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
Official URL: http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior | Version: 3.0.0 | |||
Standards status: Informative | Computable Name: SDCAdvancedRenderingExample |
LinkId | Text | Cardinality | Type | Flags | Description & Constraints![]() |
---|---|---|---|---|---|
![]() ![]() | Questionnaire | http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior#3.0.0 | |||
![]() ![]() ![]() | Value constraints | 0..1 | group | ||
![]() ![]() ![]() ![]() | First Name | 0..1 | string | Max Length: 50 | |
![]() ![]() ![]() ![]() | Last Name | 0..1 | string | ||
![]() ![]() ![]() ![]() | Postal Code (A1A 1A1) | 0..1 | string | ||
![]() ![]() ![]() ![]() | Enter your weight in kg | 0..1 | decimal | ||
![]() ![]() ![]() ![]() | Body Weight | 0..1 | quantity | ||
![]() ![]() ![]() ![]() | Attach Proof of Citizenship | 0..1 | attachment | ||
![]() ![]() ![]() | Value constraints | 0..1 | group | ||
![]() ![]() ![]() ![]() | (I/We) worried whether (my/our) food would run out before (I/we) got money to buy more. | 0..1 | choice | Options: 4 options | |
![]() ![]() ![]() ![]() | Activity Level | 0..1 | choice | Value Set: http://loinc.org/vs/LL4882-8 | |
![]() ![]() ![]() ![]() | Applicable health conditions | 0..* | choice | Value Set: #vsConditionsAll | |
![]() ![]() ![]() ![]() | Email* | 1..1 | string | ||
![]() ![]() ![]() ![]() | Current Date: | 0..1 | date | ![]() | Expressions:
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![]() ![]() ![]() ![]() | null | 0..1 | display | ||
![]() ![]() ![]() ![]() | Heart History (check all that applies) | 0..* | open-choice | Options: 5 options | |
![]() ![]() ![]() ![]() | Heart History (check at least 2): | 1..* | choice | Options: 5 options | |
![]() ![]() ![]() ![]() | Heart History (check no more than 3): | 1..* | choice | Options: 5 options | |
![]() ![]() ![]() ![]() | What treatments do you now have for heart disease? (select all that applies) | 0..* | choice | Options: 6 options | |
![]() ![]() ![]() ![]() | Dosage | 0..1 | quantity | ||
![]() ![]() ![]() ![]() | Specify age: | 0..1 | quantity | ||
![]() ![]() ![]() ![]() | Select your preferred practitioner: | 0..1 | reference | ||
![]() ![]() ![]() | Calculation | 0..1 | group | ||
![]() ![]() ![]() ![]() | Deadline for submission (7 days from now) | 0..1 | date | ![]() | Expressions:
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![]() ![]() ![]() ![]() | null | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | Last Name: | 0..1 | string | ![]() | Expressions:
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![]() ![]() ![]() ![]() ![]() | First Name: | 0..1 | string | ![]() | Expressions:
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![]() ![]() ![]() ![]() ![]() | Gender: | 0..1 | string | ![]() | Expressions:
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![]() ![]() ![]() ![]() | Calculated Expression | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | Weight (kg) | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() | Body Height (inches) | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() | Your Body Mass Index (BMI) is | 0..1 | decimal | ![]() | Expressions:
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![]() ![]() ![]() ![]() | CQF-related Example | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | Enter weight in kg | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() | Enter email address | 0..1 | string | ||
![]() ![]() ![]() ![]() | null | 0..1 | display | ||
![]() ![]() ![]() | Other Controls | 0..1 | group | ||
![]() ![]() ![]() ![]() | Marital Status | 0..1 | choice | Value Set: MaritalStatus Initial Value: Coding = MaritalStatus#D "Divorced" | |
![]() ![]() ![]() ![]() | null | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | Choose Gender | 0..1 | choice | Value Set: AdministrativeGender | |
![]() ![]() ![]() ![]() ![]() | Are you pregnant? (enableWhen = gender is Female) | 0..1 | choice | Enable When: 4.2.1 = Female (AdministrativeGender#female) Value Set: Yes/No/Don't Know | |
![]() ![]() ![]() ![]() ![]() | Are you diabetic? (enableWhen = gender is Female) | 0..1 | choice | Enable When: 4.2.1 = Female (AdministrativeGender#female) Value Set: Yes/No/Don't Know | |
![]() ![]() ![]() ![]() ![]() | Have you been diagnosed with Gestational Diabetes? (enableBehavior = only when pregnant and diabetic) | 0..1 | choice | Enable When: Value Set: Yes/No/Don't Know | |
![]() ![]() ![]() ![]() ![]() | Enter your birthdate (MM/DD/YYYY) | 0..1 | date | Value Set: AdministrativeGender | |
![]() ![]() ![]() ![]() ![]() | Have you had mammogram before?(enableWhenExpression = only when gender is female and age > 40) | 0..1 | choice | Value Set: Yes/No/Don't Know Expressions:
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![]() ![]() ![]() ![]() | Signature of Patient | 1..1 | attachment | ||
![]() ![]() ![]() ![]() | All the practitioners below can speak the patient's language. Choose all preferred practioners: | 0..* | reference | Expressions:
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![]() ![]() ![]() ![]() | null | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | Home Address | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Address | 0..1 | string | Definition: Patient.address.line Expressions:
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![]() ![]() ![]() ![]() ![]() | City | 0..1 | string | Definition: Patient.address.city Expressions:
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![]() ![]() ![]() ![]() ![]() | Province | 0..1 | choice | Definition: Patient.address.state Options: 10 options Expressions:
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![]() ![]() ![]() ![]() ![]() | Postal Code | 0..1 | string | Definition: Patient.address.postalCode Expressions:
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Option Sets
Answer options for 2.1
Answer options for 2.8
Answer options for 2.9
Answer options for 2.10
Answer options for 2.11
Answer options for 4.6.4