Structured Data Capture
4.0.0-ballot - STU 4 ballot
Structured Data Capture
4.0.0-ballot - STU 4 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
| Page standards status: Informative |
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:Questionnaire ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "questionnaire-sdc-profile-example-render"] ; # fhir:meta [ ( fhir:profile [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-render"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-render> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire questionnaire-sdc-profile-example-render</b></p><a name=\"questionnaire-sdc-profile-example-render\"> </a><a name=\"hcquestionnaire-sdc-profile-example-render\"> </a><a name=\"questionnaire-sdc-profile-example-render-en-US\"> </a><b>Structure</b><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 & 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,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC\" 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\"/> SDCAdvancedRenderingExample</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://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render#4.0.0-ballot</td></tr>\r\n<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.1\" 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\"/> 1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Text Appearance</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>\r\n<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.1.1\" 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: white; background-color: inherit\" title=\"string\" 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\">Enter your First 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>\r\n<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.1.2\" 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_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\"/> 1.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please answer Yes or No to each of the following questions:</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>\r\n<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.1.3\" 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-display.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> 1.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.</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\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-displayCategory.html\" title=\"Category: security \"><img src=\"icon-qi-security.png\" alt=\"icon\"/></a><img src=\"icon-qi-security.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>\r\n<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_bck101.png)\" id=\"item.1.4\" 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_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\"/> 1.4</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>\r\n<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_bck1010.png)\" id=\"item.1.4.1\" 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_blank.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\"/> 1.4.1</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\">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\"><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>\r\n<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.1.4.2\" 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_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\"/> 1.4.2</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\">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>\r\n<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.2\" 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\"/> 2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Control Appearance</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>\r\n<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.2.1\" 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-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> 2.1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">If you have any other medical problems or serious injuries, please describe them here:</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-text\">text</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>\r\n<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.2.2\" 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_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\"/> 2.2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Gender:</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-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\"><a href=\"http://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.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\">Options: <a href=\"#opt-item.2.2\">4 options</a></td></tr>\r\n<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.2.3\" 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-integer.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"integer\" class=\"hierarchy\"/> 2.3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Rate your doctor:</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-integer\">integer</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\">Initial Value: integer = 50</td></tr>\r\n<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.2.3.1\" 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-display.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> 2.3.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Completely dissatisfied</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>\r\n<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_bck1100.png)\" id=\"item.2.3.2\" 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-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> 2.3.