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

## Example Parameters: $questionnaire-package Output Parameters Example

Language: en

Profile: DTR Questionnaire Package Output Parameters

## Parameters

> packagebundle | Bundle/home-o2-questionnairepackage-bundle Profile: DTR Questionnaire Package Bundle Bundle home-o2-questionnairepackage-bundle of type collection Entry 1 - fullUrl = http://example.org/fhir/home-o2-questionnairepackage Resource Questionnaire: Profile: DTR Standard Questionnaire
> LinkID | Text | Cardinality | Type | Flags | Description & Constraints
> --- | --- | --- | --- | --- | ---
> HomeOxygenTherapyStdQuestionnaire |  |  | Questionnaire |  | http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire
> 1 | Patient Information | 0..1 | group |  |
> 1.1 | Last Name | 1..1 | string |  |
> 1.2 | Fist Name | 1..1 | string |  |
> 1.3 | Middle Name | 0..1 | string |  |
> 1.gender | What is this person's gender? | 1..1 | choice |  | Definition: Demographics.sex Value Set: Patient relationship type
> 1.4 | Date Of Birth | 0..1 | date |  |
> 1.5 | Enter your weight in lb | 0..1 | decimal |  |
> 1.6 | Attach latest x-ray | 0..1 | attachment |  |
> 2 | Calculation | 0..1 | group |  |
> 2.1 | Deadline for submission (7 days from now) | 0..1 | date |  |
> Documentation for this format
> Entry 2 - fullUrl = http://example.org/fhir/home-o2-questionnaireresponse Resource QuestionnaireResponse: Profile: DTR Questionnaire Response
> 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