# $questionnaire-package Output Parameters Example - Da Vinci - Documentation Templates and Rules v2.2.0

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



## Resource Content

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

```
