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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
<id value="home-o2-sdc-adaptive-questionnaireresponse"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Definition</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireResponseRoot" class="hierarchy"/> home-o2-sdc-adaptive-questionnaireresponse</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">QuestionnaireResponse</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> 1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">diagnosis</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> 2</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Order Reason</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span>http://example.org 4: Replacement</span></span></td></tr>
<tr><td colspan="4" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<contained>
<Questionnaire>
<id value="home-o2-sdc-adaptive-questionnaire"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-sdc-questionnaire-adapt"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml">Example adaptive questionnaire contained in a QuestionnaireResposne</div>
</text>
<extension
url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-questionnaireAdaptive">
<valueBoolean value="true"/>
</extension>
<version value="0.1.0"/>
<name value="HomeOxygenTherapyAdaptiveSDCQuestionnaire"/>
<title value="Adaptive Home Oxygen Therapy Order Template (SDC)"/>
<derivedFrom value="http://example/basequestionnaire"/>
<status value="draft"/>
<subjectType value="Patient"/>
<date value="2020-01-16T00:00:00+00:00"/>
<publisher value="Da Vinci DTR"/>
<contact>
<name value="Example Author"/>
</contact>
<item>
<linkId value="1"/>
<text
value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
<type value="text"/>
<required value="true"/>
</item>
<item>
<linkId value="2"/>
<text value="Order Reason"/>
<type value="choice"/>
<required value="true"/>
<answerOption>
<valueCoding>
<system value="http://example.org"/>
<code value="1"/>
<display value="Initial or original order for certification"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://example.org"/>
<code value="2"/>
<display value="Change in status"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://example.org"/>
<code value="3"/>
<display value="Revision or change in equipment"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://example.org"/>
<code value="4"/>
<display value="Replacement"/>
</valueCoding>
</answerOption>
</item>
</Questionnaire>
</contained>
<questionnaire value="#home-o2-sdc-adaptive-questionnaire"/>
<status value="completed"/>
<subject>
<reference value="Patient/example1"/>
<display value="Vlad"/>
</subject>
<authored value="2022-01-26T20:36:57.544Z"/>
<author>
<reference value="Practitioner/example2"/>
</author>
<item>
<linkId value="1"/>
<text
value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
<answer>
<valueString value="diagnosis"/>
</answer>
</item>
<item>
<linkId value="2"/>
<text value="Order Reason"/>
<answer>
<valueCoding>
<system value="http://example.org"/>
<code value="4"/>
<display value="Replacement"/>
</valueCoding>
</answer>
</item>
</QuestionnaireResponse>