.3Means of oxygen delivery and accessoriesexample.org 134: Mask

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