SDC-LOINC AHRQ - XML Representation - Structured Data Capture v4.0.0-ballot

This page is part of the Structured Data Capture FHIR IG (v4.0.0-ballot: STU 4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions
: SDC-LOINC AHRQ - XML Representation

Page standards status: Informative
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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="questionnaire-sdc-profile-example-loinc"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire questionnaire-sdc-profile-example-loinc</b></p><a name="questionnaire-sdc-profile-example-loinc"> </a><a name="hcquestionnaire-sdc-profile-example-loinc"> </a><a name="questionnaire-sdc-profile-example-loinc-en-US"> </a><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Other attributes of the item">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> MedicationorOtherSubstance</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-loinc#4.0.0-ballot</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.Medication/header" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> Medication/header</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 0</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Form ID:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/extension-questionnaire-hidden.html" title="Is a hidden item"><img src="icon-qi-hidden.png" alt="icon"/></a><img src="icon-qi-hidden.png" alt="icon"/></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.74080-3/74081-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74081-1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Event ID:</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.74080-3/30947-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/30947-6</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Initial Report Date (HERF Q1)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.Medication/SEC00" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> Medication/SEC00</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Medication or Other Substance</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.Medication/SEC00.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> Medication/SEC00.0</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Use this form to report any patient safety event or unsafe condition involving a substance such as a medications, biological products, nutritional products, expressed human breast milk, medical gases, or contrast media. Do not complete this form if the event involves appropriateness of therapeutic choice or decision making (e.g., physician decision to prescribe medication despite known drug-drug interaction). If the event involves a device, please also complete the Device or Medical/Surgical Supply including Health Information Technology (HIT) form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)" id="item.Medication/SEC01/74080-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> Medication/SEC01/74080-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111.png)" id="item.74080-3/74076-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74076-1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1.. What type of medication/substance was involved?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Definition: http://loinc.org/74076-1<br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2654-3.html">AHRQ_Medication_Q1</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)" id="item.74080-3/74075-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74075-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">2.. What type of medication?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Definition: http://loinc.org/vs/74075-3<br/>Enable When: <span><a href="#item.74080-3/74076-1">74080-3/74076-1</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2655-0.html">AHRQ_Medication_Q2</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)" id="item.74080-3/74077-9-q" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74077-9-q</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">3.. Please list all ingredients:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Definition: http://loinc.org/74077-9<br/>Enable When: <span><a href="#item.74080-3/74075-3">74080-3/74075-3</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)" id="item.74080-3/74074-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74074-6</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">4.. What type of biological product?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74076-1">74080-3/74076-1</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2657-6.html">AHRQ_Medication_Q4</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)" id="item.74080-3/30959-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/30959-1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">5.. What was the lot number of the vaccine?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74074-6">74080-3/74074-6</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)" id="item.74080-3/74073-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74073-8</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">6.. What type of nutritional product?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74076-1">74080-3/74076-1</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2659-2.html">AHRQ_Medication_Q6</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)" id="item.74080-3/74073-8/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74073-8/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74073-8">74080-3/74073-8</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11100.png)" id="item.74080-3/74076-1/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74076-1/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74076-1">74080-3/74076-1</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74072-0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74072-0</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">7.. Which of the following best characterizes the event?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <ul><li><a href="#item.74080-3/74076-1">74080-3/74076-1</a> != </li><li><a href="#item.74080-3/74076-1">74080-3/74076-1</a> != </li><li><a href="#item.74080-3/74076-1">74080-3/74076-1</a> != </li></ul><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2660-0.html">AHRQ_Medication_Q7</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111.png)" id="item.74080-3/74071-2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74071-2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">8.. What was the incorrect action?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74072-0">74080-3/74072-0</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2661-8.html">AHRQ_Medication_Q8</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)" id="item.74080-3/74070-4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74070-4</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">9.. Which best describes the incorrect dose(s)?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2662-6.html">AHRQ_Medication_Q9</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)" id="item.Medication/74069-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> Medication/74069-6</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">10.. Which best describes the incorrect timing?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2663-4.html">AHRQ_Medication_Q10</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)" id="item.74080-3/74068-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74068-8</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">11.. Which best describes the incorrect rate?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2664-2.html">AHRQ_Medication_Q11</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)" id="item.Medication/74067-0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> Medication/74067-0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">12.. Which best describes the incorrect strength or concentration?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2665-9.html">AHRQ_Medication_Q12</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)" id="item.Medication/74066-2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> Medication/74066-2</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">13.. What was the expiration date?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)" id="item.Medication/74065-4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> Medication/74065-4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">14.. Was there a documented history of allergies or sensitivities to the medication/substance administered?