Structured Data Capture
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This page is part of the Structured Data Capture FHIR IG (v3.0.0: STU 3) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Questionnaire - ANC Quick Check - XML Representation

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="anc-quick-check"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><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 the itemcan 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="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" 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"/> ANC_Quick_Check</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">A sample questionnaire using itemMedia and itemAnswerMedia extensions</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">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://hl7.org/fhir/uv/sdc/Questionnaire/anc-quick-check#3.0.0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.reason-for-visit" 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> reason-for-visit</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Why did you come?</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">Options: <a href="#opt-item.reason-for-visit">5 options</a></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Option Sets</b></p><a name="opt-item.reason-for-visit"> </a><p><b>Answer options for reason-for-visit</b></p><ul><li style="font-size: 11px">For a scheduled (routine) visit</li><li style="font-size: 11px">For specific complaints about you or your baby</li><li style="font-size: 11px">First visit</li><li style="font-size: 11px">Follow-up visit</li><li style="font-size: 11px">Do you want to include your companion or other family member (parent if adolescent) in the examination and discussion?</li></ul></div>
  </text>
  <url value="http://hl7.org/fhir/uv/sdc/Questionnaire/anc-quick-check"/>
  <version value="3.0.0"/>
  <name value="ANC_Quick_Check"/>
  <title value="Questionnaire - ANC Quick Check"/>
  <status value="draft"/>
  <experimental value="true"/>
  <subjectType value="Patient"/>
  <date value="2022-03-08T18:33:14+00:00"/>
  <publisher value="HL7 International - FHIR Infrastructure Work Group"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <description
               value="A sample questionnaire using itemMedia and itemAnswerMedia extensions"/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
    </coding>
  </jurisdiction>
  <item>
    <extension
               url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia">
      <valueAttachment>
        <url value="http://example.org/images/reason-for-visit.png"/>
      </valueAttachment>
    </extension>
    <linkId value="reason-for-visit"/>
    <text value="Why did you come?"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia">
        <valueAttachment>
          <url value="http://example.org/images/reason-for-visit-routine.png"/>
        </valueAttachment>
      </extension>
      <valueString value="For a scheduled (routine) visit"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia">
        <valueAttachment>
          <url
               value="http://example.org/images/reason-for-visit-specific-complaint.png"/>
        </valueAttachment>
      </extension>
      <valueString value="For specific complaints about you or your baby"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia">
        <valueAttachment>
          <url value="http://example.org/images/reason-for-visit-first.png"/>
        </valueAttachment>
      </extension>
      <valueString value="First visit"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia">
        <valueAttachment>
          <url value="http://example.org/images/reason-for-visit-follow-up.png"/>
        </valueAttachment>
      </extension>
      <valueString value="Follow-up visit"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia">
        <valueAttachment>
          <url
               value="http://example.org/images/reason-for-visit-include-family-member.png"/>
        </valueAttachment>
      </extension>
      <valueString
                   value="Do you want to include your companion or other family member (parent if adolescent) in the examination and discussion?"/>
    </answerOption>
  </item>
</Questionnaire>