Da Vinci - Documentation Templates and Rules
2.2.0 - STU 2.2

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 2.2.0 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

## : $questionnaire-package Output Parameters Example

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    <Parameters xmlns="http://hl7.org/fhir">
      <id value="QuestionnairePackageOutputParamsExample"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-output-parameters"/>
      </meta>
      <language value="en"/>
      <parameter>
        <name value="packagebundle"/>
        <resource>
          <Bundle>
            <id value="home-o2-questionnairepackage-bundle"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/DTR-QPackageBundle"/>
            </meta>
            <language value="en"/>
            <type value="collection"/>
            <entry>
              <fullUrl
                       value="http://example.org/fhir/home-o2-questionnairepackage"/>
              <resource>
                <Questionnaire>
                  <id value="home-o2-std-questionnaire"/>
                  <meta>
                    <profile
                             value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-std-questionnaire"/>
                  </meta>
                  <language value="en"/>
                  <extension
                             url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm">
                    <valueCoding>
                      <system value="http://hl7.org/fhir/version-algorithm"/>
                      <code value="semver"/>
                    </valueCoding>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/questionnaireAudience">
                    <valueCode value="clinical"/>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/request-specific">
                    <valueBoolean value="false"/>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive">
                    <valueBoolean value="false"/>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode">
                    <valueCode value="sequential"/>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/estimated-completion-time">
                    <extension url="totalTime">
                      <valueCode value="over-5min"/>
                    </extension>
                    <extension url="clinicalTime">
                      <valueCode value="under-3min"/>
                    </extension>
                  </extension>
                  <url
                       value="http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire"/>
                  <name value="HomeOxygenTherapyStdQuestionnaire"/>
                  <title value="Home Oxygen Therapy Order Template"/>
                  <status value="draft"/>
                  <subjectType value="Patient"/>
                  <date value="2020-01-13T00:00:00+00:00"/>
                  <publisher value="Da Vinci DTR"/>
                  <contact>
                    <name value="Example Author"/>
                  </contact>
                  <item>
                    <linkId value="1"/>
                    <text value="Patient Information"/>
                    <type value="group"/>
                    <item>
                      <linkId value="1.1"/>
                      <text value="Last Name"/>
                      <type value="string"/>
                      <required value="true"/>
                    </item>
                    <item>
                      <linkId value="1.2"/>
                      <text value="Fist Name"/>
                      <type value="string"/>
                      <required value="true"/>
                    </item>
                    <item>
                      <linkId value="1.3"/>
                      <text value="Middle Name"/>
                      <type value="string"/>
                      <required value="false"/>
                    </item>
                    <item>
                      <linkId value="1.gender"/>
                      <definition
                                  value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-question-library#Demographics.sex"/>
                      <text value="What is this person's gender?"/>
                      <type value="choice"/>
                      <required value="true"/>
                      <answerValueSet
                                      value="http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype"/>
                    </item>
                    <item>
                      <linkId value="1.4"/>
                      <text value="Date Of Birth"/>
                      <type value="date"/>
                    </item>
                    <item>
                      <extension
                                 url="http://hl7.org/fhir/StructureDefinition/minValue">
                        <valueDecimal value="1"/>
                      </extension>
                      <extension
                                 url="http://hl7.org/fhir/StructureDefinition/maxValue">
                        <valueDecimal value="400"/>
                      </extension>
                      <extension
                                 url="http://hl7.org/fhir/StructureDefinition/maxDecimalPlaces">
                        <valueInteger value="2"/>
                      </extension>
                      <linkId value="1.5"/>
                      <text value="Enter your weight in lb"/>
                      <type value="decimal"/>
                    </item>
                    <item>
                      <extension
                                 url="http://hl7.org/fhir/StructureDefinition/mimeType">
                        <valueCode value="image/jpeg"/>
                      </extension>
                      <extension
                                 url="http://hl7.org/fhir/StructureDefinition/maxSize">
                        <valueDecimal value="1048576"/>
                      </extension>
                      <linkId value="1.6"/>
                      <text value="Attach latest x-ray"/>
                      <type value="attachment"/>
                    </item>
                  </item>
                  <item>
                    <linkId value="2"/>
                    <text value="Calculation"/>
                    <type value="group"/>
                    <item>
                      <extension
                                 url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression">
                        <valueExpression>
                          <extension
                                     url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/alternativeExpression">
                            <valueExpression>
                              <language value="application/elm+json"/>
                              <expression value="corresponding elm data"/>
                            </valueExpression>
                          </extension>
                          <description value="deadline for submission"/>
                          <language value="text/fhirpath"/>
                          <expression value="today() + 7 days"/>
                        </valueExpression>
                      </extension>
                      <linkId value="2.1"/>
                      <text value="Deadline for submission (7 days from now)"/>
                      <type value="date"/>
                      <readOnly value="true"/>
                    </item>
                  </item>
                </Questionnaire>
              </resource>
            </entry>
            <entry>
              <fullUrl
                       value="http://example.org/fhir/home-o2-questionnaireresponse"/>
              <resource>
                <QuestionnaireResponse>
                  <id value="home-o2-questionnaireresponse"/>
                  <meta>
                    <profile
                             value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"/>
                  </meta>
                  <language value="en"/>
