Structured Data Capture 2.5.0 - Edition 3(STU), For Comment 2018Sep Ballot

This page is part of the Structured Data Capture FHIR IG (v2.5.0: STU 3 Ballot 1) based on FHIR v3.5.0. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

10.29 SDC-Advanced Rendering

Format(s):

Narrative view 

				<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
					<head>
						<meta content="text/html;charset=utf-8" http-equiv="Content-Type"/>
						<title>Advanced Rendering Questionnaire Demonstration</title>
					</head>
					<body>
						<div id="questionnaire-title">
							<h1>
								<span style="color:blue;">
									<b>Advanced</b>
									<i>Rendering</i>
									<u>Questionnaire</u>
									<b>
										<i>Demonstration</i>
									</b>
								</span>
							</h1>
						</div>
						<div id="linkitem-1" class="group">
							<h2><span style="color:red;"><u>1</u></span> Demographics</h2>
							<div id="linkitem-1.0" class="display">
								<p>
									<span style="color:green;"><i>Please</i> complete the questionnaire</span>
								</p>
								<!-- Instructions | The text provides guidance on how to populate or use a portion of the questionnaire (or the questionnaire as a whole). -->
								<span id="linkitem-1.0-displayCategory" style="display:none;">Instructions | The text provides guidance on how to populate or use a portion of the questionnaire (or the questionnaire as a whole).</span>
							</div>
							<div id="linkitem-1.1" class="string">
								<form action="http://hl7.org/fhir/">
								First Name
								<input id="linkitem-1.1-input" type="text"/>
							</form>
								<!-- optionalDisplay=true -->
							</div>
							<div id="linkitem-1.2" class="string" style="display:none;">
								<form action="http://hl7.org/fhir/">
								Hidden Name
								<input id="linkitem-1.2-input" type="text"/>
							</form>
							</div>
							<div id="linkitem-1.3" class="string">
								<form action="http://hl7.org/fhir/">
									<a href="http://hl7.org/fhir/">Middle Name</a>
									<input id="linkitem-1.3-input" type="text"/>
								</form>
							</div>
							<div id="linkitem-1.4" class="string">
								<form action="http://hl7.org/fhir/">
								Last Name
								<input id="linkitem-1.4-input" type="text"/>
							</form>
							</div>
							<div id="linkitem-1.5" class="string">
								<form action="http://hl7.org/fhir/">
								Gender
								<input id="linkitem-1.5-f" type="radio" name="Gender" value="F" checked="checked"/>(a) Female 
								<input id="linkitem-1.5-m" type="radio" name="Gender" value="M"/>Male 
								<input id="linkitem-1.5-o" type="radio" name="Gender" value="O"/>Other 
								<input id="linkitem-1.5-u" type="radio" name="Gender" value="U"/>Unknown 
							</form>
							</div>
						</div>
						<div id="linkitem-2" class="group">
							<h2>2 Medical History</h2>
							<form action="http://hl7.org/fhir/">
								<table border="1">
									<col width="65%"/>
									<col width="35%"/>
									<tr>
										<td>
											Diabetes
										</td>
										<td>
											Other Information
										</td>
									</tr>
									<tr>
										<td>
											<input id="linkitem-2.1-choice1" type="checkbox" name="diabetes-type1" value="diabetes-type1"/>Type 1
										</td>
										<td>
											<input id="linkitem-2.2-choice1" type="checkbox" name="otherinformation-hypertension" value="otherinformation-hypertension"/>Hypertension
										</td>
									</tr>
									<tr>
										<td>
											<input id="linkitem-2.1-choice2" type="checkbox" name="diabetes-type2" value="diabetes-type2"/>Type 2
										</td>
										<td>
											<input id="linkitem-2.2-choice2" type="checkbox" name="otherinformation-smoker" value="otherinformation-smoker"/>Smoker
										</td>
									</tr>
								</table>
							</form>
						</div>
						<div id="linkitem-3" class="group">
							<h2>3 Slider demonstration</h2>
							<div id="linkitem-3.1" class="slidecontainer">
							Adjust the slider<br/>
							<form action="http://hl7.org/fhir/">
								<input type="range" min="0" max="100" value="50" step="10" class="slider" id="linkitem-3.1-slider"/>
							</form>
						</div>
						</div>
					</body>
				</html>