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
<Parameters xmlns="http://hl7.org/fhir">
<id value="NextQuestionInputParamsExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-next-question-input-parameters"/>
</meta>
<parameter>
<name value="in"/>
<resource>
<QuestionnaireResponse>
<id value="home-o2-questionnaireresponse"/>
<meta>
<profile
value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"/>
</meta>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context">
<valueReference>🔗
<reference value="Coverage/CoverageExample"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context">
<valueReference>🔗
<reference value="ServiceRequest/ServiceRequestExample"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/intendedUse">
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
<code value="withorder"/>
<display value="Include with order"/>
</coding>
</valueCodeableConcept>
</extension>
<questionnaire
value="http://hl7.org/fhir/us/davinci-dtr/Questionnaire/referred-questionnaire"/>
<status value="completed"/>
<subject>🔗
<reference value="Patient/examplepatient"/>
<display value="Vlad"/>
</subject>
<authored value="2023-08-21"/>
<item>
<linkId value="1"/>
<text value="Patient Information"/>
<item>
<linkId value="1.1"/>
<text value="Last Name but Different This Time"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="override"/>
</extension>
<extension url="author">
<extension url="role">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/practitioner-role"/>
<code value="doctor"/>
<display value="Doctor"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="practitioner">
<valueReference>🔗
<reference value="Practitioner/PractitionerExample"/>
<display value="Dr. Jane Doe"/>
</valueReference>
</extension>
</extension>
</extension>
<valueString value="Quinton"/>
</answer>
</item>
<item>
<linkId value="1.2"/>
<text value="First Name"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="Vlad"/>
</answer>
</item>
<item>
<linkId value="1.3"/>
<text value="Middle Initial"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="A, N"/>
</answer>
</item>
<item>
<linkId value="1.4"/>
<text value="Date Of Birth"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueDate value="1956-12-01"/>
</answer>
</item>
<item>
<linkId value="1.5"/>
<text value="Gender"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="male"/>
<display value="Male"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="1.6"/>
<text value="Medicare ID"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="10A3D58WH22"/>
</answer>
</item>
</item>
<item>
<linkId value="2"/>
<text value="Provider who is performing face-to-face evaluation"/>
<item>
<linkId value="2.1"/>
<text value="Last Name"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="Doe"/>
</answer>
</item>
<item>
<linkId value="2.2"/>
<text value="First Name"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="Jane"/>
</answer>
</item>
<item>
<linkId value="2.3"/>
<text value="Middle Initial"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="B"/>
</answer>
</item>
<item>
<linkId value="2.4"/>
<text value="NPI"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="1122334455"/>
</answer>
</item>
<item>
<linkId value="2.5"/>
<text value="Date of Face-To-Face Evaluation"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="override"/>
</extension>
<extension url="author">
<extension url="role">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/practitioner-role"/>
<code value="doctor"/>
<display value="Doctor"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="practitioner">
<valueReference>🔗
<reference value="Practitioner/PractitionerExample"/>
<display value="Dr. Jane Doe"/>
</valueReference>
</extension>
</extension>
</extension>
<valueDate value="2019-07-18"/>
</answer>
</item>
<item>
<linkId value="2.6"/>
<text value="Record"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference">
<valueBoolean value="false"/>
</extension>
<valueReference>🔗
<reference value="Patient/examplepatient"/>
<display value="Mr. Saul Moki"/>
</valueReference>
</answer>
</item>
</item>
<item>
<linkId value="3"/>
<text value="Coverage Requirements"/>
<item>
<linkId value="3.1"/>
<text
value="Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="313296004"/>
<display value="Mild chronic obstructive pulmonary disease"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="3.2"/>
<text
value="Arterial oxygen saturation (Patient on room air while at rest and awake when tested)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="95"/>
<system value="http://unitsofmeasure.org"/>
<code value="mm[Hg]"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="3.3"/>
<text
value="Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="83"/>
<system value="http://unitsofmeasure.org"/>
<code value="mm[Hg]"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="3.4"/>
<text
value="Arterial oxygen saturation (Patient tested during exercise)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="95"/>
<system value="http://unitsofmeasure.org"/>
<code value="mm[Hg]"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="3.5"/>
<text
value="Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="78"/>
<system value="http://unitsofmeasure.org"/>
<code value="mm[Hg]"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="3.6"/>
<text
value="Is there a documented improvement of hypoxemia during exercise with oxygen?"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueBoolean value="true"/>
</answer>
</item>
</item>
<item>
<linkId value="4"/>
<text value="Prescribed Use"/>
<item>
<linkId value="4.1"/>
<text value="Start date"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueDate value="2019-07-18"/>
</answer>
</item>
<item>
<linkId value="4.2"/>
<text value="Length of need: (months) (99 = lifetime)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="99"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="4.3"/>
<text value="Peak Flow Rate"/>
<item>
<linkId value="4.3.1"/>
<text value="LPM"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="2"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="4.3.2"/>
<text value="oxygen %"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="98"/>
</valueQuantity>
</answer>
</item>
</item>
<item>
<linkId value="4.4"/>
<text value="Average Flow Rate"/>
<item>
<linkId value="4.4.1"/>
<text value="LPM"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="2"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="4.4.2"/>
<text value="oxygen %"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueQuantity>
<value value="97"/>
</valueQuantity>
</answer>
</item>
</item>
<item>
<linkId value="4.5"/>
<text value="Frequency of use (choose all that apply)"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString value="At rest and awake"/>
</answer>
</item>
</item>
<item>
<linkId value="5"/>
<text value="Oxygen Supply Order Details"/>
<item>
<linkId value="5.1"/>
<text value="Current Order Description"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueString
value="HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"/>
</answer>
</item>
<item>
<linkId value="5.1b"/>
<text value="Current Order Is For A Portable Device"/>
</item>
<item>
<linkId value="5.2"/>
<text value="Type"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueCoding>
<system value="http://example.org"/>
<code value="122"/>
<display value="Compressed Gas"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="5.3"/>
<text value="Means of oxygen delivery and accessories"/>
<answer>
<extension
url="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin">
<extension url="source">
<valueCode value="auto"/>
</extension>
</extension>
<valueCoding>
<system value="http://example.org"/>
<code value="134"/>
<display value="Mask"/>
</valueCoding>
</answer>
</item>
</item>
</QuestionnaireResponse>
</resource>
</parameter>
</Parameters>
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
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change