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2817-6.html">AHRQ_Y/N/UNK</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)" id="item.Medication/74064-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> Medication/74064-7</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">15.. What was the contraindication (potential or actual interaction)?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2668-3.html">AHRQ_Medication_Q15</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)" id="item.Medication/74064-7/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> Medication/74064-7/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.Medication/74064-7">Medication/74064-7</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11100.png)" id="item.74080-3/74071-2/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74071-2/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74071-2">74080-3/74071-2</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1101.png)" id="item.74080-3/74063-9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74063-9</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">16.. At what stage in the process did the event originate, regardless of the stage at which it was discovered?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74072-0">74080-3/74072-0</a> = </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2669-1.html">AHRQ_Medication_Q16</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11000.png)" id="item.74080-3/74063-9/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74063-9/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74063-9">74080-3/74063-9</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.74080-3/74078-7.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> 74080-3/74078-7.0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Please provide the following medication details for any medications or other substances directly involved in the event.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.74080-3/74078-x" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> 74080-3/74078-x</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">For an near miss, omit question 27</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74072-0">74080-3/74072-0</a> != </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)" id="item.74080-3/74078-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> 74080-3/74078-7</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <ul><li><a href="#item.74080-3/74072-0">74080-3/74072-0</a> != </li><li><a href="#item.74080-3/74072-0">74080-3/74072-0</a> != </li><li><a href="#item.74080-3/74076-1">74080-3/74076-1</a> != </li><li><a href="#item.74080-3/74075-3">74080-3/74075-3</a> != </li></ul></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74062-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74062-1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">17.. Generic name or investigational drug name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74061-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74061-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">18.. Ingredient RXCUI (if known)</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74060-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74060-5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">19.. Brand name (if known)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74059-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74059-7</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">20.. Brand name RXCUI (if known)</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74058-9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74058-9</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">21.. Manufacturer (if known)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74057-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74057-1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">22.. Strength or concentration of product</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74056-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74056-3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">23.. Clinical drug component RXCUI (if known)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74055-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74055-5</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">24.. Dosage form of Product</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74054-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74078-7/74054-8</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">25.. Dose form RXCUI (if known)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)" id="item.74080-3/74078-7/74053-0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74078-7/74053-0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">26.. Was this medication/substance prescribed for this patient?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74072-0">74080-3/74072-0</a> != </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2828-3.html">AHRQ_Y/N</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)" id="item.Medication/74052-2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> Medication/74052-2</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">27.. Was this medication/substance given to this patient?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74072-0">74080-3/74072-0</a> != </span><br/>Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2828-3.html">AHRQ_Y/N</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)" id="item.Medication/SEC03" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> Medication/SEC03</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74072-0">74080-3/74072-0</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111.png)" id="item.74080-3/74051-4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74051-4</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">28.. What was the intended route of administration?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2682-4.html">AHRQ_Medication_Q28_Q29</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11100.png)" id="item.74080-3/74051-4/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74051-4/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74051-4">74080-3/74051-4</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1101.png)" id="item.74080-3/74050-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 74080-3/74050-6</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">29.. What was the actual route of administration (attempted or completed)?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Value Set: <a href="ValueSet-questionnaire-sdc-profile-example-loinc_ll2682-4.html">AHRQ_Medication_Q28_Q29</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11000.png)" id="item.74080-3/74050-6/Other/Specify" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> 74080-3/74050-6/Other/Specify</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.74080-3/74050-6">74080-3/74050-6</a> = </span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck101.png)" id="item.Medication/SEC04" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> Medication/SEC04</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Thank you for completing these questions.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1000.png)" id="item.Medication/SEC04.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> Medication/SEC04.0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">OMB No. 0935-0143 Exp. Date 10/31/2014 Public reporting burden for the collection of information is estimated to average 10 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer, Attention: PRA, Paperwork Reduction Project (0935-0143), AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.Reporting" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> Reporting</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Reporting information</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/extension-questionnaire-hidden.html" title="Is a hidden item"><img src="icon-qi-hidden.png" alt="icon"/></a><img src="icon-qi-hidden.png" alt="icon"/></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.Reporting/who" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> Reporting/who</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Reported by:</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.Reporting/when" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> Reporting/when</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Reported date:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item.Medication/footer" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> Medication/footer</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)" id="item.Medication/footer.