Da Vinci - Documentation Templates and Rules
2.2.0-snapshot - STU 2.2 - Peer Review
Da Vinci - Documentation Templates and Rules
2.2.0-snapshot - STU 2.2 - Peer Review
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-snapshot 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
<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/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"/>
<version value="0.1.0"/>
<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/temp"/>
<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>
IG © 2022+ HL7 International / Clinical Decision Support.
Package hl7.fhir.us.davinci-dtr#2.2.0-snapshot based on FHIR 4.0.1.
Generated
2026-02-12
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