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Completely satisfied</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>\r\n<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_bck111.png)\" id=\"item.2.4\" 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_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\"/> 2.4</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Medical History</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>\r\n<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.2.4.1\" 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: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 2.4.1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Diabetes</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\">Options: <a href=\"#opt-item.2.4.1\">2 options</a></td></tr>\r\n<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.2.4.2\" 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\"/> 2.4.2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other 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-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\">Options: <a href=\"#opt-item.2.4.2\">4 options</a></td></tr>\r\n<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.2.5\" 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_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\"/> 2.5</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>\r\n<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.2.5.1\" 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\"/> 2.5.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Relationship to patient</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-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\">Options: <a href=\"#opt-item.2.5.1\">3 options</a></td></tr>\r\n<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.2.5.2\" 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-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> 2.5.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Name</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>\r\n<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.2.5.3\" 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_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\"/> 2.5.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Gender</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-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\">Options: <a href=\"#opt-item.2.5.3\">4 options</a></td></tr>\r\n<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_bck101.png)\" id=\"item.2.6\" 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-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 2.6</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Lifestyle Factors</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>\r\n<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_bck1010.png)\" id=\"item.2.6.1\" 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_blank.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\"/> 2.6.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Exercise Habits</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-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\">Options: <a href=\"#opt-item.2.6.1\">4 options</a></td></tr>\r\n<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_bck1010.png)\" id=\"item.2.6.2\" 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_blank.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\"/> 2.6.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Smoking Frequency</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\">Options: <a href=\"#opt-item.2.6.2\">4 options</a></td></tr>\r\n<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_bck1000.png)\" id=\"item.2.6.3\" 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_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-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 2.6.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Alcohol Consumption</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-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\">Options: <a href=\"#opt-item.2.6.3\">4 options</a></td></tr>\r\n<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.3\" 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\"/> 3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Additional Display Content</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>\r\n<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_bck010.png)\" id=\"item.3.1\" 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.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\"/> 3.1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Have you traveled outside the country within the last 14 days?</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-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\">Options: <a href=\"#opt-item.3.1\">2 options</a></td></tr>\r\n<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_bck010.png)\" id=\"item.3.2\" 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.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\"/> 3.2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Select Platelet:</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\">Value Set: http://loinc.org/vs/LL715-4</td></tr>\r\n<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_bck010.png)\" id=\"item.3.3\" 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.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\"/> 3.3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Gender:</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-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\">Options: <a href=\"#opt-item.3.3\">4 options</a></td></tr>\r\n<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_bck010.png)\" id=\"item.3.4\" 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.