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 
<Questionnaire xmlns="http://hl7.org/fhir"> <id value="questionnaire-sdc-profile-example-render"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <pre> <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> </pre> </div> </text> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-provenanceSignatureRequired"> <valueBoolean value="false"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired"> <valueCodeableConcept> <coding> <system value="urn:iso-astm:E1762-95:2013"/> <code value="1.2.840.10065.1.12.1.1"/> <display value="Author's Signature"/> </coding> <text value="the signature of the primary or sole author of a health information document. There can be only one primary author of a health information document."/> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive"> <valueBoolean value="true"/> </extension> <url value="http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-render"/> <version value="2.5.0"/> <title value="Advanced Rendering Questionnaire Profile Demonstration"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="color:blue;"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<b>Advanced</b> <i>Rendering</i> <u>Questionnaire</u> <b><i>Demonstration</i></b>"/> </extension> </title> <status value="draft"/> <subjectType value="Patient"/> <date value="2018-08"/> <item> <linkId value="1"/> <code> <system value="http://example.org/system/code/sections"/> <code value="DEMOGRAPHICS"/> </code> <prefix value="1"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="color:red;"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<u>1</u>"/> </extension> </prefix> <text value="Demographics"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-display-category"/> <code value="instructions"/> <display value="Instructions"/> </coding> <text value="The text provides guidance on how to populate or use a portion of the questionnaire (or the questionnaire as a whole)."/> </valueCodeableConcept> </extension> <linkId value="1.0"/> <text value="Please complete the questionnaire"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="color:green;"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<i>Please</i> complete the questionnaire"/> </extension> </text> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-optionalDisplay"> <valueBoolean value="true"/> </extension> <linkId value="1.1"/> <text value="First Name"/> <type value="string"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true"/> </extension> <linkId value="1.2"/> <text value="Hidden Name"/> <type value="string"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-supportLink"> <valueUri value="http://hl7.org/fhir/"/> </extension> <linkId value="1.3"/> <text value="Middle Name"/> <type value="string"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired"> <valueCodeableConcept> <coding> <system value="urn:iso-astm:E1762-95:2013"/> <code value="1.2.840.10065.1.12.1.8"/> <display value="Signature Witness Signature"/> </coding> <text value="the signature of a witness to any other signature."/> </valueCodeableConcept> </extension> <modifierExtension url="http://hl7.org/fhir/StructureDefinition/questionnaire-usageMode"> <valueCode value="capture"/> </modifierExtension> <linkId value="1.4"/> <text value="Last Name"/> <type value="string"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"> <valueCode value="horizontal"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="radio-button"/> <display value="Radio Button"/> </coding> <text value="A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others."/> </valueCodeableConcept> </extension> <linkId value="1.5"/> <text value="Gender"/> <type value="choice"/> <answerOption> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"> <valueString value="(a)"/> </extension> <valueCoding> <code value="F"/> <display value="Female"/> </valueCoding> <initialSelected value="true"/> </answerOption> <answerOption> <valueCoding> <code value="M"/> <display value="Male"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="O"/> <display value="Other"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="U"/> <display value="Unknown"/> </valueCoding> </answerOption> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="htable"/> <display value="Horizontal Answer Table"/> </coding> <text value="Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions."/> </valueCodeableConcept> </extension> <linkId value="2"/> <code> <system value="http://example.org/system/code/sections"/> <code value="FAMILYDOC"/> </code> <prefix value="2"/> <text value="Family Physician Name"/> <type value="group"/> <item> <linkId value="2.1"/> <text value="Diabetes"/> <type value="choice"/> <answerOption> <valueCoding> <code value="diabetes-type1"/> <display value="Type 1"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="diabetes-type2"/> <display value="Type 2"/> </valueCoding> </answerOption> </item> <item> <linkId value="2.2"/> <text value="Other Information"/> <type value="choice"/> <answerOption> <valueCoding> <code value="otherinformation-hypertension"/> <display value="Hypertension"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="otherinformation-smoker"/> <display value="Smoker"/> </valueCoding> </answerOption> </item> </item> <item> <linkId value="3"/> <code> <system value="http://example.org/system/code/sections"/> <code value="SLIDER"/> </code> <prefix value="3"/> <text value="Slider demonstration"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="slider"/> <display value="Slider"/> </coding> <text value="A control where an axis is displayed between the high and low values and the control can be visually manipulated to select a value anywhere on the axis."/> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue"> <valueInteger value="10"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/minValue"> <valueInteger value="0"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/maxValue"> <valueInteger value="100"/> </extension> <linkId value="3.1"/> <text value="Adjust the slider"/> <type value="integer"/> <initial> <valueInteger value="50"/> </initial> </item> </item> </Questionnaire>
© 2015+ HL7 International (OO work group). Based on FHIR version (3.5.0-14923). IG generated on Fri, Aug 31, 2018 16:04+1000.
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