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> Medication/footer.0</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">AHRQ Common Formats - Hospital Version 1.2 - 2012 Medication or Other Substance</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="6" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><h2>Contained Resources</h2><hr/><p class="res-header-id"><b>ValueSet  #ll2654-3</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2654-3"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2654-3"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2654-3-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20271-5/">LA20271-5</a></td><td>Medications</td></tr><tr><td><a href="https://loinc.org/LA20335-8/">LA20335-8</a></td><td>Biological products</td></tr><tr><td><a href="https://loinc.org/LA20336-6/">LA20336-6</a></td><td>Nutritional products</td></tr><tr><td><a href="https://loinc.org/LA20337-4/">LA20337-4</a></td><td>Expressed human breast milk</td></tr><tr><td><a href="https://loinc.org/LA20338-2/">LA20338-2</a></td><td>Medical gases (e.g., oxygen, nitrogen, nitrous oxide)</td></tr><tr><td><a href="https://loinc.org/LA20339-0/">LA20339-0</a></td><td>Contrast media</td></tr><tr><td><a href="https://loinc.org/LA20340-8/">LA20340-8</a></td><td>Radiopharmaceuticals</td></tr><tr><td><a href="https://loinc.org/LA20341-6/">LA20341-6</a></td><td>Patient food (not suspected in drug-food interactions)</td></tr><tr><td><a href="https://loinc.org/LA20342-4/">LA20342-4</a></td><td>Drug-drug, drug-food, or adverse drug reaction as a result of a prescription and/or administration of a drug and/or food prior to admission</td></tr><tr><td><a href="https://loinc.org/LA20343-2/">LA20343-2</a></td><td>Other substance: PLEASE SPECIFY</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2655-0</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2655-0"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2655-0"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2655-0-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20278-0/">LA20278-0</a></td><td>Prescription or over-the-counter (including herbal supplements)</td></tr><tr><td><a href="https://loinc.org/LA20298-8/">LA20298-8</a></td><td>Compounded preparations</td></tr><tr><td><a href="https://loinc.org/LA20299-6/">LA20299-6</a></td><td>Investigational drugs</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2657-6</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2657-6"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2657-6"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2657-6-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20283-0/">LA20283-0</a></td><td>Vaccines</td></tr><tr><td><a href="https://loinc.org/LA20287-1/">LA20287-1</a></td><td>Other biological products (e.g., thrombolytic)</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2659-2</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2659-2"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2659-2"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2659-2-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20273-1/">LA20273-1</a></td><td>Dietary supplements (other than vitamins or minerals)</td></tr><tr><td><a href="https://loinc.org/LA16117-6/">LA16117-6</a></td><td>Vitamins or minerals</td></tr><tr><td><a href="https://loinc.org/LA20320-0/">LA20320-0</a></td><td>Enteral nutritional products, including infant formula</td></tr><tr><td><a href="https://loinc.org/LA20321-8/">LA20321-8</a></td><td>Parenteral nutritional products</td></tr><tr><td><a href="https://loinc.org/LA20318-4/">LA20318-4</a></td><td>Other: PLEASE SPECIFY</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2660-0</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2660-0"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2660-0"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2660-0-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20275-6/">LA20275-6</a></td><td>Incorrect action (process failure or error) (e.g., such as administering overdose or incorrect medication)</td></tr><tr><td><a href="https://loinc.org/LA20314-3/">LA20314-3</a></td><td>Unsafe condition</td></tr><tr><td><a href="https://loinc.org/LA20315-0/">LA20315-0</a></td><td>Adverse reaction in patient to the administered substance without any apparent incorrect action</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2661-8</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2661-8"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2661-8"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2661-8-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20276-4/">LA20276-4</a></td><td>Incorrect patient</td></tr><tr><td><a href="https://loinc.org/LA20302-8/">LA20302-8</a></td><td>Incorrect medication/substance</td></tr><tr><td><a href="https://loinc.org/LA20303-6/">LA20303-6</a></td><td>Incorrect dose(s)</td></tr><tr><td><a href="https://loinc.org/LA20304-4/">LA20304-4</a></td><td>Incorrect route of administration</td></tr><tr><td><a href="https://loinc.org/LA20305-1/">LA20305-1</a></td><td>Incorrect timing</td></tr><tr><td><a href="https://loinc.org/LA20306-9/">LA20306-9</a></td><td>Incorrect rate</td></tr><tr><td><a href="https://loinc.org/LA20307-7/">LA20307-7</a></td><td>Incorrect duration of administration or course of therapy</td></tr><tr><td><a href="https://loinc.org/LA20308-5/">LA20308-5</a></td><td>Incorrect dosage form (e.g., sustained release instead of immediate release)</td></tr><tr><td><a href="https://loinc.org/LA20309-3/">LA20309-3</a></td><td>Incorrect strength or concentration</td></tr><tr><td><a href="https://loinc.org/LA20310-1/">LA20310-1</a></td><td>Incorrect preparation, including inappropriate cutting of tablets, error in compounding, mixing, etc.</td></tr><tr><td><a href="https://loinc.org/LA20311-9/">LA20311-9</a></td><td>Expired or deteriorated medication/substance</td></tr><tr><td><a href="https://loinc.org/LA20312-7/">LA20312-7</a></td><td>Medication/substance that is known to be an allergen to the patient</td></tr><tr><td><a href="https://loinc.org/LA20345-7/">LA20345-7</a></td><td>Medication/substance that is known to be contraindicated for the patient</td></tr><tr><td><a href="https://loinc.org/LA20313-5/">LA20313-5</a></td><td>Incorrect patient/family action (e.g., self-administration error)</td></tr><tr><td><a href="https://loinc.org/LA20318-4/">LA20318-4</a></td><td>Other: PLEASE SPECIFY</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2662-6</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2662-6"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2662-6"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2662-6-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20277-2/">LA20277-2</a></td><td>Overdose</td></tr><tr><td><a href="https://loinc.org/LA20300-2/">LA20300-2</a></td><td>Underdose</td></tr><tr><td><a href="https://loinc.org/LA20301-0/">LA20301-0</a></td><td>Missed or omitted dose</td></tr><tr><td><a href="https://loinc.org/LA7271-5/">LA7271-5</a></td><td>Extra dose</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2663-4</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2663-4"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2663-4"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2663-4-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20280-6/">LA20280-6</a></td><td>Too early</td></tr><tr><td><a href="https://loinc.org/LA20290-5/">LA20290-5</a></td><td>Too late</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2664-2</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2664-2"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2664-2"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2664-2-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20282-2/">LA20282-2</a></td><td>Too quickly</td></tr><tr><td><a href="https://loinc.org/LA20288-9/">LA20288-9</a></td><td>Too slowly</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2665-9</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2665-9"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2665-9"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2665-9-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20281-4/">LA20281-4</a></td><td>Too high</td></tr><tr><td><a href="https://loinc.org/LA20289-7/">LA20289-7</a></td><td>Too low</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2817-6</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2817-6"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2817-6"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2817-6-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA33-6/">LA33-6</a></td><td>Yes</td></tr><tr><td><a href="https://loinc.org/LA32-8/">LA32-8</a></td><td>No</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2668-3</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2668-3"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2668-3"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2668-3-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20274-9/">LA20274-9</a></td><td>Drug-drug</td></tr><tr><td><a