STU 3 Candidate
This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
LOINC perspective on the AHRQ form found in the SDC - Combination set of questionnaires
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xs: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir//Questionnaire/questionnaire-sdc-profile-example-loinc> a fhir:Questionnaire;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "questionnaire-sdc-profile-example-loinc"];
fhir:DomainResource.text [
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];
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fhir:ValueSet.name [ fhir:value "AHRQ_Medication_Q1" ];
fhir:ValueSet.status [ fhir:value "active" ];
fhir:ValueSet.description [ fhir:value "The answer list for question 1 on the AHRQ \"Medication or Other Substance\" form" ];
fhir:ValueSet.copyright [ fhir:value "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20271-5" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20335-8" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Biological products" ] ];
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fhir:ValueSet.compose.include.concept.display [ fhir:value "Nutritional products" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20337-4" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Expressed human breast milk" ] ];
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fhir:Extension.valueString [ fhir:value "e." ] ];
fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20338-2" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Medical gases (e.g., oxygen, nitrogen, nitrous oxide)" ] ];
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fhir:Element.extension [
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/valueset-label" ];
fhir:Extension.valueString [ fhir:value "f." ] ];
fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20339-0" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Contrast media" ] ];
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fhir:Element.extension [
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder" ];
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/valueset-label" ];
fhir:Extension.valueString [ fhir:value "g." ] ];
fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20340-8" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Radiopharmaceuticals" ] ];
fhir:ValueSet.compose.include.concept [
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder" ];
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/valueset-label" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20341-6" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Patient food (not suspected in drug-food interactions)" ] ];
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fhir:Extension.valueString [ fhir:value "i." ] ];
fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20342-4" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Drug-drug, drug-food, or adverse drug reaction as a result of a prescription and/or administration of a drug and/or food prior to admission" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20343-2" ];
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fhir:ValueSet [
fhir:index 0;
fhir:Resource.id [ fhir:value "ll2655-0" ];
fhir:ValueSet.name [ fhir:value "AHRQ_Medication_Q2" ];
fhir:ValueSet.status [ fhir:value "active" ];
fhir:ValueSet.description [ fhir:value "The answer list for question 2 on the AHRQ \"Medication or Other Substance\" form" ];
fhir:ValueSet.copyright [ fhir:value "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20278-0" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Prescription or over-the-counter (including herbal supplements)" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20298-8" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Compounded preparations" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20299-6" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Investigational drugs" ] ];
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fhir:ValueSet.name [ fhir:value "AHRQ_Medication_Q4" ];
fhir:ValueSet.status [ fhir:value "active" ];
fhir:ValueSet.description [ fhir:value "The answer list for question 4 on the AHRQ \"Medication or Other Substance\" form" ];
fhir:ValueSet.copyright [ fhir:value "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use" ];
fhir:ValueSet.compose [
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20283-0" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Vaccines" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20287-1" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Other biological products (e.g., thrombolytic)" ] ] ] ] ]
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fhir:ValueSet.description [ fhir:value "The answer list for question 6 on the AHRQ \"Medication or Other Substance\" form" ];
fhir:ValueSet.copyright [ fhir:value "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use" ];
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/valueset-label" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20273-1" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Dietary supplements (other than vitamins or minerals)" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA16117-6" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Vitamins or minerals" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20320-0" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Enteral nutritional products, including infant formula" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20321-8" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Parenteral nutritional products" ] ];
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fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/style" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20304-4" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Incorrect route of administration" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20305-1" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20306-9" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20309-3" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20310-1" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Incorrect preparation, including inappropriate cutting of tablets, error in compounding, mixing, etc." ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20311-9" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Expired or deteriorated medication/substance" ] ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20312-7" ];
fhir:ValueSet.compose.include.concept.display [ fhir:value "Medication/substance that is known to be an allergen to the patient" ] ];
fhir:ValueSet.compose.include.concept [
