This page is part of the Documentation Templates and Rules (v0.2.0: STU 1 Ballot 2) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

DTR Questionnaire Home Oxygen Therapy Example R4 - JSON Representation

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Raw json

{
  "resourceType" : "Questionnaire",
  "id" : "home-o2-questionnaire",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaire-r4"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This form is used to collect information from the provider on Home Oxygen Therapy.</p></div>"
  },
  "contained" : [
    {
      "resourceType" : "ValueSet",
      "id" : "gender",
      "identifier" : [
        {
          "system" : "http://hl7.org/fhir/ValueSet/administrative-gender",
          "value" : "todo"
        }
      ],
      "name" : "Gender",
      "status" : "draft",
      "description" : "Gender",
      "compose" : {
        "include" : [
          {
            "system" : "todo",
            "concept" : [
              {
                "code" : "M",
                "display" : "Male"
              },
              {
                "code" : "F",
                "display" : "Female"
              },
              {
                "code" : "Other",
                "display" : "Other"
              }
            ]
          }
        ]
      }
    }
  ],
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-library",
      "valueCanonical" : "todo/Library/home-oxygen-logic"
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-questionnaire",
  "version" : "0.2.0",
  "name" : "Home-o2-questionnaire",
  "title" : "Home Oxygen Therapy Order Template",
  "status" : "draft",
  "subjectType" : [
    "Patient"
  ],
  "date" : "2019-03-11T00:00:00-04:00",
  "publisher" : "Da Vinci DTR",
  "contact" : [
    {
      "name" : "Example Author"
    }
  ],
  "item" : [
    {
      "linkId" : "1",
      "text" : "Patient Information",
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
              "valueExpression" : {
                "language" : "text/cql",
                "expression" : "PatientLastName"
              }
            }
          ],
          "linkId" : "1.1",
          "text" : "Last Name",
          "type" : "string",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
              "valueExpression" : {
                "language" : "text/cql",
                "expression" : "PatientFirstName"
              }
            }
          ],
          "linkId" : "1.2",
          "text" : "First Name",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "1.1",
              "operator" : "=",
              "answerString" : "5"
            },
            {
              "question" : "1.3",
              "operator" : "=",
              "answerString" : "S"
            }
          ],
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
              "valueExpression" : {
                "language" : "text/cql",
                "expression" : "PatientMiddleInitial"
              }
            }
          ],
          "linkId" : "1.3",
          "text" : "Middle Initial",
          "type" : "text",
          "required" : false
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
              "valueExpression" : {
                "language" : "text/cql",
                "expression" : "PatientDateOfBirth"
              }
            }
          ],
          "linkId" : "1.4",
          "text" : "Date Of Birth",
          "type" : "date",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
              "valueExpression" : {
                "language" : "text/cql",
                "expression" : "PatientGender"
              }
            }
          ],
          "linkId" : "1.5",
          "text" : "Gender",
          "type" : "choice",
          "required" : true,
          "answerValueSet" : "#gender"
        }
      ]
    }
  ]
}