<status value="draft"/> <subjectType value="Patient"/> <date value="2016-11-14"/> <publisher value="HL7 International / FHIR Infrastructure"/> <contact> <telecom> <system value="url"/> <value value="http://www.hl7.org/Special/committees/fiwg"/> </telecom> </contact> <description value="Example questionnaire to assess Zika virus exposure potential."/> <effectivePeriod> <start value="2016-11-14"/> </effectivePeriod> <item> <extension url="http://example.org/additional-information"> <valueAttachment> <url value="http://www.cdc.gov/zika/geo/index.html"/> <title value="Areas with active Zika virus transmission/exposure risk"/> </valueAttachment> </extension> <linkId value="1"/> <code> <system value="http://example.org/questionnaires"/> <code value="CDE: Resident of or Frequent Traveler to Zika Area"/> </code> <text value="Are you a resident of, or do you travel frequently to, an area with active Zika transmission?"/> <type value="boolean"/> </item> <item> <extension url="http://example.org/additional-information"> <valueAttachment> <url value="http://www.cdc.gov/zika/geo/index.html"/> <title value="Areas with active Zika virus transmission/exposure risk"/> </valueAttachment> </extension> <linkId value="2"/> <code> <system value="http://example.org/questionnaires"/> <code value="CDE: Recent Travel to Zika Area"/> </code> <text value="Have you recently traveled to an area with active Zika transmission?"/> <type value="boolean"/> <enableWhen> <question value="1"/> <operator value="="/> <answerBoolean value="false"/> </enableWhen> </item> <item> <linkId value="3"/> <code> <system value="http://example.org/questionnaires"/> <code value="CDE: Time Since Returned From Travel"/> </code> <text value="How long has it been since you returned?"/> <type value="quantity"/> <enableWhen> <question value="2"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> </item> <item> <extension url="http://example.org/additional-information"> <valueAttachment> <url value="http://www.cdc.gov/zika/geo/index.html"/> <title value="Areas with active Zika virus transmission/exposure risk"/> </valueAttachment> </extension> <linkId value="4"/> <code> <system value="http://example.org/questionnaires"/> <code value="CDE: Recent Sexual Encounter with Traveler to Zika Area"/> </code> <text value="Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?"/> <type value="boolean"/> <enableWhen> <question value="2"/> <operator value="="/> <answerBoolean value="false"/> </enableWhen> </item> <item> <linkId value="5"/> <code> <system value="http://example.org/questionnaires"/> <code value="CDE: Time Since Sexual Encounter"/> </code> <text value="How long has it been since your last condomless sexual encounter?"/> <type value="quantity"/> <enableWhen> <question value="4"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> </item> <item> <extension url="http://example.org/additional-information"> <valueAttachment> <url value="http://www.cdc.gov/zika/geo/index.html"/> <title value="Areas with active Zika virus transmission/exposure risk"/> </valueAttachment> </extension> <linkId value="6"/> <code> <system value="http://example.org/questionnaires"/> <code value="CDE: Planned Travel to Zika Area"/> </code> <text value="Do you plan to travel to an area with active Zika transmission?"/> <type value="boolean"/> <enableWhen> <question value="4"/> <operator value="="/> <answerBoolean value="false"/> </enableWhen> </item> </Questionnaire>