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20345-7" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20313-5" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA20318-4" ];
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fhir:ValueSet.description [ fhir:value "AHRQ Common Format Answer list for Yes (A15), No (A18), Unknown (UNK)" ];
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fhir:ValueSet.copyright [ fhir:value "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use" ];
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fhir:ValueSet.name [ fhir:value "AHRQ_Medication_Q28_Q29" ];
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fhir:ValueSet.description [ fhir:value "The answer list for questions 28 and 29 on the AHRQ 'Medication or Other Substance' form" ];
fhir:ValueSet.copyright [ fhir:value "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use" ];
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fhir:ValueSet.compose.include.concept.code [ fhir:value "LA9444-6" ];
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fhir:Questionnaire.publisher [ fhir:value "Agency for Healthcare Research and Quality (AHRQ)"];
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fhir:Extension.valueString [ fhir:value "color:#0000FF" ] ]
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fhir:Questionnaire.subjectType [
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fhir:Questionnaire.item.linkId [ fhir:value "74080-3/30947-6" ];
fhir:Questionnaire.item.text [ fhir:value "Initial Report Date (HERF Q1)" ];
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fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ]
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fhir:Questionnaire.item.item [
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fhir:Questionnaire.item.text [
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fhir:Questionnaire.item.linkId [ fhir:value "Medication/SEC01/74080-3" ];
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fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2654-3" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "7"^^xs:int ] ];
fhir:Element.extension [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference" ];
fhir:Extension.valueReference [
fhir:reference <http://loinc.org/vs/74075-3>;
fhir:Reference.reference [ fhir:value "http://loinc.org/vs/74075-3" ] ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74075-3" ];
fhir:Questionnaire.item.text [ fhir:value "What type of medication?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2655-0" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Element.extension [
fhir:index 1;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference" ];
fhir:Extension.valueReference [
fhir:reference <http://loinc.org/74077-9>;
fhir:Reference.reference [ fhir:value "http://loinc.org/74077-9" ] ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74077-9-q" ];
fhir:Questionnaire.item.text [ fhir:value "Please list all ingredients:" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.repeats [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 1;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "8"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74074-6" ];
fhir:Questionnaire.item.text [ fhir:value "What type of biological product?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2657-6" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/30959-1" ];
fhir:Questionnaire.item.text [ fhir:value "What was the lot number of the vaccine?" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 2;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74073-8" ];
fhir:Questionnaire.item.text [ fhir:value "What type of nutritional product?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2659-2" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74073-8/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 3;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74076-1/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 1;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74072-0" ];
fhir:Questionnaire.item.text [ fhir:value "Which of the following best characterizes the event?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2660-0" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 2;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74071-2" ];
fhir:Questionnaire.item.text [ fhir:value "What was the incorrect action?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2661-8" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74070-4" ];
fhir:Questionnaire.item.text [ fhir:value "Which best describes the incorrect dose(s)?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2662-6" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 1;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74069-6" ];
fhir:Questionnaire.item.text [ fhir:value "Which best describes the incorrect timing?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2663-4" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 2;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74068-8" ];
fhir:Questionnaire.item.text [ fhir:value "Which best describes the incorrect rate?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2664-2" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 3;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74067-0" ];
fhir:Questionnaire.item.text [ fhir:value "Which best describes the incorrect strength or concentration?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2665-9" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 4;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74066-2" ];
fhir:Questionnaire.item.text [ fhir:value "What was the expiration date?" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ];
fhir:Questionnaire.item.item [
fhir:index 5;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74065-4" ];
fhir:Questionnaire.item.text [ fhir:value "Was there a documented history of allergies or sensitivities to the medication/substance administered?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2817-6" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 6;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74064-7" ];
fhir:Questionnaire.item.text [ fhir:value "What was the contraindication (potential or actual interaction)?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2668-3" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74064-7/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 7;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74071-2/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 3;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74063-9" ];
