Structured Data Capture
4.0.0-ballot - STU 4 ballot International flag

Structured Data Capture, published by HL7 International / FHIR Infrastructure. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/sdc/ and changes regularly. See the Directory of published versions

Questionnaire: SDC-Advanced Rendering

Official URL: http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render Version: 4.0.0-ballot
Standards status: Informative Computable Name: SDCAdvancedRenderingExample
Other Identifiers: OID:2.16.840.1.113883.4.642.40.17.35.16

Generated Narrative: Questionnaire questionnaire-sdc-profile-example-render

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. SDCAdvancedRenderingExampleQuestionnairehttp://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render#4.0.0-ballot
... 1Text Appearance0..1group
.... 1.1Enter your First Name0..1string
.... 1.2Please answer Yes or No to each of the following questions:0..1display
.... 1.3ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.0..1displayiconicon
.... 1.4null0..1group
..... 1.4.1Form ID0..1stringiconicon
..... 1.4.2Event ID0..1string
... 2Control Appearance0..1group
.... 2.1If you have any other medical problems or serious injuries, please describe them here:0..1text
.... 2.2Gender:0..1choiceiconiconOptions: 4 options
.... 2.3Rate your doctor:0..1integerInitial Value: integer = 50
..... 2.3.1Completely dissatisfied0..1display
..... 2.3.2Completely satisfied0..1display
.... 2.4Medical History0..1group
..... 2.4.1Diabetes0..1choiceOptions: 2 options
..... 2.4.2Other Information0..1choiceOptions: 4 options
.... 2.5null0..1group
..... 2.5.1Relationship to patient0..1choiceOptions: 3 options
..... 2.5.2Name0..1string
..... 2.5.3Gender0..1choiceOptions: 4 options
.... 2.6Lifestyle Factors0..1group
..... 2.6.1Exercise Habits0..1choiceOptions: 4 options
..... 2.6.2Smoking Frequency0..1choiceOptions: 4 options
..... 2.6.3Alcohol Consumption0..1choiceOptions: 4 options
... 3Additional Display Content0..1group
.... 3.1Have you traveled outside the country within the last 14 days?0..1choiceOptions: 2 options
.... 3.2Select Platelet:0..1choiceValue Set: http://loinc.org/vs/LL715-4
.... 3.3Gender:0..1choiceOptions: 4 options
.... 3.4Enter timing of harm assessment:0..1choiceiconiconValue Set: Timing of harm assessment [AHRQ]
.... 3.5Birth Date0..1date
.... 3.6IMPORTANT: Please complete questionnaire.0..1display
.... 3.7Enter your Middle Name0..1stringiconicon
.... 3.8During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.0..1decimal
.... 3.9Which of the following time-slots are you available for?0..1stringOptions: 6 options

doco Documentation for this format

Options Sets

Answer options for 2.2

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 2.4.1

  • http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")
  • http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")

Answer options for 2.4.2

  • http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")
  • http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")
  • http://example.org/CodeSystem/conditions#otherinformation-hypertension ("Hypertension")
  • http://example.org/CodeSystem/conditions#otherinformation-smoker ("Smoker")

Answer options for 2.5.1

  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Father")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Mother")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIB ("Sibling")

Answer options for 2.5.3

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 2.6.1

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 2.6.2

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 2.6.3

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 3.1

  • http://terminology.hl7.org/CodeSystem/v2-0532#Y ("Yes")
  • http://terminology.hl7.org/CodeSystem/v2-0532#N ("No")

Answer options for 3.3

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 3.9

  • 9-10am
  • 10-11am
  • 11am-12pm
  • 1-2pm
  • 2-3pm
  • 3-4pm

Contained Resources

ValueSet #LL2821-8