href="https://loinc.org/LA20316-8/">LA20316-8</a></td><td>Drug-food</td></tr><tr><td><a href="https://loinc.org/LA20317-6/">LA20317-6</a></td><td>Drug-disease</td></tr><tr><td><a href="https://loinc.org/LA20318-4/">LA20318-4</a></td><td>Other: PLEASE SPECIFY</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2669-1</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2669-1"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2669-1"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2669-1-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20279-8/">LA20279-8</a></td><td>Purchasing</td></tr><tr><td><a href="https://loinc.org/LA20291-3/">LA20291-3</a></td><td>Storing</td></tr><tr><td><a href="https://loinc.org/LA20292-1/">LA20292-1</a></td><td>Prescribing/ordering</td></tr><tr><td><a href="https://loinc.org/LA20293-9/">LA20293-9</a></td><td>Transcribing</td></tr><tr><td><a href="https://loinc.org/LA20294-7/">LA20294-7</a></td><td>Preparing</td></tr><tr><td><a href="https://loinc.org/LA20295-4/">LA20295-4</a></td><td>Dispensing</td></tr><tr><td><a href="https://loinc.org/LA20296-2/">LA20296-2</a></td><td>Administering</td></tr><tr><td><a href="https://loinc.org/LA20297-0/">LA20297-0</a></td><td>Monitoring</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr><tr><td><a href="https://loinc.org/LA20318-4/">LA20318-4</a></td><td>Other: PLEASE SPECIFY</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2828-3</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2828-3"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2828-3"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2828-3-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA33-6/">LA33-6</a></td><td>Yes</td></tr><tr><td><a href="https://loinc.org/LA32-8/">LA32-8</a></td><td>No</td></tr></table></li></ul><hr/><p class="res-header-id"><b>ValueSet  #ll2682-4</b></p><a name="questionnaire-sdc-profile-example-loinc/ll2682-4"> </a><a name="hcquestionnaire-sdc-profile-example-loinc/ll2682-4"> </a><a name="questionnaire-sdc-profile-example-loinc/ll2682-4-en-US"> </a><ul><li>Include these codes as defined in <a href="http://loinc.org"><code>http://loinc.org</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href="https://loinc.org/LA20272-3/">LA20272-3</a></td><td>Cutaneous, topical application, including ointment, spray, patch</td></tr><tr><td><a href="https://loinc.org/LA9451-1/">LA9451-1</a></td><td>Subcutaneous</td></tr><tr><td><a href="https://loinc.org/LA9444-6/">LA9444-6</a></td><td>Ophthalmic</td></tr><tr><td><a href="https://loinc.org/LA20324-2/">LA20324-2</a></td><td>Oral, including sublingual or buccal</td></tr><tr><td><a href="https://loinc.org/LA9445-3/">LA9445-3</a></td><td>Otic</td></tr><tr><td><a href="https://loinc.org/LA9263-0/">LA9263-0</a></td><td>Nasal</td></tr><tr><td><a href="https://loinc.org/LA9427-1/">LA9427-1</a></td><td>Inhalation</td></tr><tr><td><a href="https://loinc.org/LA9437-0/">LA9437-0</a></td><td>Intravenous</td></tr><tr><td><a href="https://loinc.org/LA9429-7/">LA9429-7</a></td><td>Intramuscular</td></tr><tr><td><a href="https://loinc.org/LA9435-4/">LA9435-4</a></td><td>Intrathecal</td></tr><tr><td><a href="https://loinc.org/LA9418-0/">LA9418-0</a></td><td>Epidural</td></tr><tr><td><a href="https://loinc.org/LA20332-5/">LA20332-5</a></td><td>Gastric</td></tr><tr><td><a href="https://loinc.org/LA9369-5/">LA9369-5</a></td><td>Rectal</td></tr><tr><td><a href="https://loinc.org/LA9459-4/">LA9459-4</a></td><td>Vaginal</td></tr><tr><td><a href="https://loinc.org/LA4489-6/">LA4489-6</a></td><td>Unknown</td></tr><tr><td><a href="https://loinc.org/LA20318-4/">LA20318-4</a></td><td>Other: PLEASE SPECIFY</td></tr></table></li></ul></div>
  </text>
  <contained>
    <ValueSet>
      <id value="ll2654-3"/>
      <url value="http://hl7.org/fhir/uv/sdc/ValueSet/LL2654-3"/>
      <name value="AhrqMedicationQ1"/>
      <title value="AHRQ_Medication_Q1"/>
      <status value="active"/>
      <description
                   value="The answer list for question 1 on the AHRQ &quot;Medication or Other Substance&quot; form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="1"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="a."/>
            </extension>
            <code value="LA20271-5"/>
            <display value="Medications"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="2"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="b."/>
            </extension>
            <code value="LA20335-8"/>
            <display value="Biological products"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="3"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="c."/>
            </extension>
            <code value="LA20336-6"/>
            <display value="Nutritional products"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="4"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="d."/>
            </extension>
            <code value="LA20337-4"/>
            <display value="Expressed human breast milk"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="5"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="e."/>
            </extension>
            <code value="LA20338-2"/>
            <display
                     value="Medical gases (e.g., oxygen, nitrogen, nitrous oxide)"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="6"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="f."/>
            </extension>
            <code value="LA20339-0"/>
            <display value="Contrast media"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="7"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="g."/>
            </extension>
            <code value="LA20340-8"/>
            <display value="Radiopharmaceuticals"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="8"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="h."/>
            </extension>
            <code value="LA20341-6"/>
            <display
                     value="Patient food (not suspected in drug-food interactions)"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="9"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="i."/>
            </extension>
            <code value="LA20342-4"/>
            <display
                     value="Drug-drug, drug-food, or adverse drug reaction as a result of a prescription and/or administration of a drug and/or food prior to admission"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="10"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="j."/>
            </extension>
            <code value="LA20343-2"/>
            <display value="Other substance: PLEASE SPECIFY"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2655-0"/>
      <url value="http://example.org/ValueSet/ll2655-0"/>
      <name value="AhrqMedicationQ2"/>
      <title value="AHRQ_Medication_Q2"/>
      <status value="active"/>
      <description
                   value="The answer list for question 2 on the AHRQ &quot;Medication or Other Substance&quot; form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="1"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="a."/>
            </extension>
            <code value="LA20278-0"/>
            <display
                     value="Prescription or over-the-counter (including herbal supplements)"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="2"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="b."/>
            </extension>
            <code value="LA20298-8"/>
            <display value="Compounded preparations"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="3"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="c."/>
            </extension>
            <code value="LA20299-6"/>
            <display value="Investigational drugs"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="4"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="d."/>
            </extension>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2657-6"/>
      <name value="AhrqMedicationQ4"/>
      <title value="AHRQ_Medication_Q4"/>
      <status value="active"/>
      <description
                   value="The answer list for question 4 on the AHRQ &quot;Medication or Other Substance&quot; form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20283-0"/>
            <display value="Vaccines"/>
          </concept>
          <concept>
            <code value="LA20287-1"/>
            <display value="Other biological products (e.g., thrombolytic)"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2659-2"/>
      <url value="http://example.org/ValueSet/ll2659-2"/>
      <name value="AhrqMedicationQ6"/>
      <title value="AHRQ_Medication_Q6"/>
      <status value="active"/>
      <description
