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Example Questionnaire/gcs (XML)

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: No defined compartments

Raw XML (canonical form + also see XML Format Specification)

Jump past Narrative

Glasgow Coma Score example form (id = "gcs")

<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="gcs"/> 
  <text> <status value="extensions"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: Questionnaire</b> <a name="gcs"> </a> <a name="hcgcs"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border:
       1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Questionnaire &quot;gcs&quot; </p> </div> <p> <b> StructureDefinition Work Group</b> : fhir</p> <p> <b> url</b> : <code> http://hl7.org/fhir/Questionnaire/gcs</code> </p> <p> <b> identifier</b> : <a href="http://terminology.hl7.org/5.5.0/NamingSystem-uri.html" title="As defined by RFC 3986 (http://www.ietf.org/rfc/rfc3986.txt)(with many schemes
         defined in many RFCs). For OIDs and UUIDs, use the URN form (urn:oid:(note: lowercase)
         and urn:uuid:). See http://www.ietf.org/rfc/rfc3001.txt and http://www.ietf.org/rfc/rfc4122.t
        xt 

This oid is used as an identifier II.root to indicate the the extension is an absolute
         URI (technically, an IRI). Typically, this is used for OIDs and GUIDs. Note that
         when this OID is used with OIDs and GUIDs, the II.extension should start with urn:oid
         or urn:uuid: 

Note that this OID is created to aid with interconversion between CDA and FHIR
         - FHIR uses urn:ietf:rfc:3986 as equivalent to this OID. URIs as identifiers appear
         more commonly in FHIR.

