Da Vinci - Documentation Templates and Rules
2.0.1 - STU 2
Da Vinci - Documentation Templates and Rules
2.0.1 - STU 2
This page is part of the Documentation Templates and Rules (v2.0.1: STU 2.0) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "home-o2-questionnaireresponse-bundle",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/DTR-QRBundle"
]
},
"type" : "collection",
"entry" : [
{
"fullUrl" : "http://example.org/home-o2-questionnaireresponse",
"resource" : {
"resourceType" : "QuestionnaireResponse",
"id" : "home-o2-questionnaireresponse",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: QuestionnaireResponse</b><a name=\"home-o2-questionnaireresponse\"> </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 QuestionnaireResponse "home-o2-questionnaireresponse" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-dtr-questionnaireresponse.html\">DTR Questionnaire Response</a></p></div><p><b>Questionnaire Response Context</b>: <a href=\"Coverage-CoverageExample.html\">Coverage/CoverageExample</a></p><p><b>Questionnaire Response Context</b>: <a href=\"ServiceRequest-ServiceRequestExample.html\">ServiceRequest/ServiceRequestExample</a></p><p><b>Intended Use</b>: Include with order <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://build.fhir.org/ig/HL7/davinci-crd//CodeSystem-temp.html\">CRD Temporary Codes</a>#withorder)</span></p><p><b>questionnaire</b>: <a href=\"http://example.com/Questionnaire/referred-questionnaire\">http://example.com/Questionnaire/referred-questionnaire</a></p><p><b>status</b>: completed</p><p><b>subject</b>: <a href=\"Patient-examplepatient.html\">Patient/examplepatient: Vlad</a></p><p><b>authored</b>: 2023-08-21</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 1</p><p><b>text</b>: Patient Information</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 1.1</p><p><b>text</b>: Last Name but Different This Time</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 1.2</p><p><b>text</b>: First Name</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 1.3</p><p><b>text</b>: Middle Initial</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 1.4</p><p><b>text</b>: Date Of Birth</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 1.5</p><p><b>text</b>: Gender</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 1.6</p><p><b>text</b>: Medicare ID</p><blockquote><p><b>answer</b></p></blockquote></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2</p><p><b>text</b>: Provider who is performing face-to-face evaluation</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 2.1</p><p><b>text</b>: Last Name</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2.2</p><p><b>text</b>: First Name</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2.3</p><p><b>text</b>: Middle Initial</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2.4</p><p><b>text</b>: NPI</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2.5</p><p><b>text</b>: Date of Face-To-Face Evaluation</p><blockquote><p><b>answer</b></p></blockquote></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3</p><p><b>text</b>: Coverage Requirements</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 3.1</p><p><b>text</b>: Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)</p><blockquote><p><b>answer</b></p></blockquote><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3.2</p><p><b>text</b>: Arterial oxygen saturation (Patient on room air while at rest and awake when tested)</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3.3</p><p><b>text</b>: Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3.4</p><p><b>text</b>: Arterial oxygen saturation (Patient tested during exercise)</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3.5</p><p><b>text</b>: Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3.6</p><p><b>text</b>: Is there a documented improvement of hypoxemia during exercise with oxygen?</p><blockquote><p><b>answer</b></p></blockquote></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4</p><p><b>text</b>: Prescribed Use</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 4.1</p><p><b>text</b>: Start date</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4.2</p><p><b>text</b>: Length of need: (months) (99 = lifetime)</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4.3</p><p><b>text</b>: Peak Flow Rate</p><blockquote><p><b>item</b></p></blockquote><blockquote><p><b>item</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4.4</p><p><b>text</b>: Average Flow Rate</p><blockquote><p><b>item</b></p></blockquote><blockquote><p><b>item</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4.5</p><p><b>text</b>: Frequency of use (choose all that apply)</p><blockquote><p><b>answer</b></p></blockquote></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 5</p><p><b>text</b>: Oxygen Supply Order Details</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 5.1</p><p><b>text</b>: Current Order Description</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 5.1b</p><p><b>text</b>: Current Order Is For A Portable Device</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 5.2</p><p><b>text</b>: Type</p><blockquote><p><b>answer</b></p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 5.3</p><p><b>text</b>: Means of oxygen delivery and accessories</p><blockquote><p><b>answer</b></p></blockquote></blockquote></blockquote></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
"valueReference" : {
🔗 "reference" : "Coverage/CoverageExample"
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
"valueReference" : {
🔗 "reference" : "ServiceRequest/ServiceRequestExample"
}
},
{
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/intendedUse",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code" : "withorder",
"display" : "Include with order"
}
]
}
}
],
"questionnaire" : "http://example.com/Questionnaire/referred-questionnaire",
"status" : "completed",
