Generated Narrative: Questionnaire questionnaire-sdc-profile-example-render

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. SDCAdvancedRenderingExampleQuestionnairehttp://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render#4.0.0
... 1Text Appearance0..1group
.... 1.1Enter your First Name0..1string
.... 1.2Please answer Yes or No to each of the following questions:0..1display
.... 1.2bPlease answer Yes or No to each of the following questions:0..1display
.... 1.3ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.0..1displayiconicon
.... 1.4null0..1group
..... 1.4.1Form ID0..1stringiconicon
..... 1.4.2Event ID0..1string
... 2Control Appearance0..1group
.... 2.1If you have any other medical problems or serious injuries, please describe them here:0..1text
.... 2.2Gender:0..1choiceiconiconOptions: 4 options
.... 2.3Rate your doctor:0..1integerInitial Value: integer = 50
..... 2.3.1Completely dissatisfied0..1display
..... 2.3.2Completely satisfied0..1display
.... 2.4Medical History0..1group
..... 2.4.1Diabetes0..1choiceOptions: 2 options
..... 2.4.2Other Information0..1choiceOptions: 4 options
.... 2.5null0..1group
..... 2.5.1Relationship to patient0..1choiceOptions: 3 options
..... 2.5.2Name0..1string
..... 2.5.3Gender0..1choiceOptions: 4 options
.... 2.6Lifestyle Factors0..1group
..... 2.6.1Exercise Habits0..1choiceOptions: 4 options
..... 2.6.2Smoking Frequency0..1choiceOptions: 4 options
..... 2.6.3Alcohol Consumption0..1choiceOptions: 4 options
... 3Additional Display Content0..1group
.... 3.1Have you traveled outside the country within the last 14 days?0..1choiceOptions: 2 options
.... 3.2Select Platelet:0..1choiceValue Set: LOINC Answer Codes for LL715-4
.... 3.3Gender:0..1choiceOptions: 4 options
.... 3.4Enter timing of harm assessment:0..1choiceiconiconValue Set: Timing of harm assessment [AHRQ]
.... 3.5Birth Date0..1date
.... 3.6IMPORTANT: Please complete questionnaire.0..1display
.... 3.7Enter your Middle Name0..1stringiconicon
.... 3.8During 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..1decimal
.... 3.9Which of the following time-slots are you available for?0..1stringOptions: 6 options
.... 3.10Select a condition (terminology server: tx.fhir.org)0..1choiceValue Set: All Codes SCT ValueSet

doco 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

 <status value="active"/> <description value="The answer list for timing of harm assessment"/> <copyright value="This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use"/> <compose> <include> <system value="http://loinc.org"/> <concept> <extension url="http://hl7.org/fhir/StructureDefinition/valueset-label"> <valueString value="A."/> </extension> <code value="LA20752-4"/> <display value="Within 24 hours"/> </concept> <concept> <extension url="http://hl7.org/fhir/StructureDefinition/valueset-label"> <valueString value="B."/> </extension> <code value="LA20753-2"/> <display value="After 24 hours but before 3 days"/> </concept> <concept> <extension url="http://hl7.org/fhir/StructureDefinition/valueset-label"> <valueString value="C."/> </extension> <code value="LA20754-0"/> <display value="Three days or later"/> </concept> <concept> <extension url="http://hl7.org/fhir/StructureDefinition/valueset-label"> <valueString value="D."/> </extension> <code value="LA4489-6"/> <display value="Unknown"/> </concept> </include> </compose> </ValueSet> </contained> <extension url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm"> <valueCoding> <system value="http://hl7.org/fhir/version-algorithm"/> <code value="semver"/> </valueCoding> </extension> <modifierExtension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-rendering-criticalExtension"> <valueCanonical value="http://hl7.org/fhir/StructureDefinition/rendering-style|5.3.0-ballot-tc1"/> </modifierExtension> <modifierExtension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-rendering-criticalExtension"> <valueCanonical value="http://hl7.org/fhir/StructureDefinition/rendering-xhtml|5.3.0-ballot-tc1"/> </modifierExtension> <url value="http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render"/> <identifier> <system value="urn:ietf:rfc:3986"/> <value value="urn:oid:2.16.840.1.113883.4.642.40.17.35.16"/> </identifier> <version value="4.0.0"/> <name value="SDCAdvancedRenderingExample"/> <status value="active"/> <date value="2026-03-24T16:31:45+11:00"/> <publisher value="HL7 International / FHIR Infrastructure"/> <contact> <name value="HL7 International / FHIR Infrastructure"/> <telecom> <system value="url"/> <value value="http://www.hl7.org/Special/committees/fiwg"/> </telecom> </contact> <contact> <telecom> <system value="url"/> <value value="http://www.hl7.org/Special/committees/fiwg"/> </telecom> </contact> <jurisdiction> <coding> <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/> <code value="001"/> <display value="World"/> </coding> </jurisdiction> <item> <linkId value="1"/> <text value="Text Appearance"/> <type value="group"/> <item> <linkId value="1.1"/> <text value="Enter your First Name"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="color:green;"/> </extension> </text> <type value="string"/> </item> <item> <linkId value="1.2"/> <text value="Please answer Yes or No to each of the following questions:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<i>Please</i> answer <b><u>Yes</u></b> or <b><u>No</u></b> to each of the following questions:"/> </extension> </text> <type value="display"/> </item> <item> <linkId value="1.2b"/> <text value="Please answer Yes or No to each of the following questions:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-markdown"> <valueMarkdown value="_Please_ answer **Yes** or **No** to each of the following questions:"/> </extension> </text> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-display-category"/> <code value="security"/> <display value="Security"/> </coding> <text value="The text provides guidance on how the information will be handled from a security perspective."/> </valueCodeableConcept> </extension> <linkId value="1.3"/> <text value="ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL."/> <type value="display"/> </item> <item> <linkId value="1.4"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true"/> </extension> <linkId value="1.4.1"/> <text value="Form ID"/> <type value="string"/> </item> <item> <linkId value="1.4.2"/> <text value="Event ID"/> <type value="string"/> </item> </item> </item> <item> <linkId value="2"/> <text value="Control Appearance"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="text-box"/> <display value="Text Box"/> </coding> <text value="A control where a user can type in their answer freely."/> </valueCodeableConcept> </extension> <linkId value="2.1"/> <text value="If you have any other medical problems or serious injuries, please describe them here:"/> <type value="text"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"> <valueCode value="horizontal"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="radio-button"/> <display value="Radio Button"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="2.2"/> <text value="Gender:"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="female"/> <display value="Female"/> </valueCoding> <initialSelected value="true"/> </answerOption> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="male"/> <display value="Male"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="other"/> <display value="Other"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="unknown"/> <display value="Unknown"/> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="slider"/> <display value="Slider"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue"> <valueInteger value="10"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/minValue"> <valueInteger value="0"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/maxValue"> <valueInteger value="100"/> </extension> <linkId value="2.3"/> <text value="Rate your doctor:"/> <type value="integer"/> <initial> <valueInteger value="50"/> </initial> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="lower"/> <display value="Lower-bound"/> </coding> </valueCodeableConcept> </extension> <linkId value="2.3.1"/> <text value="Completely dissatisfied"/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="upper"/> <display value="Upper-bound"/> </coding> </valueCodeableConcept> </extension> <linkId value="2.3.2"/> <text value="Completely satisfied"/> <type value="display"/> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="htable"/> <display value="Horizontal Answer Table"/> </coding> <text value="Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions."/> </valueCodeableConcept> </extension> <linkId value="2.4"/> <text value="Medical History"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="check-box"/> <display value="Check-box"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-width"> <valueQuantity> <value value="65"/> <system value="http://unitsofmeasure.org"/> <code value="%"/> </valueQuantity> </extension> <linkId value="2.4.1"/> <text value="Diabetes"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/conditions"/> <code value="diabetes-type1"/> <display value="Type 1"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/conditions"/> <code value="diabetes-type2"/> <display value="Type 2"/> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="check-box"/> <display value="Check-box"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-width"> <valueQuantity> <value value="35"/> <system value="http://unitsofmeasure.org"/> <code value="%"/> </valueQuantity> </extension> <linkId value="2.4.2"/> <text value="Other Information"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/conditions"/> <code value="diabetes-type1"/> <display value="Type 1"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/conditions"/> <code value="diabetes-type2"/> <display value="Type 2"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/conditions"/> <code value="otherinformation-hypertension"/> <display value="Hypertension"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/conditions"/> <code value="otherinformation-smoker"/> <display value="Smoker"/> </valueCoding> </answerOption> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-collapsible"> <valueCode value="default-closed"/> </extension> <linkId value="2.5"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="2.5.1"/> <text value="Relationship to patient"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <code value="FTH"/> <display value="Father"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <code value="MTH"/> <display value="Mother"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <code value="SIB"/> <display value="Sibling"/> </valueCoding> </answerOption> </item> <item> <linkId value="2.5.2"/> <text value="Name"/> <type value="string"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="radio-button"/> <display value="Radio Button"/> </coding> </valueCodeableConcept> </extension> <linkId value="2.5.3"/> <text value="Gender"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="female"/> <display value="Female"/> </valueCoding> <initialSelected value="true"/> </answerOption> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="male"/> <display value="Male"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="other"/> <display value="Other"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="unknown"/> <display value="Unknown"/> </valueCoding> </answerOption> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="htable"/> <display value="Horizontal Answer Table"/> </coding> <text value="Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions."