Generated Narrative: Questionnaire questionnaire-sdc-profile-example-render Profile: Advanced Rendering Questionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints SDCAdvancedRenderingExample Questionnaire http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render#4.0.0 #xD; 1 Text Appearance 0..1 group #xD; 1.1 Enter your First Name 0..1 string #xD; 1.2 Please answer Yes or No to each of the following questions: 0..1 display #xD; 1.2b Please answer Yes or No to each of the following questions: 0..1 display #xD; 1.3 ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL. 0..1 display #xD; 1.4 null 0..1 group #xD; 1.4.1 Form ID 0..1 string #xD; 1.4.2 Event ID 0..1 string #xD; 2 Control Appearance 0..1 group #xD; 2.1 If you have any other medical problems or serious injuries, please describe them here: 0..1 text #xD; 2.2 Gender: 0..1 choice Options: 4 options #xD; 2.3 Rate your doctor: 0..1 integer Initial Value: integer = 50 #xD; 2.3.1 Completely dissatisfied 0..1 display #xD; 2.3.2 Completely satisfied 0..1 display #xD; 2.4 Medical History 0..1 group #xD; 2.4.1 Diabetes 0..1 choice Options: 2 options #xD; 2.4.2 Other Information 0..1 choice Options: 4 options #xD; 2.5 null 0..1 group #xD; 2.5.1 Relationship to patient 0..1 choice Options: 3 options #xD; 2.5.2 Name 0..1 string #xD; 2.5.3 Gender 0..1 choice Options: 4 options #xD; 2.6 Lifestyle Factors 0..1 group #xD; 2.6.1 Exercise Habits 0..1 choice Options: 4 options #xD; 2.6.2 Smoking Frequency 0..1 choice Options: 4 options #xD; 2.6.3 Alcohol Consumption 0..1 choice Options: 4 options #xD; 3 Additional Display Content 0..1 group #xD; 3.1 Have you traveled outside the country within the last 14 days? 0..1 choice Options: 2 options #xD; 3.2 Select Platelet: 0..1 choice Value Set: LOINC Answer Codes for LL715-4 #xD; 3.3 Gender: 0..1 choice Options: 4 options #xD; 3.4 Enter timing of harm assessment: 0..1 choice Value Set: Timing of harm assessment [AHRQ] #xD; 3.5 Birth Date 0..1 date #xD; 3.6 IMPORTANT: Please complete questionnaire. 0..1 display #xD; 3.7 Enter your Middle Name 0..1 string #xD; 3.8 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. 0..1 decimal #xD; 3.9 Which of the following time-slots are you available for? 0..1 string Options: 6 options #xD; 3.10 Select a condition (terminology server: tx.fhir.org) 0..1 choice Value Set: All Codes SCT ValueSet #xD; Documentation for this format Options Sets Answer options for 2.2 http://hl7.org/fhir/administrative-gender#female ("Female") http://hl7.org/fhir/administrative-gender#male ("Male") http://hl7.org/fhir/administrative-gender#other ("Other") http://hl7.org/fhir/administrative-gender#unknown ("Unknown") Answer options for 2.4.1 http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1") http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2") Answer options for 2.4.2 http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1") http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2") http://example.org/CodeSystem/conditions#otherinformation-hypertension ("Hypertension") http://example.org/CodeSystem/conditions#otherinformation-smoker ("Smoker") Answer options for 2.5.1 http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Father") http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Mother") http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIB ("Sibling") Answer options for 2.5.3 http://hl7.org/fhir/administrative-gender#female ("Female") http://hl7.org/fhir/administrative-gender#male ("Male") http://hl7.org/fhir/administrative-gender#other ("Other") http://hl7.org/fhir/administrative-gender#unknown ("Unknown") Answer options for 2.6.1 http://example.org/CodeSystem/lifestyle#daily ("Daily") http://example.org/CodeSystem/lifestyle#weekly ("Weekly") http://example.org/CodeSystem/lifestyle#monthly ("Monthly") http://example.org/CodeSystem/lifestyle#never ("Never") Answer options for 2.6.2 http://example.org/CodeSystem/lifestyle#daily ("Daily") http://example.org/CodeSystem/lifestyle#weekly ("Weekly") http://example.org/CodeSystem/lifestyle#monthly ("Monthly") http://example.org/CodeSystem/lifestyle#never ("Never") Answer options for 2.6.3 http://example.org/CodeSystem/lifestyle#daily ("Daily") http://example.org/CodeSystem/lifestyle#weekly ("Weekly") http://example.org/CodeSystem/lifestyle#monthly ("Monthly") http://example.org/CodeSystem/lifestyle#never ("Never") Answer options for 3.1 http://terminology.hl7.org/CodeSystem/v2-0532#Y ("Yes") http://terminology.hl7.org/CodeSystem/v2-0532#N ("No") Answer options for 3.3 http://hl7.org/fhir/administrative-gender#female ("Female") http://hl7.org/fhir/administrative-gender#male ("Male") http://hl7.org/fhir/administrative-gender#other ("Other") http://hl7.org/fhir/administrative-gender#unknown ("Unknown") Answer options for 3.9 9-10am 10-11am 11am-12pm 1-2pm 2-3pm 3-4pm Contained Resources ValueSet #LL2821-8 Include these codes as defined in http://loinc.org version Not Stated (use latest from terminology server) Code Display LA20752-4 Within 24 hours LA20753-2 After 24 hours but before 3 days LA20754-0 Three days or later LA4489-6 Unknown
The answer list for timing of harm assessment
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
Please answer Yes or No to each of the following questions:
_Please_ answer **Yes** or **No** to each of the following questions:
The text provides guidance on how the information will be handled from a security perspective.
ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.
A control where a user can type in their answer freely.
If you have any other medical problems or serious injuries, please describe them here:
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.
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.
Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions.
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.
Have you traveled outside the country within the last 14 days?
IMPORTANT: Please complete questionnaire.
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.
Which of the following time-slots are you available for?
Select a condition (terminology server: tx.fhir.org)