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\"/> 3.4</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enter timing of harm assessment:</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\"><a href=\"http://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: vertical \"><img src=\"icon-qi-vertical.png\" alt=\"icon\"/></a><img src=\"icon-qi-vertical.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Value Set: <a href=\"ValueSet-questionnaire-sdc-profile-example-render_LL2821-8.html\">Timing of harm assessment [AHRQ]</a></td></tr>\r\n<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_bck010.png)\" id=\"item.3.5\" 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.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\"/> 3.5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Birth 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>\r\n<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_bck010.png)\" id=\"item.3.6\" 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.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\"/> 3.6</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">IMPORTANT: Please complete questionnaire.</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>\r\n<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_bck010.png)\" id=\"item.3.7\" 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.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\"/> 3.7</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enter your Middle 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\"><a href=\"StructureDefinition-sdc-questionnaire-optionalDisplay.html\" title=\"Is optional to display\"><img src=\"icon-qi-optional.png\" alt=\"icon\"/></a><img src=\"icon-qi-optional.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>\r\n<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_bck010.png)\" id=\"item.3.8\" 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.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-decimal.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"decimal\" class=\"hierarchy\"/> 3.8</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.</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-decimal\">decimal</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>\r\n<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.3.9\" 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-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> 3.9</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Which of the following time-slots are you available for?</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\">Options: <a href=\"#opt-item.3.9\">6 options</a></td></tr>\r\n<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><hr/><p><b>Options Sets</b></p><a name=\"opt-item.2.2\"> </a><p><b>Answer options for 2.2 </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#female ("Female")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#male ("Male")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#other ("Other")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#unknown ("Unknown")</li></ul><a name=\"opt-item.2.4.1\"> </a><p><b>Answer options for 2.4.1 </b></p><ul><li style=\"font-size: 11px\">http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")</li></ul><a name=\"opt-item.2.4.2\"> </a><p><b>Answer options for 2.4.2 </b></p><ul><li style=\"font-size: 11px\">http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/conditions#otherinformation-hypertension ("Hypertension")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/conditions#otherinformation-smoker ("Smoker")</li></ul><a name=\"opt-item.2.5.1\"> </a><p><b>Answer options for 2.5.1 </b></p><ul><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Father")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Mother")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIB ("Sibling")</li></ul><a name=\"opt-item.2.5.3\"> </a><p><b>Answer options for 2.5.3 </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#female ("Female")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#male ("Male")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#other ("Other")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#unknown ("Unknown")</li></ul><a name=\"opt-item.2.6.1\"> </a><p><b>Answer options for 2.6.1 </b></p><ul><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#daily ("Daily")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#weekly ("Weekly")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#monthly ("Monthly")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#never ("Never")</li></ul><a name=\"opt-item.2.6.2\"> </a><p><b>Answer options for 2.6.2 </b></p><ul><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#daily ("Daily")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#weekly ("Weekly")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#monthly ("Monthly")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#never ("Never")</li></ul><a name=\"opt-item.2.6.3\"> </a><p><b>Answer options for 2.6.3 </b></p><ul><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#daily ("Daily")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#weekly ("Weekly")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#monthly ("Monthly")</li><li style=\"font-size: 11px\">http://example.org/CodeSystem/lifestyle#never ("Never")</li></ul><a name=\"opt-item.3.1\"> </a><p><b>Answer options for 3.1 </b></p><ul><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v2-0532#Y ("Yes")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v2-0532#N ("No")</li></ul><a name=\"opt-item.3.3\"> </a><p><b>Answer options for 3.3 </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#female ("Female")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#male ("Male")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#other ("Other")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#unknown ("Unknown")</li></ul><a name=\"opt-item.3.9\"> </a><p><b>Answer options for 3.9 </b></p><ul><li style=\"font-size: 11px\">9-10am</li><li style=\"font-size: 