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Questionnaire-zika-virus-exposure-assessment.json

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Not linked to any defined compartments

Raw JSON (canonical form + also see JSON Format Specification)

Example instrument for assessing Zika virus exposure potential

{
  "resourceType": "Questionnaire",
  "id": "zika-virus-exposure-assessment",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div><p>Resource &quot;zika-virus-exposure-assessment&quot; </p></div><p><b>url</b>: <code>http://example.org/Questionnaire/zika-virus-exposure-assessment</code></p><p><b>name</b>: ExampleZikaVirusExposureAssessment</p><p><b>title</b>: Example Zika Virus Exposure Assessment</p><p><b>status</b>: draft</p><p><b>subjectType</b>: Patient</p><p><b>date</b>: 2016-11-14</p><p><b>description</b>: Example questionnaire to assess Zika virus exposure potential.</p><p><b>effectivePeriod</b>: 2016-11-14 --&gt; (ongoing)</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 1</p><p><b>code</b>: CDE: Resident of or Frequent Traveler to Zika Area (Details: http://example.org/questionnaires code CDE: Resident of or Frequent Traveler to Zika Area = 'CDE: Resident of or Frequent Traveler to Zika Area', stated as 'null')</p><p><b>text</b>: Are you a resident of, or do you travel frequently to, an area with active Zika transmission?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2</p><p><b>code</b>: CDE: Recent Travel to Zika Area (Details: http://example.org/questionnaires code CDE: Recent Travel to Zika Area = 'CDE: Recent Travel to Zika Area', stated as 'null')</p><p><b>text</b>: Have you recently traveled to an area with active Zika transmission?</p><p><b>type</b>: boolean</p><h3>EnableWhens</h3><table><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>1</td><td>=</td><td>false</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3</p><p><b>code</b>: CDE: Time Since Returned From Travel (Details: http://example.org/questionnaires code CDE: Time Since Returned From Travel = 'CDE: Time Since Returned From Travel', stated as 'null')</p><p><b>text</b>: How long has it been since you returned?</p><p><b>type</b>: quantity</p><h3>EnableWhens</h3><table><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>2</td><td>=</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4</p><p><b>code</b>: CDE: Recent Sexual Encounter with Traveler to Zika Area (Details: http://example.org/questionnaires code CDE: Recent Sexual Encounter with Traveler to Zika Area = 'CDE: Recent Sexual Encounter with Traveler to Zika Area', stated as 'null')</p><p><b>text</b>: Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?</p><p><b>type</b>: boolean</p><h3>EnableWhens</h3><table><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>2</td><td>=</td><td>false</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 5</p><p><b>code</b>: CDE: Time Since Sexual Encounter (Details: http://example.org/questionnaires code CDE: Time Since Sexual Encounter = 'CDE: Time Since Sexual Encounter', stated as 'null')</p><p><b>text</b>: How long has it been since your last condomless sexual encounter?</p><p><b>type</b>: quantity</p><h3>EnableWhens</h3><table><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>4</td><td>=</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 6</p><p><b>code</b>: CDE: Planned Travel to Zika Area (Details: http://example.org/questionnaires code CDE: Planned Travel to Zika Area = 'CDE: Planned Travel to Zika Area', stated as 'null')</p><p><b>text</b>: Do you plan to travel to an area with active Zika transmission?</p><p><b>type</b>: boolean</p><h3>EnableWhens</h3><table><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>4</td><td>=</td><td>false</td></tr></table></blockquote></div>"
  },
  "url": "http://example.org/Questionnaire/zika-virus-exposure-assessment",
  "name": "ExampleZikaVirusExposureAssessment",
  "title": "Example Zika Virus Exposure Assessment",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "date": "2016-11-14",
  "description": "Example questionnaire to assess Zika virus exposure potential.",
  "effectivePeriod": {
    "start": "2016-11-14"
  },
  "item": [
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "1",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Resident of or Frequent Traveler to Zika Area"
        }
      ],
      "text": "Are you a resident of, or do you travel frequently to, an area with active Zika transmission?",
      "type": "boolean"
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "2",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Recent Travel to Zika Area"
        }
      ],
      "text": "Have you recently traveled to an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "1",
          "operator": "=",
          "answerBoolean": false
        }
      ]
    },
    {
      "linkId": "3",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Time Since Returned From Travel"
        }
      ],
      "text": "How long has it been since you returned?",
      "type": "quantity",
      "enableWhen": [
        {
          "question": "2",
          "operator": "=",
          "answerBoolean": true
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "4",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Recent Sexual Encounter with Traveler to Zika Area"
        }
      ],
      "text": "Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "2",
          "operator": "=",
          "answerBoolean": false
        }
      ]
    },
    {
      "linkId": "5",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Time Since Sexual Encounter"
        }
      ],
      "text": "How long has it been since your last condomless sexual encounter?",
      "type": "quantity",
      "enableWhen": [
        {
          "question": "4",
          "operator": "=",
          "answerBoolean": true
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "6",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Planned Travel to Zika Area"
        }
      ],
      "text": "Do you plan to travel to an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "4",
          "operator": "=",
          "answerBoolean": false
        }
      ]
    }
  ]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.