This OID may also be used in CD.codeSystem.">URI</a> /urn:oid:2.16.840.1.113883.4.642.20.5</p> <p> <b> name</b> : GlasgowComaScore</p> <p> <b> title</b> : Glasgow Coma Score</p> <p> <b> status</b> : draft</p> <p> <b> subjectType</b> : Patient</p> <p> <b> date</b> : 2015-08-03</p> <p> <b> publisher</b> : HL7 International / FHIR Infrastructure</p> <p> <b> contact</b> : </p> <p> <b> description</b> : Glasgow Coma Score</p> <p> <b> code</b> : Glasgow coma score total (Details: LOINC code 9269-2 = 'Glasgow coma score total',
         stated as 'null')</p> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1.1</p> <p> <b> code</b> : Glasgow coma score verbal (Details: LOINC code 9270-0 = 'Glasgow coma score verbal',
           stated as 'null')</p> <p> <b> type</b> : coding</p> <p> <b> answerValueSet</b> : <code> #verbal</code> </p> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1.2</p> <p> <b> code</b> : Glasgow coma score motor (Details: LOINC code 9268-4 = 'Glasgow coma score motor',
           stated as 'null')</p> <p> <b> type</b> : coding</p> <p> <b> answerValueSet</b> : <code> #motor</code> </p> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1.3</p> <p> <b> code</b> : Glasgow coma score eye opening (Details: LOINC code 9267-6 = 'Glasgow coma score
           eye opening', stated as 'null')</p> <p> <b> type</b> : coding</p> <p> <b> answerValueSet</b> : <code> #eye</code> </p> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ValueSet #motor</b> <a name="motor"> </a> <a name="hcmotor"> </a> </p> <p> <b> identifier</b> : <a href="http://terminology.hl7.org/5.5.0/NamingSystem-v3-loinc.html" title="LOINC provides a set of universal names and ID codes for identifying laboratory
           and clinical test results.1,2 LOINC facilitates the exchange and pooling of results,
           such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes
           management, and research. LOINC's universal identifiers (names and codes) can be
           used in the context of order and observation exchanges between information systems
           that use syntax standards such as HL73, CEN TC251, ISO TC215, ASTM4, and DICOM.
           Specifically, the identifier can be used as the coded value for an observation
           in any other standard that uses the observation/observation value paradigm, whether
           messages, documents, application programming interface (API), etc. For example,
           LOINC codes are used widely in the OBX segment Observation Identifier field (OBX-3)
           of an ORU HL7 (HL7 version 2.x or ASTM 1238-9410) message that may be sent between
           a Clinical Laboratory Information Management Systems (LIMS) and Electronic Health
           Record Systems (EHR).5, 6 In this way, LOINC codes provide universal identifiers
           that allow the exchange of clinical data between heterogeneous computing environments.">LOINC</a> /http://loinc.org/ValueSet/LL357-5</p> <p> <b> name</b> : GCS Motor Value Set</p> <p> <b> status</b> : active</p> <p> <b> description</b> : LOINC ANSWER LIST    (LL357-5)</p> <blockquote> <p> <b> compose</b> </p> <blockquote> <p> <b> include</b> </p> <p> <b> system</b> : <a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a> </p> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6562-8</p> <p> <b> display</b> : No motor response</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6563-6</p> <p> <b> display</b> : Extension to pain</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6564-4</p> <p> <b> display</b> : Flexion to pain</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6565-1</p> <p> <b> display</b> : Withdrawl from pain</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6566-9</p> <p> <b> display</b> : Localizing pain</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6567-7</p> <p> <b> display</b> : Obeys commands</p> </blockquote> </blockquote> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ValueSet #verbal</b> <a name="verbal"> </a> <a name="hcverbal"> </a> </p> <p> <b> identifier</b> : <a href="http://terminology.hl7.org/5.5.0/NamingSystem-v3-loinc.html" title="LOINC provides a set of universal names and ID codes for identifying laboratory
           and clinical test results.1,2 LOINC facilitates the exchange and pooling of results,
           such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes
           management, and research. LOINC's universal identifiers (names and codes) can be
           used in the context of order and observation exchanges between information systems
           that use syntax standards such as HL73, CEN TC251, ISO TC215, ASTM4, and DICOM.
           Specifically, the identifier can be used as the coded value for an observation
           in any other standard that uses the observation/observation value paradigm, whether
           messages, documents, application programming interface (API), etc. For example,
           LOINC codes are used widely in the OBX segment Observation Identifier field (OBX-3)
           of an ORU HL7 (HL7 version 2.x or ASTM 1238-9410) message that may be sent between
           a Clinical Laboratory Information Management Systems (LIMS) and Electronic Health
           Record Systems (EHR).5, 6 In this way, LOINC codes provide universal identifiers
           that allow the exchange of clinical data between heterogeneous computing environments.">LOINC</a> /http://loinc.org/ValueSet/LL356-7</p> <p> <b> name</b> : GCS Verbal Value Set</p> <p> <b> status</b> : active</p> <p> <b> description</b> : LOINC ANSWER LIST    (LL356-7)</p> <blockquote> <p> <b> compose</b> </p> <blockquote> <p> <b> include</b> </p> <p> <b> system</b> : <a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a> </p> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6557-8</p> <p> <b> display</b> : No verbal response (&gt;2yrs); no vocal response (&lt;=2yrs)</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6558-6</p> <p> <b> display</b> : Incomprehensible sounds</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6559-4</p> <p> <b> display</b> : Inappropriate words</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6560-2</p> <p> <b> display</b> : Confused</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6561-0</p> <p> <b> display</b> : Oriented</p> </blockquote> </blockquote> </blockquote> </blockquote> <hr/>  <blockquote> <p> <b> Generated Narrative: ValueSet #eye</b> <a name="eye"> </a> <a name="hceye"> </a> </p> <p> <b> identifier</b> : <a href="http://terminology.hl7.org/5.5.0/NamingSystem-v3-loinc.html" title="LOINC provides a set of universal names and ID codes for identifying laboratory
           and clinical test results.1,2 LOINC facilitates the exchange and pooling of results,
           such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes
