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Example Questionnaire/zika-virus-exposure-assessment (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

Example instrument for assessing Zika virus exposure potential (id = "zika-virus-exposure-assessment")

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

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="zika-virus-exposure-assessment"/> 
  <text> <status value="extensions"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: Questionnaire</b> <a name="zika-virus-exposure-assessment"> </a> <a name="hczika-virus-exposure-assessment"> </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;zika-virus-exposure-assessment&quot; </p> </div> <p> <b> StructureDefinition Work Group</b> : fhir</p> <p> <b> url</b> : <code> http://example.org/Questionnaire/zika-virus-exposure-assessment</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:2.16.840.1.113883.4.642.20.1</p> <p> <b> name</b> : ExampleZikaVirusExposureAssessment</p> <p> <b> title</b> : Example Zika Virus Exposure Assessment</p> <p> <b> status</b> : draft</p> <p> <b> subjectType</b> : Patient</p> <p> <b> date</b> : 2016-11-14</p> <p> <b> publisher</b> : HL7 International / FHIR Infrastructure</p> <p> <b> contact</b> : </p> <p> <b> description</b> : Example questionnaire to assess Zika virus exposure potential.</p> <p> <b> effectivePeriod</b> : 2016-11-14 --&gt; (ongoing)</p> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1</p> <p> <b> code</b> : CDE: Resident of or Frequent Traveler to Zika Area (Details: http://example.org/questionnai
          res code CDE: Resident of or Frequent Traveler to Zika Area = 'CDE: Resident of
           or Frequent Traveler to Zika Area', stated as 'null')</p> <p> <b> text</b> : Are you a resident of, or do you travel frequently to, an area with active Zika
           transmission?</p> <p> <b> type</b> : boolean</p> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 2</p> <p> <b> code</b> : CDE: Recent Travel to Zika Area (Details: http://example.org/questionnaires code
           CDE: Recent Travel to Zika Area = 'CDE: Recent Travel to Zika Area', stated as
           'null')</p> <p> <b> text</b> : Have you recently traveled to an area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 1</td> <td> =</td> <td> false</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 3</p> <p> <b> code</b> : CDE: Time Since Returned From Travel (Details: http://example.org/questionnaires
           code CDE: Time Since Returned From Travel = 'CDE: Time Since Returned From Travel',
           stated as 'null')</p> <p> <b> text</b> : How long has it been since you returned?</p> <p> <b> type</b> : quantity</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 2</td> <td> =</td> <td> true</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 4</p> <p> <b> code</b> : CDE: Recent Sexual Encounter with Traveler to Zika Area (Details: http://example.org/questi
          onnaires code CDE: Recent Sexual Encounter with Traveler to Zika Area = 'CDE: Recent
           Sexual Encounter with Traveler to Zika Area', stated as 'null')</p> <p> <b> text</b> : Have you recently had condomless sex with a partner that has travelled in an
           area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 2</td> <td> =</td> <td> false</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 5</p> <p> <b> code</b> : CDE: Time Since Sexual Encounter (Details: http://example.org/questionnaires
           code CDE: Time Since Sexual Encounter = 'CDE: Time Since Sexual Encounter', stated
           as 'null')</p> <p> <b> text</b> : How long has it been since your last condomless sexual encounter?</p> <p> <b> type</b> : quantity</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 4</td> <td> =</td> <td> true</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 6</p> <p> <b> code</b> : CDE: Planned Travel to Zika Area (Details: http://example.org/questionnaires
           code CDE: Planned Travel to Zika Area = 'CDE: Planned Travel to Zika Area', stated
           as 'null')</p> <p> <b> text</b> : Do you plan to travel to an area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 4</td> <td> =</td> <td> false</td> </tr> </table> </blockquote> </div> </text> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"><valueCode value="fhir"/> </extension> 
  <url value="http://example.org/Questionnaire/zika-virus-exposure-assessment"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.20.1"/> 
  </identifier> 
  <name value="ExampleZikaVirusExposureAssessment"/> 
  <title value="Example Zika Virus Exposure Assessment"/> 
  <status value="draft"/> 
  <subjectType value="Patient"/> 
  <date value="2016-11-14"/> 
  <publisher value="HL7 International / FHIR Infrastructure"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      </telecom> 
  </contact> 
  <description value="Example questionnaire to assess Zika virus exposure potential."/> 
  <effectivePeriod> 
    <start value="2016-11-14"/> 
  </effectivePeriod> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="1"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Resident of or Frequent Traveler to Zika Area"/> 
    </code> 
    <text value="Are you a resident of, or do you travel frequently to, an area with active Zika
     transmission?"/> 
    <type value="boolean"/> 
  </item> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="2"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Recent Travel to Zika Area"/> 
    </code> 
    <text value="Have you recently traveled to an area with active Zika transmission?"/> 
    <type value="boolean"/> 
    <enableWhen> 
      <question value="1"/> 
      <operator value="="/> 
      <answerBoolean value="false"/> 
    </enableWhen> 
  </item> 
  <item> 
    <linkId value="3"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Time Since Returned From Travel"/> 
    </code> 
    <text value="How long has it been since you returned?"/> 
    <type value="quantity"/> 
    <enableWhen> 
      <question value="2"/> 
      <operator value="="/> 
      <answerBoolean value="true"/> 
    </enableWhen> 
  </item> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="4"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Recent Sexual Encounter with Traveler to Zika Area"/> 
    </code> 
    <text value="Have you recently had condomless sex with a partner that has travelled in an area
     with active Zika transmission?"/> 
    <type value="boolean"/> 
    <enableWhen> 
      <question value="2"/> 
      <operator value="="/> 
      <answerBoolean value="false"/> 
    </enableWhen> 
  </item> 
  <item> 
    <linkId value="5"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Time Since Sexual Encounter"/> 
    </code> 
    <text value="How long has it been since your last condomless sexual encounter?"/> 
    <type value="quantity"/> 
    <enableWhen> 
      <question value="4"/> 
      <operator value="="/> 
      <answerBoolean value="true"/> 
    </enableWhen> 
  </item> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="6"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Planned Travel to Zika Area"/> 
    </code> 
    <text value="Do you plan to travel to an area with active Zika transmission?"/> 
    <type value="boolean"/> 
    <enableWhen> 
      <question value="4"/> 
      <operator value="="/> 
      <answerBoolean value="false"/> 
    </enableWhen> 
  </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.