Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1
Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1
This page is part of the Documentation Templates and Rules (v2.1.0: STU 2.1) 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" : "Parameters",
"id" : "NextQuestionInputParamsExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-next-question-input-parameters"
]
},
"parameter" : [
{
"name" : "in",
"resource" : {
"resourceType" : "QuestionnaireResponse",
"id" : "home-o2-questionnaireresponse",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"
]
},
"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://hl7.org/fhir/us/davinci-dtr/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" : "2.6",
"text" : "Record",
"answer" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference",
"valueBoolean" : false
}
],
"valueReference" : {
🔗 "reference" : "Patient/examplepatient",
"display" : "Mr. Saul Moki"
}
}
]
}
]
},
{
"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"
}
}
]
},
{
"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"
}
],
"valueQuantity" : {
"value" : 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"
}
],
"valueQuantity" : {
"value" : 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"
}
],
"valueQuantity" : {
"value" : 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"
}
],
"valueQuantity" : {
"value" : 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"
}
],
"valueString" : "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#2.1.0 based on FHIR 4.0.1. Generated 2024-12-21
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