Da Vinci - Documentation Templates and Rules
1.0.0 - STU 1

This page is part of the Documentation Templates and Rules (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: DTR Home Oxygen Therapy Questionnaire - R4 - XML Representation

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="home-o2-questionnaire"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaire-r4"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This form is used to collect information from the provider on Home Oxygen Therapy.</p></div>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/cqf-library">
    <valueCanonical value="#HomeOxygenTherapy-prepopulation"/>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-questionnaire"/>
  <version value="1.0.0"/>
  <name value="HomeOxygenTherapyQuestionnaire"/>
  <title value="Home Oxygen Therapy Order Template"/>
  <status value="draft"/>
  <subjectType value="Patient"/>
  <date value="2019-03-11T00:00:00+00:00"/>
  <publisher value="HL7 Clinical Decision Support Work Group"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/dss"/>
    </telecom>
  </contact>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <item>
    <linkId value="1"/>
    <text value="Patient Information"/>
    <type value="group"/>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
        <valueExpression>
          <language value="text/cql"/>
          <expression value="PatientLastName"/>
        </valueExpression>
      </extension>
      <linkId value="1.1"/>
      <text value="Last Name"/>
      <type value="string"/>
      <required value="true"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
        <valueExpression>
          <language value="text/cql"/>
          <expression value="PatientMiddleInitial"/>
        </valueExpression>
      </extension>
      <linkId value="1.3"/>
      <text value="Middle Initial"/>
      <type value="text"/>
      <required value="false"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
        <valueExpression>
          <language value="text/cql"/>
          <expression value="PatientFirstName"/>
        </valueExpression>
      </extension>
      <linkId value="1.2"/>
      <text value="First Name"/>
      <type value="string"/>
      <enableWhen>
        <question value="1.3"/>
        <operator value="="/>
        <answerString value="S"/>
      </enableWhen>
      <required value="true"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
        <valueExpression>
          <language value="text/cql"/>
          <expression value="PatientDateOfBirth"/>
        </valueExpression>
      </extension>
      <linkId value="1.4"/>
      <text value="Date Of Birth"/>
      <type value="date"/>
      <required value="true"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
        <valueExpression>
          <language value="text/cql"/>
          <expression value="PatientGender"/>
        </valueExpression>
      </extension>
      <linkId value="1.5"/>
      <text value="Gender"/>
      <type value="choice"/>
      <required value="true"/>
      <answerValueSet value="http://hl7.org/fhir/ValueSet/administrative-gender"/>
    </item>
  </item>
</Questionnaire>