home-o2-questionnaireresponse-bundle - Da Vinci - Documentation Templates and Rules v2.1.0

Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1 United States of America flag

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 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 Bundle: home-o2-questionnaireresponse-bundle

Generated Narrative: Bundle home-o2-questionnaireresponse-bundle

Bundle home-o2-questionnaireresponse-bundle of type collection

Entry 1 - fullUrl = http://example.org/fhir/home-o2-questionnaireresponse

Resource QuestionnaireResponse:

Generated Narrative: QuestionnaireResponse home-o2-questionnaireresponse

LinkID Text Definition Answer
home-o2-questionnaireresponse Questionnaire:Referred Questionnaire for QuestionnaireResponse

1 Patient Information

1.1 Last Name but Different This Time Quinton

1.2 First Name Vlad

1.3 Middle Initial A, N

1.4 Date Of Birth 1956-12-01

1.5 Gender AdministrativeGender male: Male

1.6 Medicare ID 10A3D58WH22

2 Provider who is performing face-to-face evaluation

2.1 Last Name Doe

2.2 First Name Jane

2.3 Middle Initial B

2.4 NPI 1122334455

2.5 Date of Face-To-Face Evaluation 2019-07-18

2.6 Record Mr. Saul Moki

3 Coverage Requirements

3.1 Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy) SNOMED CT 313296004: Mild chronic obstructive pulmonary disease

3.2 Arterial oxygen saturation (Patient on room air while at rest and awake when tested) 95 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')

3.3 Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested) 83 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')

3.4 Arterial oxygen saturation (Patient tested during exercise) 95 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')

3.5 Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise) 78 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')

3.6 Is there a documented improvement of hypoxemia during exercise with oxygen? true

4 Prescribed Use

4.1 Start date 2019-07-18

4.2 Length of need: (months) (99 = lifetime) 99

4.3 Peak Flow Rate

4.3.1 LPM 2

4.3.2 oxygen % 98

4.4 Average Flow Rate

4.4.1 LPM 2

4.4.2 oxygen % 97

4.5 Frequency of use (choose all that apply) At rest and awake

5 Oxygen Supply Order Details

5.1 Current Order Description HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental

5.1b Current Order Is For A Portable Device

5.2 Type example.org 122: Compressed Gas

5.3 Means of oxygen delivery and accessories example.org 134: Mask

Documentation for this format

LinkID	Text	Answer
home-o2-questionnaireresponse		Questionnaire:Referred Questionnaire for QuestionnaireResponse
1	Patient Information
1.1	Last Name but Different This Time	Quinton
1.2	First Name	Vlad
1.3	Middle Initial	A, N
1.4	Date Of Birth	1956-12-01
1.5	Gender	AdministrativeGender male: Male
1.6	Medicare ID	10A3D58WH22
2	Provider who is performing face-to-face evaluation
2.1	Last Name	Doe
2.2	First Name	Jane
2.3	Middle Initial	B
2.4	NPI	1122334455
2.5	Date of Face-To-Face Evaluation	2019-07-18
2.6	Record	Mr. Saul Moki
3	Coverage Requirements
3.1	Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)	SNOMED CT 313296004: Mild chronic obstructive pulmonary disease
3.2	Arterial oxygen saturation (Patient on room air while at rest and awake when tested)	95 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
3.3	Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)	83 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
3.4	Arterial oxygen saturation (Patient tested during exercise)	95 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
3.5	Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)	78 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]')
3.6	Is there a documented improvement of hypoxemia during exercise with oxygen?	true
4	Prescribed Use
4.1	Start date	2019-07-18
4.2	Length of need: (months) (99 = lifetime)	99
4.3	Peak Flow Rate
4.3.1	LPM	2
4.3.2	oxygen %	98
4.4	Average Flow Rate
4.4.1	LPM	2
4.4.2	oxygen %	97
4.5	Frequency of use (choose all that apply)	At rest and awake
5	Oxygen Supply Order Details
5.1	Current Order Description	HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental
5.1b	Current Order Is For A Portable Device
5.2	Type	example.org 122: Compressed Gas
5.3	Means of oxygen delivery and accessories	example.org 134: Mask
Documentation for this format

IG © 2022+ HL7 International / Clinical Decision Support. Package hl7.fhir.us.davinci-dtr#2.1.0 based on FHIR 4.0.1. Generated 2024-11-21
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