                   value="The answer list for question 6 on the AHRQ &quot;Medication or Other Substance&quot; form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="1"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="a."/>
            </extension>
            <code value="LA20273-1"/>
            <display
                     value="Dietary supplements (other than vitamins or minerals)"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="2"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="b."/>
            </extension>
            <code value="LA16117-6"/>
            <display value="Vitamins or minerals"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="3"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="c."/>
            </extension>
            <code value="LA20320-0"/>
            <display
                     value="Enteral nutritional products, including infant formula"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="4"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="d."/>
            </extension>
            <code value="LA20321-8"/>
            <display value="Parenteral nutritional products"/>
          </concept>
          <concept>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-conceptOrder">
              <valueInteger value="5"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/valueset-label">
              <valueString value="e."/>
            </extension>
            <code value="LA20318-4"/>
            <display value="Other: PLEASE SPECIFY"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2660-0"/>
      <url value="http://example.org/ValueSet/ll2660-0"/>
      <name value="AHRQMedicationQ7"/>
      <title value="AHRQ_Medication_Q7"/>
      <status value="active"/>
      <description
                   value="The answer list for question 7 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20275-6"/>
            <display
                     value="Incorrect action (process failure or error) (e.g., such as administering overdose or incorrect medication)">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString
                             value="Incorrect action (process failure or error) (e.g., such as administering overdose or incorrect medication)"/>
              </extension>
            </display>
          </concept>
          <concept>
            <code value="LA20314-3"/>
            <display value="Unsafe condition">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="color:green"/>
              </extension>
            </display>
          </concept>
          <concept>
            <code value="LA20315-0"/>
            <display
                     value="Adverse reaction in patient to the administered substance without any apparent incorrect action"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2661-8"/>
      <name value="AHRQMedicationQ8"/>
      <title value="AHRQ_Medication_Q8"/>
      <status value="active"/>
      <description
                   value="The answer list for question 8 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20276-4"/>
            <display value="Incorrect patient"/>
          </concept>
          <concept>
            <code value="LA20302-8"/>
            <display value="Incorrect medication/substance"/>
          </concept>
          <concept>
            <code value="LA20303-6"/>
            <display value="Incorrect dose(s)"/>
          </concept>
          <concept>
            <code value="LA20304-4"/>
            <display value="Incorrect route of administration"/>
          </concept>
          <concept>
            <code value="LA20305-1"/>
            <display value="Incorrect timing"/>
          </concept>
          <concept>
            <code value="LA20306-9"/>
            <display value="Incorrect rate"/>
          </concept>
          <concept>
            <code value="LA20307-7"/>
            <display
                     value="Incorrect duration of administration or course of therapy"/>
          </concept>
          <concept>
            <code value="LA20308-5"/>
            <display
                     value="Incorrect dosage form (e.g., sustained release instead of immediate release)"/>
          </concept>
          <concept>
            <code value="LA20309-3"/>
            <display value="Incorrect strength or concentration"/>
          </concept>
          <concept>
            <code value="LA20310-1"/>
            <display
                     value="Incorrect preparation, including inappropriate cutting of tablets, error in compounding, mixing, etc."/>
          </concept>
          <concept>
            <code value="LA20311-9"/>
            <display value="Expired or deteriorated medication/substance"/>
          </concept>
          <concept>
            <code value="LA20312-7"/>
            <display
                     value="Medication/substance that is known to be an allergen to the patient"/>
          </concept>
          <concept>
            <code value="LA20345-7"/>
            <display
                     value="Medication/substance that is known to be contraindicated for the patient"/>
          </concept>
          <concept>
            <code value="LA20313-5"/>
            <display
                     value="Incorrect patient/family action (e.g., self-administration error)"/>
          </concept>
          <concept>
            <code value="LA20318-4"/>
            <display value="Other: PLEASE SPECIFY"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2662-6"/>
      <name value="AHRQMedicationQ9"/>
      <title value="AHRQ_Medication_Q9"/>
      <status value="active"/>
      <description
                   value="The answer list for question 9 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20277-2"/>
            <display value="Overdose"/>
          </concept>
          <concept>
            <code value="LA20300-2"/>
            <display value="Underdose"/>
          </concept>
          <concept>
            <code value="LA20301-0"/>
            <display value="Missed or omitted dose"/>
          </concept>
          <concept>
            <code value="LA7271-5"/>
            <display value="Extra dose"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2663-4"/>
      <name value="AHRQMedicationQ10"/>
      <title value="AHRQ_Medication_Q10"/>
      <status value="active"/>
      <description
                   value="The answer list for question 10 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20280-6"/>
            <display value="Too early"/>
          </concept>
          <concept>
            <code value="LA20290-5"/>
            <display value="Too late"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2664-2"/>
      <name value="AHRQMedicationQ11"/>
      <title value="AHRQ_Medication_Q11"/>
      <status value="active"/>
      <description
                   value="The answer list for question 11 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20282-2"/>
            <display value="Too quickly"/>
          </concept>
          <concept>
            <code value="LA20288-9"/>
            <display value="Too slowly"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2665-9"/>
      <name value="AHRQMedicationQ12"/>
      <title value="AHRQ_Medication_Q12"/>
      <status value="active"/>
      <description
                   value="The answer list for question 12 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20281-4"/>
            <display value="Too high"/>
          </concept>
          <concept>
            <code value="LA20289-7"/>
            <display value="Too low"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2817-6"/>
      <name value="AhrqYNUnk"/>
      <title value="AHRQ_Y/N/UNK"/>
      <status value="active"/>
      <description
                   value="AHRQ Common Format Answer list for Yes (A15), No (A18), Unknown (UNK)"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </concept>
          <concept>
            <code value="LA32-8"/>
            <display value="No"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2668-3"/>
      <name value="AHRQMedicationQ15"/>
      <title value="AHRQ_Medication_Q15"/>
      <status value="active"/>
      <description
                   value="The answer list for question 15 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20274-9"/>
            <display value="Drug-drug"/>
          </concept>
          <concept>
            <code value="LA20316-8"/>
            <display value="Drug-food"/>
          </concept>
          <concept>
            <code value="LA20317-6"/>
            <display value="Drug-disease"/>
          </concept>
          <concept>
            <code value="LA20318-4"/>
            <display value="Other: PLEASE SPECIFY"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2669-1"/>
      <name value="AHRQMedicationQ16"/>
      <title value="AHRQ_Medication_Q16"/>
      <status value="active"/>