           management, and research. LOINC's universal identifiers (names and codes) can be
           used in the context of order and observation exchanges between information systems
           that use syntax standards such as HL73, CEN TC251, ISO TC215, ASTM4, and DICOM.
           Specifically, the identifier can be used as the coded value for an observation
           in any other standard that uses the observation/observation value paradigm, whether
           messages, documents, application programming interface (API), etc. For example,
           LOINC codes are used widely in the OBX segment Observation Identifier field (OBX-3)
           of an ORU HL7 (HL7 version 2.x or ASTM 1238-9410) message that may be sent between
           a Clinical Laboratory Information Management Systems (LIMS) and Electronic Health
           Record Systems (EHR).5, 6 In this way, LOINC codes provide universal identifiers
           that allow the exchange of clinical data between heterogeneous computing environments.">LOINC</a> /http://loinc.org/ValueSet/LL355-9</p> <p> <b> name</b> : GCS Eye Value Set</p> <p> <b> status</b> : active</p> <p> <b> description</b> : LOINC ANSWER LIST    (LL355-9)</p> <blockquote> <p> <b> compose</b> </p> <blockquote> <p> <b> include</b> </p> <p> <b> system</b> : <a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html">Logical Observation Identifiers, Names and Codes (LOINC)</a> </p> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6553-7</p> <p> <b> display</b> : No eye opening</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6554-5</p> <p> <b> display</b> : Eye opening to pain</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6555-2</p> <p> <b> display</b> : Eye opening to verbal command</p> </blockquote> <blockquote> <p> <b> concept</b> </p> <p> <b> code</b> : LA6556-0</p> <p> <b> display</b> : Eyes open spontaneously</p> </blockquote> </blockquote> </blockquote> </blockquote> </div> </text> <contained> 
    <ValueSet> 
      <id value="motor"/> 
      <identifier> 
        <system value="http://loinc.org"/> 
        <value value="http://loinc.org/ValueSet/LL357-5"/> 
      </identifier> 
      <name value="GCS Motor Value Set"/> 
      <status value="active"/> 
      <description value="LOINC ANSWER LIST    (LL357-5)"/> 
      <compose> 
        <include> 
          <system value="http://loinc.org"/> 
          <concept> 
            <code value="LA6562-8"/> 
            <display value="No motor response"/> 
          </concept> 
          <concept> 
            <code value="LA6563-6"/> 
            <display value="Extension to pain"/> 
          </concept> 
          <concept> 
            <code value="LA6564-4"/> 
            <display value="Flexion to pain"/> 
          </concept> 
          <concept> 
            <code value="LA6565-1"/> 
            <display value="Withdrawl from pain"/> 
          </concept> 
          <concept> 
            <code value="LA6566-9"/> 
            <display value="Localizing pain"/> 
          </concept> 
          <concept> 
            <code value="LA6567-7"/> 
            <display value="Obeys commands"/> 
          </concept> 
        </include> 
      </compose> 
    </ValueSet> 
  </contained> 
  <contained> 
    <ValueSet> 
      <id value="verbal"/> 
      <identifier> 
        <system value="http://loinc.org"/> 
        <value value="http://loinc.org/ValueSet/LL356-7"/> 
      </identifier> 
      <name value="GCS Verbal Value Set"/> 
      <status value="active"/> 
      <description value="LOINC ANSWER LIST    (LL356-7)"/> 
      <compose> 
        <include> 
          <system value="http://loinc.org"/> 
          <concept> 
            <code value="LA6557-8"/> 
            <display value="No verbal response (&gt;2yrs); no vocal response (&lt;=2yrs)"/> 
          </concept> 
          <concept> 
            <code value="LA6558-6"/> 
            <display value="Incomprehensible sounds"/> 
          </concept> 
          <concept> 
            <code value="LA6559-4"/> 
            <display value="Inappropriate words"/> 
          </concept> 
          <concept> 
            <code value="LA6560-2"/> 
            <display value="Confused"/> 
          </concept> 
          <concept> 
            <code value="LA6561-0"/> 
            <display value="Oriented"/> 
          </concept> 
        </include> 
      </compose> 
    </ValueSet> 
  </contained> 
  <contained> 
    <ValueSet> 
      <id value="eye"/> 
      <identifier> 
        <system value="http://loinc.org"/> 
        <value value="http://loinc.org/ValueSet/LL355-9"/> 
      </identifier> 
      <name value="GCS Eye Value Set"/> 
      <status value="active"/> 
      <description value="LOINC ANSWER LIST    (LL355-9)"/> 
      <compose> 
        <include> 
          <system value="http://loinc.org"/> 
          <concept> 
            <code value="LA6553-7"/> 
            <display value="No eye opening"/> 
          </concept> 
          <concept> 
            <code value="LA6554-5"/> 
            <display value="Eye opening to pain"/> 
          </concept> 
          <concept> 
            <code value="LA6555-2"/> 
            <display value="Eye opening to verbal command"/> 
          </concept> 
          <concept> 
            <code value="LA6556-0"/> 
            <display value="Eyes open spontaneously"/> 
          </concept> 
        </include> 
      </compose> 
    </ValueSet> 
  </contained> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"><valueCode value="fhir"/> </extension> 
  <url value="http://hl7.org/fhir/Questionnaire/gcs"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.20.5"/> 
  </identifier> 
  <name value="GlasgowComaScore"/> 
  <title value="Glasgow Coma Score"/> 
  <status value="draft"/> 
  <subjectType value="Patient"/> 
  <date value="2015-08-03"/> 
  <publisher value="HL7 International / FHIR Infrastructure"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      </telecom> 
  </contact> 
  <description value="Glasgow Coma Score"/> 
  <code> 
    <system value="http://loinc.org"/> 
    <code value="9269-2"/> 
  </code> 
  <item> 
    <linkId value="1.1"/> 
    <code> 
      <system value="http://loinc.org"/> 
      <code value="9270-0"/> 
    </code> 
    <type value="coding"/> 
    <answerValueSet value="#verbal"/> 
  </item> 
  <item> 
    <linkId value="1.2"/> 
    <code> 
      <system value="http://loinc.org"/> 
      <code value="9268-4"/> 
    </code> 
    <type value="coding"/> 
    <answerValueSet value="#motor"/> 
  </item> 
  <item> 
    <linkId value="1.3"/> 
    <code> 
      <system value="http://loinc.org"/> 
      <code value="9267-6"/> 
    </code> 
    <type value="coding"/> 
    <answerValueSet value="#eye"/> 
  </item> 
</Questionnaire> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.