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Example Questionnaire/zika-virus-exposure-assessment (XML)
Raw XML (canonical form + also see XML Format Specification)
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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="generated"/> <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/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> -</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/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> -</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> </text> <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"/>
<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.
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