      <description
                   value="The answer list for question 16 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20279-8"/>
            <display value="Purchasing"/>
          </concept>
          <concept>
            <code value="LA20291-3"/>
            <display value="Storing"/>
          </concept>
          <concept>
            <code value="LA20292-1"/>
            <display value="Prescribing/ordering"/>
          </concept>
          <concept>
            <code value="LA20293-9"/>
            <display value="Transcribing"/>
          </concept>
          <concept>
            <code value="LA20294-7"/>
            <display value="Preparing"/>
          </concept>
          <concept>
            <code value="LA20295-4"/>
            <display value="Dispensing"/>
          </concept>
          <concept>
            <code value="LA20296-2"/>
            <display value="Administering"/>
          </concept>
          <concept>
            <code value="LA20297-0"/>
            <display value="Monitoring"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
          <concept>
            <code value="LA20318-4"/>
            <display value="Other: PLEASE SPECIFY"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2828-3"/>
      <name value="AhrqYN"/>
      <title value="AHRQ_Y/N"/>
      <status value="active"/>
      <description
                   value="AHRQ Common Format Answer list for Yes (A15) and No (A18)"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </concept>
          <concept>
            <code value="LA32-8"/>
            <display value="No"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <contained>
    <ValueSet>
      <id value="ll2682-4"/>
      <name value="AHRQMedicationQ28Q29"/>
      <title value="AHRQ_Medication_Q28_Q29"/>
      <status value="active"/>
      <description
                   value="The answer list for questions 28 and 29 on the AHRQ 'Medication or Other Substance' form"/>
      <copyright
                 value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/>
      <compose>
        <include>
          <system value="http://loinc.org"/>
          <concept>
            <code value="LA20272-3"/>
            <display
                     value="Cutaneous, topical application, including ointment, spray, patch"/>
          </concept>
          <concept>
            <code value="LA9451-1"/>
            <display value="Subcutaneous"/>
          </concept>
          <concept>
            <code value="LA9444-6"/>
            <display value="Ophthalmic"/>
          </concept>
          <concept>
            <code value="LA20324-2"/>
            <display value="Oral, including sublingual or buccal"/>
          </concept>
          <concept>
            <code value="LA9445-3"/>
            <display value="Otic"/>
          </concept>
          <concept>
            <code value="LA9263-0"/>
            <display value="Nasal"/>
          </concept>
          <concept>
            <code value="LA9427-1"/>
            <display value="Inhalation"/>
          </concept>
          <concept>
            <code value="LA9437-0"/>
            <display value="Intravenous"/>
          </concept>
          <concept>
            <code value="LA9429-7"/>
            <display value="Intramuscular"/>
          </concept>
          <concept>
            <code value="LA9435-4"/>
            <display value="Intrathecal"/>
          </concept>
          <concept>
            <code value="LA9418-0"/>
            <display value="Epidural"/>
          </concept>
          <concept>
            <code value="LA20332-5"/>
            <display value="Gastric"/>
          </concept>
          <concept>
            <code value="LA9369-5"/>
            <display value="Rectal"/>
          </concept>
          <concept>
            <code value="LA9459-4"/>
            <display value="Vaginal"/>
          </concept>
          <concept>
            <code value="LA4489-6"/>
            <display value="Unknown"/>
          </concept>
          <concept>
            <code value="LA20318-4"/>
            <display value="Other: PLEASE SPECIFY"/>
          </concept>
        </include>
      </compose>
    </ValueSet>
  </contained>
  <extension
             url="http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm[x]">
    <valueCoding>
      <system value="http://hl7.org/fhir/version-algorithm"/>
      <code value="semver"/>
    </valueCoding>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
    <valueUrl value="https://tx.fhir.org/r4"/>
  </extension>
  <url
       value="http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-loinc"/>
  <identifier>
    <system value="http://loinc.org/vs"/>
    <value value="74080-3"/>
  </identifier>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.17.35.13"/>
  </identifier>
  <version value="4.0.0-ballot"/>
  <name value="MedicationorOtherSubstance"/>
  <title value="Medication or Other Substance">
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="color:#0000FF"/>
    </extension>
  </title>
  <status value="active"/>
  <subjectType value="Patient"/>
  <date value="2012-04-01"/>
  <publisher value="HL7 International / FHIR Infrastructure"/>
  <contact>
    <name value="HL7 International / FHIR Infrastructure"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <item>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
      <valueCodeableConcept>
        <coding>
          <system value="http://hl7.org/fhir/questionnaire-item-control"/>
          <code value="header"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <linkId value="Medication/header"/>
    <type value="group"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
        <valueBoolean value="true"/>
      </extension>
      <linkId value="0"/>
      <text value="Form ID:"/>
      <type value="string"/>
      <required value="true"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
        <valueInteger value="3"/>
      </extension>
      <linkId value="74080-3/74081-1"/>
      <text value="Event ID:"/>
      <type value="string"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="74080-3/30947-6"/>
      <text value="Initial Report Date (HERF Q1)"/>
      <type value="string"/>
      <required value="true"/>
    </item>
  </item>
  <item>
    <linkId value="Medication/SEC00"/>
    <text value="Medication or Other Substance"/>
    <type value="group"/>
    <item>
      <linkId value="Medication/SEC00.0"/>
      <text
            value="Use this form to report any patient safety event or unsafe condition involving a substance such as a medications, biological products, nutritional products, expressed human breast milk, medical gases, or contrast media. Do not complete this form if the event involves appropriateness of therapeutic choice or decision making (e.g., physician decision to prescribe medication despite known drug-drug interaction). If the event involves a device, please also complete the Device or Medical/Surgical Supply including Health Information Technology (HIT) form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString
                       value="Use this form to report any patient safety event or unsafe condition involving a substance such as a medications, biological products, nutritional products, expressed human breast milk, medical gases, or contrast media. Do not complete this form if the event involves appropriateness of therapeutic choice or decision making (e.g., physician decision to prescribe medication despite known drug-drug interaction). If the event involves a device, please also complete the Device or Medical/Surgical Supply including Health Information Technology (HIT) form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF)."/>
        </extension>
      </text>
      <type value="display"/>
    </item>
    <item>
      <linkId value="Medication/SEC01/74080-3"/>
      <type value="group"/>
      <required value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="1"/>
        </extension>
        <linkId value="74080-3/74076-1"/>
        <definition value="http://loinc.org/74076-1"/>
        <prefix value="1."/>
        <text value="What type of medication/substance was involved?"/>
        <type value="choice"/>
        <required value="true"/>
        <answerValueSet value="#ll2654-3"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
            <valueInteger value="7"/>
          </extension>
          <linkId value="74080-3/74075-3"/>
          <definition value="http://loinc.org/vs/74075-3"/>
          <prefix value="2."/>
          <text value="What type of medication?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74076-1"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20271-5"/>
              <display value="Medications"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2655-0"/>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/minLength">
