Example instrument for assessing Zika virus exposure potential
{
"resourceType": "Questionnaire",
"id": "zika-virus-exposure-assessment",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Questionnaire</b><a name=\"zika-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 "zika-virus-exposure-assessment" </p></div><p><b>url</b>: <code>http://example.org/Questionnaire/zika-virus-exposure-assessment</code></p><p><b>identifier</b>: id: 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>description</b>: Example questionnaire to assess Zika virus exposure potential.</p><p><b>effectivePeriod</b>: 2016-11-14 --> (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/questionnaires 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>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</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>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</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/questionnaires 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>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</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>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</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>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>4</td><td>=</td><td>false</td></tr></table></blockquote></div>"
},
"url": "http://example.org/Questionnaire/zika-virus-exposure-assessment",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.20.1"
}
],
"name": "ExampleZikaVirusExposureAssessment",
"title": "Example Zika Virus Exposure Assessment",
"status": "draft",
"subjectType": [
"Patient"
],
"date": "2016-11-14",
"description": "Example questionnaire to assess Zika virus exposure potential.",
"effectivePeriod": {
"start": "2016-11-14"
},
"item": [
{
"extension": [
{
"url": "http://example.org/additional-information",
"valueAttachment": {
"url": "http://www.cdc.gov/zika/geo/index.html",
"title": "Areas with active Zika virus transmission/exposure risk"
}
}
],
"linkId": "1",
"code": [
{
"system": "http://example.org/questionnaires",
"code": "CDE: Resident of or Frequent Traveler to Zika Area"
}
],
"text": "Are you a resident of, or do you travel frequently to, an area with active Zika transmission?",
"type": "boolean"
},
{
"extension": [
{
"url": "http://example.org/additional-information",
"valueAttachment": {
"url": "http://www.cdc.gov/zika/geo/index.html",
"title": "Areas with active Zika virus transmission/exposure risk"
}
}
],
"linkId": "2",
"code": [
{
"system": "http://example.org/questionnaires",
"code": "CDE: Recent Travel to Zika Area"
}
],
"text": "Have you recently traveled to an area with active Zika transmission?",
"type": "boolean",
"enableWhen": [
{
"question": "1",
"operator": "=",
"answerBoolean": false
}
]
},
{
"linkId": "3",
"code": [
{
"system": "http://example.org/questionnaires",
"code": "CDE: Time Since Returned From Travel"
}
],
"text": "How long has it been since you returned?",
"type": "quantity",
"enableWhen": [
{
"question": "2",
"operator": "=",
"answerBoolean": true
}
]
},
{
"extension": [
{
"url": "http://example.org/additional-information",
"valueAttachment": {
"url": "http://www.cdc.gov/zika/geo/index.html",
"title": "Areas with active Zika virus transmission/exposure risk"
}
}
],
"linkId": "4",
"code": [
{
"system": "http://example.org/questionnaires",
"code": "CDE: Recent Sexual Encounter with Traveler to Zika Area"
}
],
"text": "Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?",
"type": "boolean",
"enableWhen": [
{
"question": "2",
"operator": "=",
"answerBoolean": false
}
]
},
{
"linkId": "5",
"code": [
{
"system": "http://example.org/questionnaires",
"code": "CDE: Time Since Sexual Encounter"
}
],
"text": "How long has it been since your last condomless sexual encounter?",
"type": "quantity",
"enableWhen": [
{
"question": "4",
"operator": "=",
"answerBoolean": true
}
]
},
{
"extension": [
{
"url": "http://example.org/additional-information",
"valueAttachment": {
"url": "http://www.cdc.gov/zika/geo/index.html",
"title": "Areas with active Zika virus transmission/exposure risk"
}
}
],
"linkId": "6",
"code": [
{
"system": "http://example.org/questionnaires",
"code": "CDE: Planned Travel to Zika Area"
}
],
"text": "Do you plan to travel to an area with active Zika transmission?",
"type": "boolean",
"enableWhen": [
{
"question": "4",
"operator": "=",
"answerBoolean": false
}
]
}
]
}
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.
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