                  <extension
                             url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-coverage">
                    <valueReference>🔗
                      <reference value="Coverage/CoverageExample"/>
                    </valueReference>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/intendedUse">
                    <valueCodeableConcept>
                      <coding>
                        <system
                                value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes"/>
                        <code value="withorder"/>
                        <display value="Include with order"/>
                      </coding>
                    </valueCodeableConcept>
                  </extension>
                  <extension
                             url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context">
                    <valueReference>🔗
                      <reference value="ServiceRequest/ServiceRequestExample"/>
                    </valueReference>
                  </extension>
                  <questionnaire
                                 value="http://hl7.org/fhir/us/davinci-dtr/Questionnaire/referred-questionnaire"/>
                  <status value="completed"/>
                  <subject>🔗
                    <reference value="Patient/examplepatient"/>
                    <display value="Vlad"/>
                  </subject>
                  <authored value="2023-08-21"/>
                  <item>
                    <linkId value="1"/>
                    <text value="Patient Information"/>
                    <item>
                      <linkId value="1.1"/>
                      <text value="Last Name but Different This Time"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="override"/>
                          </extension>
                          <extension url="author">
                            <extension url="role">
                              <valueCodeableConcept>
                                <coding>
                                  <system
                                          value="http://terminology.hl7.org/CodeSystem/practitioner-role"/>
                                  <code value="doctor"/>
                                  <display value="Doctor"/>
                                </coding>
                              </valueCodeableConcept>
                            </extension>
                            <extension url="practitioner">
                              <valueReference>🔗
                                <reference
                                           value="Practitioner/PractitionerExample"/>
                                <display value="Dr. Jane Doe"/>
                              </valueReference>
                            </extension>
                          </extension>
                        </extension>
                        <valueString value="Quinton"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="1.2"/>
                      <text value="First Name"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="Vlad"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="1.3"/>
                      <text value="Middle Initial"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="A, N"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="1.4"/>
                      <text value="Date Of Birth"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueDate value="1956-12-01"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="1.5"/>
                      <text value="Gender"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueCoding>
                          <system
                                  value="http://hl7.org/fhir/administrative-gender"/>
                          <code value="male"/>
                          <display value="Male"/>
                        </valueCoding>
                      </answer>
                    </item>
                    <item>
                      <linkId value="1.6"/>
                      <text value="Medicare ID"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="10A3D58WH22"/>
                      </answer>
                    </item>
                  </item>
                  <item>
                    <linkId value="2"/>
                    <text
                          value="Provider who is performing face-to-face evaluation"/>
                    <item>
                      <linkId value="2.1"/>
                      <text value="Last Name"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="Doe"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="2.2"/>
                      <text value="First Name"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="Jane"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="2.3"/>
                      <text value="Middle Initial"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="B"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="2.4"/>
                      <text value="NPI"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="1122334455"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="2.5"/>
                      <text value="Date of Face-To-Face Evaluation"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="override"/>
                          </extension>
                          <extension url="author">
                            <extension url="role">
                              <valueCodeableConcept>
                                <coding>
                                  <system
                                          value="http://terminology.hl7.org/CodeSystem/practitioner-role"/>
                                  <code value="doctor"/>
                                  <display value="Doctor"/>
                                </coding>
                              </valueCodeableConcept>
                            </extension>
                            <extension url="practitioner">
                              <valueReference>🔗
                                <reference
                                           value="Practitioner/PractitionerExample"/>
                                <display value="Dr. Jane Doe"/>
                              </valueReference>
                            </extension>
                          </extension>
                        </extension>
                        <valueDate value="2019-07-18"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="2.6"/>
                      <text value="Record"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference">
                          <valueBoolean value="false"/>
                        </extension>
                        <valueReference>🔗
                          <reference value="Patient/examplepatient"/>
                          <display value="Mr. Saul Moki"/>
                        </valueReference>
                      </answer>
                    </item>
                  </item>
                  <item>
                    <linkId value="3"/>
                    <text value="Coverage Requirements"/>
                    <item>
                      <linkId value="3.1"/>
                      <text
                            value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueCoding>
                          <system value="http://snomed.info/sct"/>
                          <code value="313296004"/>
                          <display
                                   value="Mild chronic obstructive pulmonary disease"/>
                        </valueCoding>
                      </answer>
                    </item>
                    <item>
                      <linkId value="3.2"/>
                      <text
                            value="Arterial oxygen saturation (Patient on room air while at rest and awake when tested)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueQuantity>
                          <value value="95"/>
                          <system value="http://unitsofmeasure.org"/>