              <valueInteger value="0"/>
            </extension>
            <linkId value="74080-3/74077-9-q"/>
            <definition value="http://loinc.org/74077-9"/>
            <prefix value="3."/>
            <text value="Please list all ingredients:"/>
            <type value="string"/>
            <enableWhen>
              <question value="74080-3/74075-3"/>
              <operator value="="/>
              <answerCoding>
                <system value="http://loinc.org"/>
                <code value="LA20298-8"/>
                <display value="Compounded preparations"/>
              </answerCoding>
            </enableWhen>
            <required value="true"/>
            <repeats value="true"/>
          </item>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
            <valueInteger value="8"/>
          </extension>
          <linkId value="74080-3/74074-6"/>
          <prefix value="4."/>
          <text value="What type of biological product?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74076-1"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20335-8"/>
              <display value="Biological products"/>
            </answerCoding>
          </enableWhen>
          <answerValueSet value="#ll2657-6"/>
          <item>
            <linkId value="74080-3/30959-1"/>
            <prefix value="5."/>
            <text value="What was the lot number of the vaccine?"/>
            <type value="string"/>
            <enableWhen>
              <question value="74080-3/74074-6"/>
              <operator value="="/>
              <answerCoding>
                <system value="http://loinc.org"/>
                <code value="LA20283-0"/>
                <display value="Vaccines"/>
              </answerCoding>
            </enableWhen>
            <required value="true"/>
          </item>
        </item>
        <item>
          <linkId value="74080-3/74073-8"/>
          <prefix value="6."/>
          <text value="What type of nutritional product?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74076-1"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20336-6"/>
              <display value="Nutritional products"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2659-2"/>
          <item>
            <linkId value="74080-3/74073-8/Other/Specify"/>
            <type value="string"/>
            <enableWhen>
              <question value="74080-3/74073-8"/>
              <operator value="="/>
              <answerCoding>
                <system value="http://loinc.org"/>
                <code value="LA20318-4"/>
                <display value="Other: PLEASE SPECIFY"/>
              </answerCoding>
            </enableWhen>
            <required value="true"/>
          </item>
        </item>
        <item>
          <linkId value="74080-3/74076-1/Other/Specify"/>
          <type value="string"/>
          <enableWhen>
            <question value="74080-3/74076-1"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20343-2"/>
              <display value="Other substance: PLEASE SPECIFY"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
      </item>
      <item>
        <linkId value="74080-3/74072-0"/>
        <prefix value="7."/>
        <text value="Which of the following best characterizes the event?"/>
        <type value="choice"/>
        <enableWhen>
          <question value="74080-3/74076-1"/>
          <operator value="!="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20340-8"/>
            <display value="Radiopharmaceuticals"/>
          </answerCoding>
        </enableWhen>
        <enableWhen>
          <question value="74080-3/74076-1"/>
          <operator value="!="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20341-6"/>
            <display
                     value="Patient food (not suspected in drug-food interactions)"/>
          </answerCoding>
        </enableWhen>
        <enableWhen>
          <question value="74080-3/74076-1"/>
          <operator value="!="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20342-4"/>
            <display
                     value="Drug-drug, drug-food, or adverse drug reaction as a result of a prescription and/or administration of a drug and/or food prior to admission"/>
          </answerCoding>
        </enableWhen>
        <enableBehavior value="all"/>
        <required value="true"/>
        <answerValueSet value="#ll2660-0"/>
      </item>
      <item>
        <linkId value="74080-3/74071-2"/>
        <prefix value="8."/>
        <text value="What was the incorrect action?"/>
        <type value="choice"/>
        <enableWhen>
          <question value="74080-3/74072-0"/>
          <operator value="="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20275-6"/>
            <display
                     value="Incorrect action (process failure or error) (e.g., such as administering overdose or incorrect medication)"/>
          </answerCoding>
        </enableWhen>
        <answerValueSet value="#ll2661-8"/>
        <item>
          <linkId value="74080-3/74070-4"/>
          <prefix value="9."/>
          <text value="Which best describes the incorrect dose(s)?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20303-6"/>
              <display value="Incorrect dose(s)"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2662-6"/>
        </item>
        <item>
          <linkId value="Medication/74069-6"/>
          <prefix value="10."/>
          <text value="Which best describes the incorrect timing?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20305-1"/>
              <display value="Incorrect timing"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2663-4"/>
        </item>
        <item>
          <linkId value="74080-3/74068-8"/>
          <prefix value="11."/>
          <text value="Which best describes the incorrect rate?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20306-9"/>
              <display value="Incorrect rate"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2664-2"/>
        </item>
        <item>
          <linkId value="Medication/74067-0"/>
          <prefix value="12."/>
          <text
                value="Which best describes the incorrect strength or concentration?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20309-3"/>
              <display value="Incorrect strength or concentration"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2665-9"/>
        </item>
        <item>
          <linkId value="Medication/74066-2"/>
          <prefix value="13."/>
          <text value="What was the expiration date?"/>
          <type value="string"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20311-9"/>
              <display value="Expired or deteriorated medication/substance"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
        <item>
          <linkId value="Medication/74065-4"/>
          <prefix value="14."/>
          <text
                value="Was there a documented history of allergies or sensitivities to the medication/substance administered?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20312-7"/>
              <display
                       value="Medication/substance that is known to be an allergen to the patient"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2817-6"/>
        </item>
        <item>
          <linkId value="Medication/74064-7"/>
          <prefix value="15."/>
          <text
                value="What was the contraindication (potential or actual interaction)?"/>
          <type value="choice"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20345-7"/>
              <display
                       value="Medication/substance that is known to be contraindicated for the patient"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
          <answerValueSet value="#ll2668-3"/>
          <item>
            <linkId value="Medication/74064-7/Other/Specify"/>
            <type value="string"/>
            <enableWhen>
              <question value="Medication/74064-7"/>
              <operator value="="/>
              <answerCoding>
                <system value="http://loinc.org"/>
                <code value="LA20318-4"/>
                <display value="Other: PLEASE SPECIFY"/>
              </answerCoding>
            </enableWhen>
            <required value="true"/>
          </item>
        </item>
        <item>
          <linkId value="74080-3/74071-2/Other/Specify"/>
          <type value="string"/>
          <enableWhen>
            <question value="74080-3/74071-2"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20318-4"/>
              <display value="Other: PLEASE SPECIFY"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
      </item>
      <item>
        <linkId value="74080-3/74063-9"/>