11px\">10-11am</li><li style=\"font-size: 11px\">11am-12pm</li><li style=\"font-size: 11px\">1-2pm</li><li style=\"font-size: 11px\">2-3pm</li><li style=\"font-size: 11px\">3-4pm</li></ul><h2>Contained Resources</h2><hr/><p class=\"res-header-id\"><b>ValueSet #LL2821-8</b></p><a name=\"questionnaire-sdc-profile-example-render/LL2821-8\"> </a><a name=\"hcquestionnaire-sdc-profile-example-render/LL2821-8\"> </a><a name=\"questionnaire-sdc-profile-example-render/LL2821-8-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/LA20752-4/\">LA20752-4</a></td><td>Within 24 hours</td></tr><tr><td><a href=\"https://loinc.org/LA20753-2/\">LA20753-2</a></td><td>After 24 hours but before 3 days</td></tr><tr><td><a href=\"https://loinc.org/LA20754-0/\">LA20754-0</a></td><td>Three days or later</td></tr><tr><td><a href=\"https://loinc.org/LA4489-6/\">LA4489-6</a></td><td>Unknown</td></tr></table></li></ul></div>" ] ; # fhir:contained ( [ a fhir:ValueSet ; fhir:id [ fhir:v "LL2821-8" ] ; fhir:url [ fhir:v "http://example.org/ValueSet/LL2821-8"^^xsd:anyURI ] ; fhir:name [ fhir:v "TimingOfHarmAssessmentValueSet" ] ; fhir:title [ fhir:v "Timing of harm assessment [AHRQ]" ] ; fhir:status [ fhir:v "active" ] ; fhir:description [ fhir:v "The answer list for timing of harm assessment" ] ; fhir:copyright [ fhir:v "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" ] ; fhir:compose [ ( fhir:include [ fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ; ( fhir:concept [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/valueset-label"^^xsd:anyURI ] ; fhir:value [ fhir:v "A." ] ] ) ; fhir:code [ fhir:v "LA20752-4" ] ; fhir:display [ fhir:v "Within 24 hours" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/valueset-label"^^xsd:anyURI ] ; fhir:value [ fhir:v "B." ] ] ) ; fhir:code [ fhir:v "LA20753-2" ] ; fhir:display [ fhir:v "After 24 hours but before 3 days" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/valueset-label"^^xsd:anyURI ] ; fhir:value [ fhir:v "C." ] ] ) ; fhir:code [ fhir:v "LA20754-0" ] ; fhir:display [ fhir:v "Three days or later" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/valueset-label"^^xsd:anyURI ] ; fhir:value [ fhir:v "D." ] ] ) ; fhir:code [ fhir:v "LA4489-6" ] ; fhir:display [ fhir:v "Unknown" ] ] ) ] ) ] ] ) ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm[x]"^^xsd:anyURI ] ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/version-algorithm"^^xsd:anyURI ] ; fhir:code [ fhir:v "semver" ] ] ] ) ; # fhir:url [ fhir:v "http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render"^^xsd:anyURI] ; # fhir:identifier ( [ fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ; fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.40.17.35.16" ] ] ) ; # fhir:version [ fhir:v "4.0.0-ballot"] ; # fhir:name [ fhir:v "SDCAdvancedRenderingExample"] ; # fhir:status [ fhir:v "active"] ; # fhir:date [ fhir:v "2024-12-17T01:55:34+00:00"^^xsd:dateTime] ; # fhir:publisher [ fhir:v "HL7 International / FHIR Infrastructure"] ; # fhir:contact ( [ fhir:name [ fhir:v "HL7 International / FHIR Infrastructure" ] ; ( fhir:telecom [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ] ] ) ] [ ( fhir:telecom [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ] ] ) ] ) ; # fhir:jurisdiction ( [ ( fhir:coding [ fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ; fhir:code [ fhir:v "001" ] ; fhir:display [ fhir:v "World" ] ] ) ] ) ; # fhir:item ( [ fhir:linkId [ fhir:v "1" ] ; fhir:text [ fhir:v "Text Appearance" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ fhir:linkId [ fhir:v "1.1" ] ; fhir:text [ fhir:v "Enter your First Name" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ] ; fhir:value [ fhir:v "color:green;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "1.2" ] ; fhir:text [ fhir:v "Please answer Yes or No to each of the following questions:" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ] ; fhir:value [ fhir:v "Please answer Yes or No to each of the following questions:" ] ] ) ] ; fhir:type [ fhir:v "display" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-display-category"^^xsd:anyURI ] ; fhir:code [ fhir:v "security" ] ; fhir:display [ fhir:v "Security" ] ] ) ; fhir:text [ fhir:v "The text provides guidance on how the information will be handled from a security perspective." ] ] ] ) ; fhir:linkId [ fhir:v "1.3" ] ; fhir:text [ fhir:v "ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL." ] ; fhir:type [ fhir:v "display" ] ] [ fhir:linkId [ fhir:v "1.4" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"^^xsd:anyURI ] ; fhir:value [ fhir:v "true"^^xsd:boolean ] ] ) ; fhir:linkId [ fhir:v "1.4.1" ] ; fhir:text [ fhir:v "Form ID" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "1.4.2" ] ; fhir:text [ fhir:v "Event ID" ] ; fhir:type [ fhir:v "string" ] ] ) ] ) ] [ fhir:linkId [ fhir:v "2" ] ; fhir:text [ fhir:v "Control Appearance" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "text-box" ] ; fhir:display [ fhir:v "Text Box" ] ] ) ; fhir:text [ fhir:v "A control where a user can type in their answer freely." ] ] ] ) ; fhir:linkId [ fhir:v "2.1" ] ; fhir:text [ fhir:v "If you have any other medical problems or serious injuries, please describe them here:" ] ; fhir:type [ fhir:v "text" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ] ; fhir:value [ fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others." ] ] ] ) ; fhir:linkId [ fhir:v "2.2" ] ; fhir:text [ fhir:v "Gender:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "female" ] ; fhir:display [ fhir:v "Female" ] ] ; fhir:initialSelected [ fhir:v "true"^^xsd:boolean ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "male" ] ; fhir:display [ fhir:v "Male" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "other" ] ; fhir:display [ fhir:v "Other" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "unknown" ] ; fhir:display [ fhir:v "Unknown" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "slider" ] ; fhir:display [ fhir:v "Slider" ] ] ) ; fhir:text [ fhir:v "A control where an axis is displayed between the high and low values and the control can be visually manipulated to select a value anywhere on the axis." ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue"^^xsd:anyURI ] ; fhir:value [ fhir:v "10"^^xsd:integer ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/minValue"^^xsd:anyURI ] ; fhir:value [ fhir:v "0"^^xsd:integer ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/maxValue"^^xsd:anyURI ] ; fhir:value [ fhir:v "100"^^xsd:integer ] ] ) ; fhir:linkId [ fhir:v "2.3" ] ; fhir:text [ fhir:v "Rate your doctor:" ] ; fhir:type [ fhir:v "integer" ] ; ( fhir:initial [ fhir:value [ fhir:v "50"^^xsd:integer ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "lower" ] ; fhir:display [ fhir:v "Lower-bound" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "2.3.1" ] ; fhir:text [ fhir:v "Completely dissatisfied" ] ; fhir:type [ fhir:v "display" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "upper" ] ; fhir:display [ fhir:v "Upper-bound" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "2.3.2" ] ; fhir:text [ fhir:v "Completely satisfied" ] ; fhir:type [ fhir:v "display" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "htable" ] ; fhir:display [ fhir:v "Horizontal Answer Table" ] ] ) ; fhir:text [ fhir:v "Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions." ] ] ] ) ; fhir:linkId [ fhir:v "2.4" ] ; fhir:text [ fhir:v "Medical History" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible." ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-width"^^xsd:anyURI ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "65"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ; fhir:code [ fhir:v "%" ] ] ] ) ; fhir:linkId [ fhir:v "2.4.1" ] ; fhir:text [ fhir:v "Diabetes" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/conditions"^^xsd:anyURI ] ; fhir:code [ fhir:v "diabetes-type1" ] ; fhir:display [ fhir:v "Type 1" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/conditions"^^xsd:anyURI ] ; fhir:code [ fhir:v "diabetes-type2" ] ; fhir:display [ fhir:v "Type 2" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible." ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-width"^^xsd:anyURI ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "35"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ; fhir:code [ fhir:v "%" ] ] ] ) ; fhir:linkId [ fhir:v "2.4.2" ] ; fhir:text [ fhir:v "Other Information" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/conditions"^^xsd:anyURI ] ; fhir:code [ fhir:v "diabetes-type1" ] ; fhir:display [ fhir:v "Type 1" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/conditions"^^xsd:anyURI ] ; fhir:code [ fhir:v "diabetes-type2" ] ; fhir:display [ fhir:v "Type 2" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/conditions"^^xsd:anyURI ] ; fhir:code [ fhir:v "otherinformation-hypertension" ] ; fhir:display [ fhir:v "Hypertension" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/conditions"^^xsd:anyURI ] ; fhir:code [ fhir:v "otherinformation-smoker" ] ; fhir:display [ fhir:v "Smoker" ] ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-collapsible"^^xsd:anyURI ] ; fhir:value [ fhir:v "default-closed" ] ] ) ; fhir:linkId [ fhir:v "2.5" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "drop-down" ] ; fhir:display [ fhir:v "Drop down" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "2.5.1" ] ; fhir:text [ fhir:v "Relationship to patient" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-RoleCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "FTH" ] ; fhir:display [ fhir:v "Father" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-RoleCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "MTH" ] ; fhir:display [ fhir:v "Mother" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-RoleCode"^^xsd:anyURI ] ; fhir:code [ fhir:v "SIB" ] ; fhir:display [ fhir:v "Sibling" ] ] ] ) ] [ fhir:linkId [ fhir:v "2.5.2" ] ; fhir:text [ fhir:v "Name" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "2.5.3" ] ; fhir:text [ fhir:v "Gender" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "female" ] ; fhir:display [ fhir:v "Female" ] ] ; fhir:initialSelected [ fhir:v "true"^^xsd:boolean ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "male" ] ; fhir:display [ fhir:v "Male" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "other" ] ; fhir:display [ fhir:v "Other" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "unknown" ] ; fhir:display [ fhir:v "Unknown" ] ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "htable" ] ; fhir:display [ fhir:v "Horizontal Answer Table" ] ] ) ; fhir:text [ fhir:v "Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions." ] ] ] ) ; fhir:linkId [ fhir:v "2.6" ] ; fhir:text [ fhir:v "Lifestyle Factors" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible." ] ] ] ) ; fhir:linkId [ fhir:v "2.6.1" ] ; fhir:text [ fhir:v "Exercise Habits" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "daily" ] ; fhir:display [ fhir:v "Daily" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "weekly" ] ; fhir:display [ fhir:v "Weekly" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "monthly" ] ; fhir:display [ fhir:v "Monthly" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "never" ] ; fhir:display [ fhir:v "Never" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible." ] ] ] ) ; fhir:linkId [ fhir:v "2.6.2" ] ; fhir:text [ fhir:v "Smoking Frequency" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "daily" ] ; fhir:display [ fhir:v "Daily" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "weekly" ] ; fhir:display [ fhir:v "Weekly" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "monthly" ] ; fhir:display [ fhir:v "Monthly" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "never" ] ; fhir:display [ fhir:v "Never" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible." ] ] ] ) ; fhir:linkId [ fhir:v "2.6.3" ] ; fhir:text [ fhir:v "Alcohol Consumption" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "daily" ] ; fhir:display [ fhir:v "Daily" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "weekly" ] ; fhir:display [ fhir:v "Weekly" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "monthly" ] ; fhir:display [ fhir:v "Monthly" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.org/CodeSystem/lifestyle"^^xsd:anyURI ] ; fhir:code [ fhir:v "never" ] ; fhir:display [ fhir:v "Never" ] ] ] ) ] ) ] ) ] [ fhir:linkId [ fhir:v "3" ] ; fhir:text [ fhir:v "Additional Display Content" ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-supportLink"^^xsd:anyURI ] ; fhir:value [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-supportLink"^^xsd:anyURI ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others." ] ] ] ) ; fhir:linkId [ fhir:v "3.1" ] ; fhir:text [ fhir:v "Have you traveled outside the country within the last 14 days?" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0532"^^xsd:anyURI ] ; fhir:code [ fhir:v "Y" ] ; fhir:display [ fhir:v "Yes" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0532"^^xsd:anyURI ] ; fhir:code [ fhir:v "N" ] ; fhir:display [ fhir:v "No" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "drop-down" ] ; fhir:display [ fhir:v "Drop down" ] ] ) ] ] [ ( fhir:extension [ fhir:url [ fhir:v "path"^^xsd:anyURI ] ; fhir:value [ fhir:v "code" ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ] ; fhir:value [ fhir:v "CODE" ] ] [ fhir:url [ fhir:v "width"^^xsd:anyURI ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "25"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ; fhir:code [ fhir:v "%" ] ] ] [ fhir:url [ fhir:v "forDisplay"^^xsd:anyURI ] ; fhir:value [ fhir:v "false"^^xsd:boolean ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "path"^^xsd:anyURI ] ; fhir:value [ fhir:v "display" ] ] [ fhir:url [ fhir:v "label"^^xsd:anyURI ] ; fhir:value [ fhir:v "DESCRIPTION" ] ] [ fhir:url [ fhir:v "width"^^xsd:anyURI ] ; fhir:value [ a fhir:Quantity ; fhir:value [ fhir:v "75"^^xsd:decimal ] ; fhir:system [ fhir:v "http://unitsofmeasure.org"^^xsd:anyURI ] ; fhir:code [ fhir:v "%" ] ] ] [ fhir:url [ fhir:v "forDisplay"^^xsd:anyURI ] ; fhir:value [ fhir:v "true"^^xsd:boolean ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"^^xsd:anyURI ] ] ) ; fhir:linkId [ fhir:v "3.2" ] ; fhir:text [ fhir:v "Select Platelet:" ] ; fhir:type [ fhir:v "choice" ] ; fhir:answerValueSet [ fhir:v "http://loinc.org/vs/LL715-4"^^xsd:anyURI ; fhir:link <http://loinc.org/vs/LL715-4> ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others." ] ] ] ) ; fhir:linkId [ fhir:v "3.3" ] ; fhir:text [ fhir:v "Gender:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"^^xsd:anyURI ] ; fhir:value [ fhir:v "(a)" ] ] ) ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "female" ] ; fhir:display [ fhir:v "Female" ] ] ; fhir:initialSelected [ fhir:v "true"^^xsd:boolean ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"^^xsd:anyURI ] ; fhir:value [ fhir:v "(b)" ] ] ) ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "male" ] ; fhir:display [ fhir:v "Male" ] ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"^^xsd:anyURI ] ; fhir:value [ fhir:v "(c)" ] ] ) ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "other" ] ; fhir:display [ fhir:v "Other" ] ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"^^xsd:anyURI ] ; fhir:value [ fhir:v "(d)" ] ] ) ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ] ; fhir:code [ fhir:v "unknown" ] ; fhir:display [ fhir:v "Unknown" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ] ; fhir:value [ fhir:v "vertical" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ; fhir:text [ fhir:v "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others." ] ] ] ) ; fhir:linkId [ fhir:v "3.4" ] ; fhir:text [ fhir:v "Enter timing of harm assessment:" ] ; fhir:type [ fhir:v "choice" ] ; fhir:answerValueSet [ fhir:v "#LL2821-8"^^xsd:anyURI ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/entryFormat"^^xsd:anyURI ] ; fhir:value [ fhir:v "mm-dd-yyyy" ] ] ) ; fhir:linkId [ fhir:v "3.5" ] ; fhir:text [ fhir:v "Birth Date" ] ; fhir:type [ fhir:v "date" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive"^^xsd:anyURI ] ; fhir:value [ fhir:v "true"^^xsd:boolean ] ] ) ; fhir:linkId [ fhir:v "3.6" ] ; fhir:text [ fhir:v "IMPORTANT: Please complete questionnaire." ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ] ; fhir:value [ fhir:v "color:red;" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ] ; fhir:value [ fhir:v "IMPORTANT: Please complete questionnaire." ] ] ) ] ; fhir:type [ fhir:v "display" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-optionalDisplay"^^xsd:anyURI ] ; fhir:value [ fhir:v "true"^^xsd:boolean ] ] ) ; fhir:linkId [ fhir:v "3.7" ] ; fhir:text [ fhir:v "Enter your Middle Name" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-shortText"^^xsd:anyURI ] ; fhir:value [ fhir:v "Annual family income" ] ] ) ; fhir:linkId [ fhir:v "3.8" ] ; fhir:text [ fhir:v "During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits." ] ; fhir:type [ fhir:v "decimal" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-columnCount"^^xsd:anyURI ] ; fhir:value [ fhir:v "3"^^xsd:positiveInteger ] ] ) ; fhir:linkId [ fhir:v "3.9" ] ; fhir:text [ fhir:v "Which of the following time-slots are you available for?" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:answerOption [ fhir:value [ fhir:v "9-10am" ] ] [ fhir:value [ fhir:v "10-11am" ] ] [ fhir:value [ fhir:v "11am-12pm" ] ] [ fhir:value [ fhir:v "1-2pm" ] ] [ fhir:value [ fhir:v "2-3pm" ] ] [ fhir:value [ fhir:v "3-4pm" ] ] ) ] ) ] ) . #
IG © 2022+ HL7 International / FHIR Infrastructure. Package hl7.fhir.uv.sdc#4.0.0-ballot based on FHIR 4.0.1. Generated 2024-12-17
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