Real-world lifelines questionnaire (fictively taken from the patient)
{
"resourceType": "Questionnaire",
"id": "f201",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <pre>Lifelines Questionnaire 1 part 1\n 1. Do you have allergies?\n 2. General Questions:\n 2.a) What is your gender?\n 2.b) What is your date of birth?\n 2.c) What is your country of birth?\n 2.d) What is your marital status?\n 3. Intoxications:\n 3.a) Do you smoke?\n 3.b) Do you drink alcohol?</pre>\n </div>"
},
"url": "http://hl7.org/fhir/Questionnaire/f201",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.20.6"
}
],
"status": "active",
"subjectType": [
"Patient"
],
"date": "2010",
"code": [
{
"system": "http://example.org/system/code/lifelines/nl",
"code": "VL 1-1, 18-65_1.2.2",
"display": "Lifelines Questionnaire 1 part 1"
}
],
"item": [
{
"linkId": "1",
"text": "Do you have allergies?",
"type": "boolean"
},
{
"linkId": "2",
"text": "General questions",
"type": "group",
"item": [
{
"linkId": "2.1",
"text": "What is your gender?",
"type": "string"
},
{
"linkId": "2.2",
"text": "What is your date of birth?",
"type": "date"
},
{
"linkId": "2.3",
"text": "What is your country of birth?",
"type": "string"
},
{
"linkId": "2.4",
"text": "What is your marital status?",
"type": "string"
}
]
},
{
"linkId": "3",
"text": "Intoxications",
"type": "group",
"item": [
{
"linkId": "3.1",
"text": "Do you smoke?",
"type": "boolean"
},
{
"linkId": "3.2",
"text": "Do you drink alchohol?",
"type": "boolean"
}
]
}
]
}
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.