fhir:Questionnaire.item.text [ fhir:value "At what stage in the process did the event originate, regardless of the stage at which it was discovered?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2669-1" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74063-9/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ] ];
fhir:Questionnaire.item.item [
fhir:index 2;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs" ];
fhir:Extension.valueInteger [ fhir:value "5"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7" ];
fhir:Questionnaire.item.type [ fhir:value "group" ];
fhir:Questionnaire.item.repeats [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.text [ fhir:value "Please provide the following medication details for any medications or other substances directly involved in the event." ];
fhir:Questionnaire.item.type [ fhir:value "display" ] ];
fhir:Questionnaire.item.item [
fhir:index 1;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74062-1" ];
fhir:Questionnaire.item.text [ fhir:value "Generic name or investigational drug name" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 2;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74061-3" ];
fhir:Questionnaire.item.text [ fhir:value "Ingredient RXCUI (if known)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 3;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74060-5" ];
fhir:Questionnaire.item.text [ fhir:value "Brand name (if known)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 4;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74059-7" ];
fhir:Questionnaire.item.text [ fhir:value "Brand name RXCUI (if known)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 5;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74058-9" ];
fhir:Questionnaire.item.text [ fhir:value "Manufacturer (if known)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 6;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74057-1" ];
fhir:Questionnaire.item.text [ fhir:value "Strength or concentration of product" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 7;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74056-3" ];
fhir:Questionnaire.item.text [ fhir:value "Clinical drug component RXCUI (if known)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 8;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74055-5" ];
fhir:Questionnaire.item.text [ fhir:value "Dosage form of Product" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 9;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/minLength" ];
fhir:Extension.valueInteger [ fhir:value "0"^^xs:int ] ];
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74054-8" ];
fhir:Questionnaire.item.text [ fhir:value "Dose form RXCUI (if known)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 10;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74078-7/74053-0" ];
fhir:Questionnaire.item.text [ fhir:value "Was this medication/substance prescribed for this patient?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2828-3" ] ] ];
fhir:Questionnaire.item.item [
fhir:index 11;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/74052-2" ];
fhir:Questionnaire.item.text [ fhir:value "Was this medication/substance given to this patient?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2828-3" ] ] ] ];
fhir:Questionnaire.item.item [
fhir:index 3;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/SEC03" ];
fhir:Questionnaire.item.type [ fhir:value "group" ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74051-4" ];
fhir:Questionnaire.item.text [ fhir:value "What was the intended route of administration?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2682-4" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74051-4/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ];
fhir:Questionnaire.item.item [
fhir:index 1;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74050-6" ];
fhir:Questionnaire.item.text [ fhir:value "What was the actual route of administration (attempted or completed)?" ];
fhir:Questionnaire.item.type [ fhir:value "open-choice" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ];
fhir:Questionnaire.item.options [
fhir:Reference.reference [ fhir:value "#ll2682-4" ] ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "74080-3/74050-6/Other/Specify" ];
fhir:Questionnaire.item.text [ fhir:value "PLEASE SPECIFY" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xs:boolean ] ] ] ];
fhir:Questionnaire.item.item [
fhir:index 4;
fhir:Questionnaire.item.linkId [ fhir:value "Medication/SEC04" ];
fhir:Questionnaire.item.text [ fhir:value "Thank you for completing these questions." ];
fhir:Questionnaire.item.type [ fhir:value "group" ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.text [ fhir:value "OMB No. 0935-0143 Exp. Date 10/31/2014 Public reporting burden for the collection of information is estimated to average 10 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer, Attention: PRA, Paperwork Reduction Project (0935-0143), AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850." ];
fhir:Questionnaire.item.type [ fhir:value "display" ] ] ]
];
fhir:Questionnaire.item [
fhir:index 2;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden" ];
fhir:Extension.valueBoolean [ fhir:value "true"^^xs:boolean ] ];
fhir:Questionnaire.item.linkId [ fhir:value "Reporting" ];
fhir:Questionnaire.item.text [ fhir:value "Reporting information" ];
fhir:Questionnaire.item.type [ fhir:value "group" ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "Reporting/who" ];
fhir:Questionnaire.item.text [ fhir:value "Reported by:" ];
fhir:Questionnaire.item.type [ fhir:value "string" ] ];
fhir:Questionnaire.item.item [
fhir:index 1;
fhir:Questionnaire.item.linkId [ fhir:value "Reporting/when" ];
fhir:Questionnaire.item.text [ fhir:value "Reported date:" ];
fhir:Questionnaire.item.type [ fhir:value "date" ] ]
];
fhir:Questionnaire.item [
fhir:index 3;
fhir:Element.extension [
fhir:index 0;
fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl" ];
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/questionnaire-item-control" ];
fhir:Coding.code [ fhir:value "footer" ] ] ] ];
fhir:Questionnaire.item.linkId [ fhir:value "Medication/footer" ];
fhir:Questionnaire.item.type [ fhir:value "group" ];
fhir:Questionnaire.item.item [
fhir:index 0;
fhir:Questionnaire.item.text [ fhir:value "AHRQ Common Formats - Hospital Version 1.2 - 2012 Medication or Other Substance" ];
fhir:Questionnaire.item.type [ fhir:value "display" ] ]
].
# -------------------------------------------------------------------------------------
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.
© HL7.org 2011+. FHIR STU3 Candidate (v1.4.0-8139) generated on Thu, Mar 31, 2016 08:09+1100. QA Page
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