/> </valueCodeableConcept> </extension> <linkId value="2.6"/> <text value="Lifestyle Factors"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="check-box"/> <display value="Check-box"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="2.6.1"/> <text value="Exercise Habits"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="daily"/> <display value="Daily"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="weekly"/> <display value="Weekly"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="monthly"/> <display value="Monthly"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="never"/> <display value="Never"/> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="check-box"/> <display value="Check-box"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="2.6.2"/> <text value="Smoking Frequency"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="daily"/> <display value="Daily"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="weekly"/> <display value="Weekly"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="monthly"/> <display value="Monthly"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="never"/> <display value="Never"/> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="check-box"/> <display value="Check-box"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="2.6.3"/> <text value="Alcohol Consumption"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="daily"/> <display value="Daily"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="weekly"/> <display value="Weekly"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="monthly"/> <display value="Monthly"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://example.org/CodeSystem/lifestyle"/> <code value="never"/> <display value="Never"/> </valueCoding> </answerOption> </item> </item> </item> <item> <linkId value="3"/> <text value="Additional Display Content"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-supportHyperlink"> <extension url="label"> <valueString value="More info"/> </extension> <extension url="link"> <valueUri value="http://example.org/more-info"/> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="radio-button"/> <display value="Radio Button"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="3.1"/> <text value="Have you traveled outside the country within the last 14 days?"/> <type value="choice"/> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/> <code value="Y"/> <display value="Yes"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/> <code value="N"/> <display value="No"/> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"> <extension url="path"> <valueString value="code"/> </extension> <extension url="label"> <valueString value="CODE"/> </extension> <extension url="width"> <valueQuantity> <value value="25"/> <system value="http://unitsofmeasure.org"/> <code value="%"/> </valueQuantity> </extension> <extension url="forDisplay"> <valueBoolean value="false"/> </extension> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"> <extension url="path"> <valueString value="display"/> </extension> <extension url="label"> <valueString value="DESCRIPTION"/> </extension> <extension url="width"> <valueQuantity> <value value="75"/> <system value="http://unitsofmeasure.org"/> <code value="%"/> </valueQuantity> </extension> <extension url="forDisplay"> <valueBoolean value="true"/> </extension> </extension> <linkId value="3.2"/> <text value="Select Platelet:"/> <type value="choice"/> <answerValueSet value="http://loinc.org/vs/LL715-4"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="radio-button"/> <display value="Radio Button"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="3.3"/> <text value="Gender:"/> <type value="choice"/> <answerOption> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"> <valueString value="(a)"/> </extension> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="female"/> <display value="Female"/> </valueCoding> <initialSelected value="true"/> </answerOption> <answerOption> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"> <valueString value="(b)"/> </extension> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="male"/> <display value="Male"/> </valueCoding> </answerOption> <answerOption> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"> <valueString value="(c)"/> </extension> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="other"/> <display value="Other"/> </valueCoding> </answerOption> <answerOption> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix"> <valueString value="(d)"/> </extension> <valueCoding> <system value="http://hl7.org/fhir/administrative-gender"/> <code value="unknown"/> <display value="Unknown"/> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"> <valueCode value="vertical"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="radio-button"/> <display value="Radio Button"/> </coding> <text value="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."/> </valueCodeableConcept> </extension> <linkId value="3.4"/> <text value="Enter timing of harm assessment:"/> <type value="choice"/> <answerValueSet value="#LL2821-8"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/entryFormat"> <valueString value="mm-dd-yyyy"/> </extension> <linkId value="3.5"/> <text value="Birth Date"/> <type value="date"/> </item> <item> <linkId value="3.6"/> <text value="IMPORTANT: Please complete questionnaire."> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="color:red;"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="IMPORTANT: Please complete questionnaire."/> </extension> </text> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-optionalDisplay"> <valueBoolean value="true"/> </extension> <linkId value="3.7"/> <text value="Enter your Middle Name"/> <type value="string"/> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-shortText"> <valueString value="Annual family income"/> </extension> <linkId value="3.8"/> <text value="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."/> <type value="decimal"/> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-columnCount"> <valuePositiveInt value="3"/> </extension> <linkId value="3.9"/> <text value="Which of the following time-slots are you available for?"/> <type value="string"/> <answerOption> <valueString value="9-10am"/> </answerOption> <answerOption> <valueString value="10-11am"/> </answerOption> <answerOption> <valueString value="11am-12pm"/> </answerOption> <answerOption> <valueString value="1-2pm"/> </answerOption> <answerOption> <valueString value="2-3pm"/> </answerOption> <answerOption> <valueString value="3-4pm"/> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer"> <valueUrl value="https://tx.fhir.org/r4"/> </extension> <linkId value="3.10"/> <text value="Select a condition (terminology server: tx.fhir.org)"/> <type value="choice"/> <answerValueSet value="http://snomed.info/sct?fhir_vs"/> </item> </item> </Questionnaire>