Questionnaire-example-gcs.xml

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

Raw XML

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="gcs"/>
  <text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: gcs</p><p><b>contained</b>: , , </p><p><b>status</b>: draft</p><p><b>date</b>: 03/08/2015</p><p><b>publisher</b>: FHIR Project team</p><p><b>subjectType</b>: Patient</p><blockquote><p><b>group</b></p><p><b>linkId</b>: 1</p><p><b>title</b>: Glasgow Coma Score</p><p><b>concept</b>: Glasgow coma score total (Details: LOINC code 9269-2 = 'Glasgow coma score total', stated
           as 'null')</p><p><b>required</b>: true</p><blockquote><p><b>question</b></p><p><b>linkId</b>: 1.1</p><p><b>concept</b>: Glasgow coma score verbal (Details: LOINC code 9270-0 = 'Glasgow coma score verbal',
             stated as 'null')</p><p><b>type</b>: choice</p><p><b>options</b>: id: verbal; http://loinc.org/ValueSet/LL356-7; name: GCS Verbal Value Set; status: active;
             description: LOINC ANSWER LIST    (LL356-7)</p></blockquote><blockquote><p><b>question</b></p><p><b>linkId</b>: 1.2</p><p><b>concept</b>: Glasgow coma score motor (Details: LOINC code 9268-4 = 'Glasgow coma score motor', stated
             as 'null')</p><p><b>type</b>: choice</p><p><b>options</b>: id: motor; http://loinc.org/ValueSet/LL357-5; name: GCS Motor Value Set; status: active;
             description: LOINC ANSWER LIST    (LL357-5)</p></blockquote><blockquote><p><b>question</b></p><p><b>linkId</b>: 1.3</p><p><b>concept</b>: Glasgow coma score eye opening (Details: LOINC code 9267-6 = 'Glasgow coma score eye
             opening', stated as 'null')</p><p><b>type</b>: choice</p><p><b>options</b>: id: eye; http://loinc.org/ValueSet/LL355-9; name: GCS Eye Value Set; status: active;
             description: LOINC ANSWER LIST    (LL355-9)</p></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>
  <status value="draft"/>
  <date value="2015-08-03"/>
  <publisher value="FHIR Project team"/>
  <subjectType value="Patient"/>
  <group>
    <linkId value="1"/>
    <!--      Only section of the form,  3 standard GCS questions : vebal ,eye, motor      -->
    <title value="Glasgow Coma Score"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="9269-2"/>
    </concept>
    <required value="true"/>
    <!--     verbal      -->
    <question>
      <linkId value="1.1"/>
      <concept>
        <system value="http://loinc.org"/>
        <code value="9270-0"/>
      </concept>
      <type value="choice"/>
      <options>
        <reference value="#verbal"/>
      </options>
      <!--     motor     -->
    </question>
    <question>
      <linkId value="1.2"/>
      <concept>
        <system value="http://loinc.org"/>
        <code value="9268-4"/>
      </concept>
      <type value="choice"/>
      <options>
        <reference value="#motor"/>
      </options>
    </question>
    <!--     eye     -->
    <question>
      <linkId value="1.3"/>
      <concept>
        <system value="http://loinc.org"/>
        <code value="9267-6"/>
      </concept>
      <type value="choice"/>
      <options>
        <reference value="#eye"/>
      </options>
    </question>
  </group>
</Questionnaire>