"subject" : {
🔗 "reference" : "Patient/examplepatient",
"display" : "Vlad"
},
"authored" : "2023-08-21",
"item" : [
{
"linkId" : "1",
"text" : "Patient Information",
"item" : [
{
"linkId" : "1.1",
"text" : "Last Name but Different This Time",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "override"
},
{
"extension" : [
{
"url" : "role",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/practitioner-role",
"code" : "doctor",
"display" : "Doctor"
}
]
}
},
{
"url" : "practitioner",
"valueReference" : {
🔗 "reference" : "Practitioner/PractitionerExample",
"display" : "Dr. Jane Doe"
}
}
],
"url" : "author"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "Quinton"
}
]
},
{
"linkId" : "1.2",
"text" : "First Name",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "Vlad"
}
]
},
{
"linkId" : "1.3",
"text" : "Middle Initial",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "A, N"
}
]
},
{
"linkId" : "1.4",
"text" : "Date Of Birth",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate" : "1956-12-01"
}
]
},
{
"linkId" : "1.5",
"text" : "Gender",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding" : {
"system" : "http://hl7.org/fhir/administrative-gender",
"code" : "male",
"display" : "Male"
}
}
]
},
{
"linkId" : "1.6",
"text" : "Medicare ID",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "10A3D58WH22"
}
]
}
]
},
{
"linkId" : "2",
"text" : "Provider who is performing face-to-face evaluation",
"item" : [
{
"linkId" : "2.1",
"text" : "Last Name",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "Doe"
}
]
},
{
"linkId" : "2.2",
"text" : "First Name",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "Jane"
}
]
},
{
"linkId" : "2.3",
"text" : "Middle Initial",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "B"
}
]
},
{
"linkId" : "2.4",
"text" : "NPI",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "1122334455"
}
]
},
{
"linkId" : "2.5",
"text" : "Date of Face-To-Face Evaluation",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "override"
},
{
"extension" : [
{
"url" : "role",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/practitioner-role",
"code" : "doctor",
"display" : "Doctor"
}
]
}
},
{
"url" : "practitioner",
"valueReference" : {
🔗 "reference" : "Practitioner/PractitionerExample",
"display" : "Dr. Jane Doe"
}
}
],
"url" : "author"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate" : "2019-07-18"
}
]
}
]
},
{
"linkId" : "3",
"text" : "Coverage Requirements",
"item" : [
{
"linkId" : "3.1",
"text" : "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "313296004",
"display" : "Mild chronic obstructive pulmonary disease"
}
},
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "389087006",
"display" : "Hypoxemia (disorder)"
}
}
]
},
{
"linkId" : "3.2",
"text" : "Arterial oxygen saturation (Patient on room air while at rest and awake when tested)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity" : {
"value" : 95,
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
}
]
},
{
"linkId" : "3.3",
"text" : "Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity" : {
"value" : 83,
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
}
]
},
{
"linkId" : "3.4",
"text" : "Arterial oxygen saturation (Patient tested during exercise)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity" : {
"value" : 95,
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
}
]
},
{
"linkId" : "3.5",
"text" : "Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity" : {
"value" : 78,
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
}
]
},
{
"linkId" : "3.6",
"text" : "Is there a documented improvement of hypoxemia during exercise with oxygen?",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueBoolean" : true
}
]
}
]
},
{
"linkId" : "4",
"text" : "Prescribed Use",
"item" : [
{
"linkId" : "4.1",
"text" : "Start date",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueDate" : "2019-07-18"
}
]
},
{
"linkId" : "4.2",
"text" : "Length of need: (months) (99 = lifetime)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueQuantity" : {
"value" : 99
}
}
]
},
{
"linkId" : "4.3",
"text" : "Peak Flow Rate",
"item" : [
{
"linkId" : "4.3.1",
"text" : "LPM",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueInteger" : 2
}
]
},
{
"linkId" : "4.3.2",
"text" : "oxygen %",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueInteger" : 98
}
]
}
]
},
{
"linkId" : "4.4",
"text" : "Average Flow Rate",
"item" : [
{
"linkId" : "4.4.1",
"text" : "LPM",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueInteger" : 2
}
]
},
{
"linkId" : "4.4.2",
"text" : "oxygen %",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueInteger" : 97
}
]
}
]
},
{
"linkId" : "4.5",
"text" : "Frequency of use (choose all that apply)",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding" : {
"system" : "http://example.org",
"code" : "2112",
"display" : "At rest and awake"
}
}
]
}
]
},
{
"linkId" : "5",
"text" : "Oxygen Supply Order Details",
"item" : [
{
"linkId" : "5.1",
"text" : "Current Order Description",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueString" : "HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"
}
]
},
{
"linkId" : "5.1b",
"text" : "Current Order Is For A Portable Device"
},
{
"linkId" : "5.2",
"text" : "Type",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding" : {
"system" : "http://example.org",
"code" : "122",
"display" : "Compressed Gas"
}
}
]
},
{
"linkId" : "5.3",
"text" : "Means of oxygen delivery and accessories",
"answer" : [
{
"extension" : [
{
"extension" : [
{
"url" : "source",
"valueCode" : "auto"
}
],
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding" : {
"system" : "http://example.org",
"code" : "134",
"display" : "Mask"
}
}
]
}
]
}
]
}
}
]
}
IG © 2022+ HL7 International / Clinical Decision Support. Package hl7.fhir.us.davinci-dtr#2.0.1 based on FHIR 4.0.1. Generated 2024-01-11
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