Da Vinci Clinical Data Exchange (CDex)
2.1.0 - STU 2.1 United States of America flag

Da Vinci Clinical Data Exchange (CDex), published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions

: CDex QuestionnaireResponse Example4 - XML Representation

Page standards status: Informative

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="cdex-questionnaireresponse-example4"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><h1>Questionnaire Response Summary for Amy Shaw</h1><p><strong>Questionnaire: </strong><a href="http://example.org/cdex-questionnaire-example2">CDEX Questionnaire Example2</a></p><p><strong>Date Completed: </strong>June 17, 2022</p><p><strong>Patient: </strong>Amy Shaw (Member Number: Member123)</p><h2>Questions and Answers</h2><ol><li><strong>Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy): </strong>Examplitis</li><li><strong>Order Reason: </strong>Replacement</li></ol></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature">
    <valueSignature>
      <type>
        <system value="urn:iso-astm:E1762-95:2013"/>
        <code value="1.2.840.10065.1.12.1.5"/>
        <display value="Verification Signature"/>
      </type>
      <when value="2020-10-23T04:54:56.048+00:00"/>
      <who>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
              <code value="NPI"/>
            </coding>
          </type>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="9941339100"/>
        </identifier>
        <display value="John Hancock, MD"/>
      </who>
      <onBehalfOf>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1234567893"/>
        </identifier>
      </onBehalfOf>
      <targetFormat
                    value="application/fhir+json;canonicalization=http://hl7.org/fhir/canonicalization/json#document"/>
      <sigFormat value="application/jose"/>
      <data
            value="ZXlKaGJHY2lPaUpTVXpJMU5pSXNJbXRwWkNJNkltSm1ZbVV6WlRWak1EUTNNRFEwTkRVM05qVTBPREV4TXpreU9HUTFaakZsTkdVelpqSmxaV0lpTENKcmRIa2lPaUpTVXlJc0luTnBaMVFpT2lJeU1ESXdMVEV3TFRJelZEQTBPalUwT2pVMkxqQTBPQ3N3TURvd01DSXNJbk55UTIxeklqcGJleUpqYjIxdFNXUWlPbnNpWkdWell5STZJbFpsY21sbWFXTmhkR2x2YmlCVGFXZHVZWFIxY21VaUxDSnBaQ0k2SW5WeWJqcHZhV1E2TVM0eUxqZzBNQzR4TURBMk5TNHhMakV5TGpFdU5TSjlMQ0pqYjIxdFVYVmhiSE1pT2xzaVZtVnlhV1pwWTJGMGFXOXVJRzltSUcxbFpHbGpZV3dnY21WamIzSmtJR2x1ZEdWbmNtbDBlU0pkZlYwc0luUjVjQ0k2SWtwWFZDSXNJbmcxWXlJNld5Sk5TVWxHVm5wRFEwRTNLMmRCZDBsQ1FXZEpWVUp1TkROR05FOHhNVEI2Vms1SVVGVjBRbTV1V0dZek0wWlJkM2RFVVZsS1MyOWFTV2gyWTA1QlVVVk1RbEZCZDJkYVZYaERla0ZLUW1kT1ZrSkJXVlJCYkZaVVRWSk5kMFZSV1VSV1VWRkpSRUZ3UkZsWGVIQmFiVGw1WW0xc2FFMVNTWGRGUVZsRVZsRlJTRVJCYkZSWldGWjZXVmQ0Y0dSSE9IaElWRUZpUW1kT1ZrSkJiMDFHUlZZMFdWY3hkMkpIVldkVU0wcHVXVmMxY0dWdFJqQmhWemwxVFZKcmQwWjNXVVJXVVZGRVJFSkNTMkl5YUhWSlJXaG9ZbTFPZGxreWMzTkpSVEZGVFZOTmQwbFJXVXBMYjFwSmFIWmpUa0ZSYTBKR2FGSnhZVWRHZFZreU9XcGhNRUpzWlVkR2RHTkhlR3hNYlRsNVducEJaVVozTUhsT1ZFRXlUV3BWZVUxNlJYbE5lbXhoUm5jd2VVNTZRVEpOVkZWNVRYcEZlVTE2YkdGTlNVZFdUVkZ6ZDBOUldVUldVVkZIUlhkS1ZsVjZSVlJOUWtWSFFURlZSVU5CZDB0Uk1rWnpZVmRhZG1OdE5YQlpWRVZUVFVKQlIwRXhWVVZDZDNkS1ZUSkdNV015Um5OaFdGSjJUVkl3ZDBkM1dVUldVVkZMUkVKU1JtVkhSblJqUjNoc1NVVTVlVm95Um5WaFdIQm9aRWRzZG1KcVJWcE5RbU5IUVRGVlJVRjNkMUZUYlRsdlltbENTVmxYTldwaU1rNXlURU5DVGxKRVJXcE5RMFZIUTFOeFIxTkpZak5FVVVWS1FWSlpWV0Z0YUdoaWJVNTJXVEowUVZwWWFHaGlXRUp6V2xNMWRtTnRZM2RuWjBkcFRVRXdSME5UY1VkVFNXSXpSRkZGUWtGUlZVRkJORWxDYW5kQmQyZG5SMHRCYjBsQ1oxRkRZMWh0ZGxnMk1FZEJOVWNyUkd3MGFWSnVPVlJUTDNkVVJqRkdWRWc1VW0xeVVESTVSelpZVTA5MVZrUkZaMGRhZDFWVVNra3ZUMnRTVEZCcUswcFZTM2t2YTAxWk0xbHROREZyTTBwU2NqaE9ja28zVldOcVpqTlVaVEpaTUhwdFVrMW1SMHRQTWxnM2NEQXhTV1E0Y2tkb2JtSnpWR3RYYW5ONlkyTnJha3RQVkdzM1JUUklXRTgzV0ZGdFZuWlNXbUZRY21wdVZsWnplalpoU1ZWdGJWVjVRbVZ0VlhoelVGRjRjV3RrTnpkNlVrdGxNVW9yWmsxaWNHSlRibUZHTWxNMVNEbEpOVWx3VVhVelpYSlRhazUzZFc1MWJVcEJMelZ6VGtGVFRWVm1LMXB5U3pWb2RIZFFabXh2Ym14V1FUbElSVkJ2Tms0MWRFcHpRMDFGV1RWeGExcEJXRVExTlZCVlltWTRTWGh5WkRNcmRERnBXRTVCWjAxa1dGQndPVTVxWm0xcmVtRklUM05TTlVWTU56aHZWbVowUzBnNFdFMW5jemxNSzFoWWFHTnRjQ3RUZFZOaVZWUXJiR0ZSUm01TFdsbzJOakZGUWpoVlZsRkhVR2h6U0dOMVdYbzNUUzhyUjBRM2JHdHRialYzTjJjMmFYcFpNRFZFY3pGMFpIUm9NMmhDSzBVeFpUQldPR0ZzTUN0SVdYaFlkRzFNTWpoUFluSjFjbHAwTlZaUFZEWXpObUZDVjJWaGF6TnRNV3gwSzBwTWFWUlhkMk5KV0hWeWFVcDNXRU5STjFjeVQyaEpjbXhsUW01ME5WbFNaRVl2Vm5kclFXWTFRbkEwTUVSTGNsbFRka0pVTDNnelVHRnlZbU5CY3pWeWRXRTBUV2w2ZEhwM2VrMURRWGRGUVVGaFQwSnVSRU5DYlZSQlNrSm5UbFpJVWsxRlFXcEJRVTFCYzBkQk1WVmtSSGRSUlVGM1NVWTBSRUpuUW1kT1ZraFNSVVZYVkVKWVoyYzVNMlF6WTNWYVdHaG9ZbGhDYzFwVE5YWmpiV1ZuUjFGWlNsbEpXa2xCV1dJMVYzZFJSMjlCZDAxRGFtczFUa1JGZWsxNmEzaE5SRU5IUzFkb01HUklRbnBQYVRoMldsaG9hR0pZUW5OYVV6VjJZMjFqZGxwdGFIQmphVGxSWTIxR2FtUkhiREJoVnpsMVdsaEpkazFVU1hwTlFqQkhRVEZWWkVSblVWZENRbE12ZG1vMVkwSklRa1ZTV0ZwVloxSlBVMnBXT0dWVWFqaDFObnBCVGtKbmEzRm9hMmxIT1hjd1FrRlJjMFpCUVU5RFFWbEZRV1pIYURCbWRqYzJRazE1VW5CcGJpODJiVEpPYms5QmQxbE9LMWRaVGxjMFduZFJTMUJ2YUN0cFFrWnFaMkl2WjFoYUwzZ3paRzVIY1RKU1ZXNVNTRXg1WW1OMmNVOTNRemgwTkN0TU1sRmhaVzUwZWk5NlUweG1Ra2xwU0ZBcmRuUmhkVlp2TkZscGNsVkxTVVpQTlU1clJHSlFVbmRGV0RaYWNHOTBkMUpGTW5BeldWQlBjVzFNYWxWd2RYRmxla3RTWm5WNlptWkZVMGxIUTFkbU5tSkJXbTlJT0c5MmVYcHJjRlZQZUZReWJHTktUREpaVVdkNFlVVkZLeTlOVDBWRWVHSjVMMGMxZEU1c1NGZFZNWEp0TWpsRVdrUTJhVlJ1T0VaSVRVOWlORVJCWlV4ek4yUmxWVUpMWlVGNGJVTk9NWGN3TjBsaVNHWlVXQ3M0ZUc5NlFtczRiVFJ5VVdGU1NUSkdZV05IWTA0dlV6UlBhMmxwYW14b2ExbHVSR1JpWWpaYWIwbENPVGxCVFVjdk1IUk5aMWRuYURVMVJrTk1PWGN5ZVhWaVJrUnpVaXN4ZVZwWE5YYzJlSFpXZFdKR2IzRXlja3RKV1U0MlFsUk5WRE0wT1U0clMxbEdVbFJpSzNCWU1EUlJSa1pEY1ZneFQzbDFVVVZLYWtwd1dtRjFURWxXVTIxVllWWjZSRmRrWVZKdGREQnlhMHhFTmxJNE5YUm9XVXB3VG5oTmNqUnZRWEp6ZVRWcGJEVk1NRXBXVFVWWVJ6RXhRMmhGZUZKRFNqZFljMmhyZEV4cWFpdEJPR3hrVlZKeVRFaFNWMWh2ZEhnMmJVNVdjRE1yVFc5cFEyaDROMUJtYmtkMlExQmhVSFpyVEZGeGFXVTRaRGh5YXpCbGFrNHpJbDE5Li5rcUZ4VkxwV1VfMU40Yzg2TVJJYXlWQXFneF9JSFBfdk5iWlpGamN3cnRvVDV3ZnhWejQyd2NCZmVtQjlTWWRYaTdUR3BqN2ZzbVNWVEVlUk1qMm1rZ1o0ek95LUF3azFOX0pkSzNvZmFUeWphYkR5NTJyUERndFN6ZzMwdlBqaWJLTFFQVWxXN3doR01Xb2NORWVXNW1yRGdwUjR6UThGMFNJSjNvU2pkbFVoalZuZzRYRmxhZ2lKOHgtZldIQ0JZXzRWTmFZU2tUc0JFMlUxZURXWUgxR2NyVmF1ejh0MlBkOFJ2allkbXg5Z1JoM0x3dVZRNmJVTVpJZS14WDVLUmtVV19KbmJmdG8tM3ZZb2JOZ3gyUVk2enNvR0ZSbzFsWHlrUDZjRDhIS2VmUFRGT0pFNUFuT0U0NjB1SVdJU1lmU3kyMXBDaThaWmYxbFRuZ1ZCME5vZXZJYjd4OFctNldJSXhSX2N2X3JlVlNfcElGb3ZSVS1tTVNDa1Y2akhoX2NDWnMxUDhOSG5oajVPdlhVaHhqajkwWHlOd1BVclJlMDdMbllHSlRxbEtmVnRoMHNfMmtWRU83b20zVVQ4RTJaZHRQdkVpeFIwWkF3RW5Ra1Qxa1BEaXd6ZXotcHpNTTBQbGJ1NWFHQlV1SGZRTFpYVHpteU9pdU0tUG1wRw=="/>
    </valueSignature>
  </extension>
  <questionnaire value="http://example.org/cdex-questionnaire-example2"/>
  <status value="completed"/>
  <subject>
    <identifier>
      <use value="usual"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
          <code value="MB"/>
          <display value="Member Number"/>
        </coding>
        <text value="Member Number"/>
      </type>
      <system value="http://example.org/cdex/payer/member-ids"/>
      <value value="Member123"/>
    </identifier>
    <display value="Amy Shaw"/>
  </subject>
  <authored value="2022-06-17"/>
  <author>
    <identifier>
      <system value="http://hl7.org/fhir/sid/us-npi"/>
      <value value="9941339100"/>
    </identifier>
  </author>
  <item>
    <linkId value="1"/>
    <text
          value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
    <answer>
      <valueString value="Examplitis"/>
    </answer>
  </item>
  <item>
    <linkId value="2"/>
    <text value="Order Reason"/>
    <answer>
      <valueCoding>
        <system value="http://example.org"/>
        <code value="4"/>
        <display value="Replacement"/>
      </valueCoding>
    </answer>
  </item>
</QuestionnaireResponse>