                          <code value="mm[Hg]"/>
                        </valueQuantity>
                      </answer>
                    </item>
                    <item>
                      <linkId value="3.3"/>
                      <text
                            value="Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueQuantity>
                          <value value="83"/>
                          <system value="http://unitsofmeasure.org"/>
                          <code value="mm[Hg]"/>
                        </valueQuantity>
                      </answer>
                    </item>
                    <item>
                      <linkId value="3.4"/>
                      <text
                            value="Arterial oxygen saturation (Patient tested during exercise)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueQuantity>
                          <value value="95"/>
                          <system value="http://unitsofmeasure.org"/>
                          <code value="mm[Hg]"/>
                        </valueQuantity>
                      </answer>
                    </item>
                    <item>
                      <linkId value="3.5"/>
                      <text
                            value="Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueQuantity>
                          <value value="78"/>
                          <system value="http://unitsofmeasure.org"/>
                          <code value="mm[Hg]"/>
                        </valueQuantity>
                      </answer>
                    </item>
                    <item>
                      <linkId value="3.6"/>
                      <text
                            value="Is there a documented improvement of hypoxemia during exercise with oxygen?"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueBoolean value="true"/>
                      </answer>
                    </item>
                  </item>
                  <item>
                    <linkId value="4"/>
                    <text value="Prescribed Use"/>
                    <item>
                      <linkId value="4.1"/>
                      <text value="Start date"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueDate value="2019-07-18"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="4.2"/>
                      <text value="Length of need: (months) (99 = lifetime)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueQuantity>
                          <value value="99"/>
                        </valueQuantity>
                      </answer>
                    </item>
                    <item>
                      <linkId value="4.3"/>
                      <text value="Peak Flow Rate"/>
                      <item>
                        <linkId value="4.3.1"/>
                        <text value="LPM"/>
                        <answer>
                          <extension
                                     url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                            <extension url="source">
                              <valueCode value="auto-client"/>
                            </extension>
                          </extension>
                          <valueQuantity>
                            <value value="2"/>
                          </valueQuantity>
                        </answer>
                      </item>
                      <item>
                        <linkId value="4.3.2"/>
                        <text value="oxygen %"/>
                        <answer>
                          <extension
                                     url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                            <extension url="source">
                              <valueCode value="auto-client"/>
                            </extension>
                          </extension>
                          <valueQuantity>
                            <value value="98"/>
                          </valueQuantity>
                        </answer>
                      </item>
                    </item>
                    <item>
                      <linkId value="4.4"/>
                      <text value="Average Flow Rate"/>
                      <item>
                        <linkId value="4.4.1"/>
                        <text value="LPM"/>
                        <answer>
                          <extension
                                     url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                            <extension url="source">
                              <valueCode value="auto-client"/>
                            </extension>
                          </extension>
                          <valueQuantity>
                            <value value="2"/>
                          </valueQuantity>
                        </answer>
                      </item>
                      <item>
                        <linkId value="4.4.2"/>
                        <text value="oxygen %"/>
                        <answer>
                          <extension
                                     url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                            <extension url="source">
                              <valueCode value="auto-client"/>
                            </extension>
                          </extension>
                          <valueQuantity>
                            <value value="97"/>
                          </valueQuantity>
                        </answer>
                      </item>
                    </item>
                    <item>
                      <linkId value="4.5"/>
                      <text value="Frequency of use (choose all that apply)"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString value="At rest and awake"/>
                      </answer>
                    </item>
                  </item>
                  <item>
                    <linkId value="5"/>
                    <text value="Oxygen Supply Order Details"/>
                    <item>
                      <linkId value="5.1"/>
                      <text value="Current Order Description"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueString
                                     value="HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"/>
                      </answer>
                    </item>
                    <item>
                      <linkId value="5.1b"/>
                      <text value="Current Order Is For A Portable Device"/>
                    </item>
                    <item>
                      <linkId value="5.2"/>
                      <text value="Type"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueCoding>
                          <system value="http://example.org"/>
                          <code value="122"/>
                          <display value="Compressed Gas"/>
                        </valueCoding>
                      </answer>
                    </item>
                    <item>
                      <linkId value="5.3"/>
                      <text value="Means of oxygen delivery and accessories"/>
                      <answer>
                        <extension
                                   url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
                          <extension url="source">
                            <valueCode value="auto-client"/>
                          </extension>
                        </extension>
                        <valueCoding>
                          <system value="http://example.org"/>
                          <code value="134"/>
                          <display value="Mask"/>
                        </valueCoding>
                      </answer>
                    </item>
                  </item>
                </QuestionnaireResponse>
              </resource>
            </entry>
          </Bundle>
        </resource>
      </parameter>
    </Parameters>