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: Home Oxygen Therapy Order Template

Official URL: http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire | Version: 2.2.0 | Highlight text changes?
Standards status: Informative Draft as of 2020-01-13 | Computable Name: HomeOxygenTherapyStdQuestionnaire

- Tree view
- Sample Rendering
- Form Logic

Profile: DTR Standard Questionnaireversion: null2.2.0)

LinkID | Text | Cardinality | Type | Flags | Description & Constraints
--- | --- | --- | --- | --- | ---
HomeOxygenTherapyStdQuestionnaire |  |  | Questionnaire |  | http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire#2.2.0
1 | Patient Information | 0..1 | group |  | Value Set:
1.1 | Last Name | 1..1 | string |  | Value Set:
1.2 | Fist Name | 1..1 | string |  | Value Set:
1.3 | Middle Name | 0..1 | string |  | Value Set:
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 |  | Value Set:
1.5 | Enter your weight in lb | 0..1 | decimal |  | Value Set:
1.6 | Attach latest x-ray | 0..1 | attachment |  | Value Set:
2 | Calculation | 0..1 | group |  | Value Set:
2.1 | Deadline for submission (7 days from now) | 0..1 | date |  | Value Set:
Documentation for this format

Profile: DTR Standard Questionnaireversion: null2.2.0)

Patient Information

- linkId: 1
- Answers:

Last Name*

- linkId: 1.1
- Answers:

Fist Name*

- linkId: 1.2
- Answers:

Middle Name

- linkId: 1.3
- Answers:

What is this person's gender?*

- linkId: 1.gender
- Definition:: Demographics.sex
- Answers: Patient relationship type

Date Of Birth

- linkId: 1.4
- Answers:

Enter your weight in lb

- linkId: 1.5
- Answers:

Attach latest x-ray

- linkId: 1.6
- Answers:

Calculation

- linkId: 2
- Answers:

Deadline for submission (7 days from now)

- linkId: 2.1
- Answers:

Profile: DTR Standard Questionnaireversion: null2.2.0)

LinkID | Description & Constraints
--- | ---
1 | Value Set:
1.1 | Value Set:
1.2 | Value Set:
1.3 | Value Set:
1.gender | Definition: Demographics.sex Value Set: Patient relationship type
1.4 | Value Set:
1.5 | Value Set:
1.6 | Value Set:
2 | Value Set:
2.1 | Value Set:
Documentation for this format

### Test this Questionnaire

Try this questionnaire out:

- NLM Forms Library

### Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.