This page is part of the Documentation Templates and Rules (v1.1.0-ballot: STU 1.1 Ballot 1) 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 
| Official URL: http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-sdc-questionnaire | Version: 1.1.0-ballot | |||
| Draft as of 2020-01-13 | Computable Name: HomeOxygenTherapySDCQuestionnaire | |||
| LinkId | Text | Cardinality | Type | Flags | Description & Constraints  | 
|---|---|---|---|---|---|
|   HomeOxygenTherapySDCQuestionnaire | Questionnaire | http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-sdc-questionnaire#1.1.0-ballot | |||
|    1 | Patient Information | 0..1 | group | ||
|     1.1 | Last Name | 1..1 | string | ||
|     1.2 | Fist Name | 1..1 | string | ||
|     1.3 | Middle Name | 0..1 | string | ||
|    1.4 | Postal Code (A1A 1A1) | 0..1 | string | ||
|    1.5 | Enter your weight in lb | 0..1 | decimal | ||
|    1.6 | Attach latest x-ray | 0..1 | attachment | ||
|    2 | Calculation | 0..1 | group | ||
|     3.1 | Deadline for submission (7 days from now) | 0..1 | date |  | Expressions: 
 | 
|  Documentation for this format | |||||