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
Page standards status: Informative |
Generated Narrative: QuestionnaireResponse home-o2-questionnaireresponse
LinkID | Text | Definition | Answer |
---|---|---|---|
home-o2-questionnaireresponse | Questionnaire:http://example.com/Questionnaire/referred-questionnaire | ||
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 | |
3 | Coverage Requirements | ||
3.1 | Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy) | ||
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) | example.org 2112: 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 |