        <prefix value="16."/>
        <text
              value="At what stage in the process did the event originate, regardless of the stage at which it was discovered?"/>
        <type value="choice"/>
        <enableWhen>
          <question value="74080-3/74072-0"/>
          <operator value="="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20275-6"/>
            <display
                     value="Incorrect action (process failure or error) (e.g., such as administering overdose or incorrect medication)"/>
          </answerCoding>
        </enableWhen>
        <required value="true"/>
        <answerValueSet value="#ll2669-1"/>
        <item>
          <linkId value="74080-3/74063-9/Other/Specify"/>
          <type value="string"/>
          <enableWhen>
            <question value="74080-3/74063-9"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20318-4"/>
              <display value="Other: PLEASE SPECIFY"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="74080-3/74078-7.0"/>
      <text
            value="Please provide the following medication details for any medications or other substances directly involved in the event."/>
      <type value="display"/>
    </item>
    <item>
      <linkId value="74080-3/74078-x"/>
      <text value="For an near miss, omit question 27"/>
      <type value="display"/>
      <enableWhen>
        <question value="74080-3/74072-0"/>
        <operator value="!="/>
        <answerCoding>
          <system value="http://loinc.org"/>
          <code value="LA20314-3"/>
          <display value="Unsafe condition"/>
        </answerCoding>
      </enableWhen>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs">
        <valueInteger value="5"/>
      </extension>
      <linkId value="74080-3/74078-7"/>
      <type value="group"/>
      <enableWhen>
        <question value="74080-3/74072-0"/>
        <operator value="!="/>
        <answerCoding>
          <system value="http://loinc.org"/>
          <code value="LA20315-0"/>
          <display
                   value="Adverse reaction in patient to the administered substance without any apparent incorrect action"/>
        </answerCoding>
      </enableWhen>
      <enableWhen>
        <question value="74080-3/74072-0"/>
        <operator value="!="/>
        <answerCoding>
          <system value="http://loinc.org"/>
          <code value="LA4489-6"/>
          <display value="Unknown"/>
        </answerCoding>
      </enableWhen>
      <enableWhen>
        <question value="74080-3/74076-1"/>
        <operator value="!="/>
        <answerCoding>
          <system value="http://loinc.org"/>
          <code value="LA20337-4"/>
          <display value="Expressed human breast milk"/>
        </answerCoding>
      </enableWhen>
      <enableWhen>
        <question value="74080-3/74075-3"/>
        <operator value="!="/>
        <answerCoding>
          <system value="http://loinc.org"/>
          <code value="LA20298-8"/>
          <display value="Compounded preparations"/>
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
      <repeats value="true"/>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74062-1"/>
        <prefix value="17."/>
        <text value="Generic name or investigational drug name"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74061-3"/>
        <prefix value="18."/>
        <text value="Ingredient RXCUI (if known)"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74060-5"/>
        <prefix value="19."/>
        <text value="Brand name (if known)"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74059-7"/>
        <prefix value="20."/>
        <text value="Brand name RXCUI (if known)"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74058-9"/>
        <prefix value="21."/>
        <text value="Manufacturer (if known)"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74057-1"/>
        <prefix value="22."/>
        <text value="Strength or concentration of product"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74056-3"/>
        <prefix value="23."/>
        <text value="Clinical drug component RXCUI (if known)"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74055-5"/>
        <prefix value="24."/>
        <text value="Dosage form of Product"/>
        <type value="string"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="0"/>
        </extension>
        <linkId value="74080-3/74078-7/74054-8"/>
        <prefix value="25."/>
        <text value="Dose form RXCUI (if known)"/>
        <type value="string"/>
      </item>
      <item>
        <linkId value="74080-3/74078-7/74053-0"/>
        <prefix value="26."/>
        <text
              value="Was this medication/substance prescribed for this patient?"/>
        <type value="choice"/>
        <enableWhen>
          <question value="74080-3/74072-0"/>
          <operator value="!="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20314-3"/>
            <display value="Unsafe condition"/>
          </answerCoding>
        </enableWhen>
        <required value="true"/>
        <answerValueSet value="#ll2828-3"/>
      </item>
      <item>
        <linkId value="Medication/74052-2"/>
        <prefix value="27."/>
        <text value="Was this medication/substance given to this patient?"/>
        <type value="choice"/>
        <enableWhen>
          <question value="74080-3/74072-0"/>
          <operator value="!="/>
          <answerCoding>
            <system value="http://loinc.org"/>
            <code value="LA20314-3"/>
            <display value="Unsafe condition"/>
          </answerCoding>
        </enableWhen>
        <required value="true"/>
        <answerValueSet value="#ll2828-3"/>
      </item>
    </item>
    <item>
      <linkId value="Medication/SEC03"/>
      <type value="group"/>
      <enableWhen>
        <question value="74080-3/74072-0"/>
        <operator value="="/>
        <answerCoding>
          <system value="http://loinc.org"/>
          <code value="LA20304-4"/>
          <display value="Incorrect route of administration"/>
        </answerCoding>
      </enableWhen>
      <item>
        <linkId value="74080-3/74051-4"/>
        <prefix value="28."/>
        <text value="What was the intended route of administration?"/>
        <type value="choice"/>
        <required value="true"/>
        <answerValueSet value="#ll2682-4"/>
        <item>
          <linkId value="74080-3/74051-4/Other/Specify"/>
          <type value="string"/>
          <enableWhen>
            <question value="74080-3/74051-4"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20318-4"/>
              <display value="Other: PLEASE SPECIFY"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
      </item>
      <item>
        <linkId value="74080-3/74050-6"/>
        <prefix value="29."/>
        <text
              value="What was the actual route of administration (attempted or completed)?"/>
        <type value="choice"/>
        <required value="true"/>
        <answerValueSet value="#ll2682-4"/>
        <item>
          <linkId value="74080-3/74050-6/Other/Specify"/>
          <type value="string"/>
          <enableWhen>
            <question value="74080-3/74050-6"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://loinc.org"/>
              <code value="LA20318-4"/>
              <display value="Other: PLEASE SPECIFY"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="Medication/SEC04"/>
      <text value="Thank you for completing these questions."/>
      <type value="group"/>
      <item>
        <linkId value="Medication/SEC04.0"/>
        <text
              value="OMB No. 0935-0143 Exp. Date 10/31/2014 Public reporting burden for the collection of information is estimated to average 10 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer, Attention: PRA, Paperwork Reduction Project (0935-0143), AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850."/>
        <type value="display"/>
      </item>
    </item>
  </item>
  <item>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
      <valueBoolean value="true"/>
    </extension>
    <linkId value="Reporting"/>
    <text value="Reporting information"/>
    <type value="group"/>
    <item>
      <linkId value="Reporting/who"/>
      <text value="Reported by:"/>
      <type value="string"/>
    </item>
    <item>
      <linkId value="Reporting/when"/>
      <text value="Reported date:"/>
      <type value="date"/>
    </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="footer"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <linkId value="Medication/footer"/>
    <type value="group"/>
    <item>
      <linkId value="Medication/footer.0"/>
      <text
            value="AHRQ Common Formats - Hospital Version 1.2 - 2012 Medication or Other Substance"/>
      <type value="display"/>
    </item>
  </item>
</Questionnaire>