Questionnaire-zika-virus-exposure-assessment.json

Example instrument for assessing Zika virus exposure potential

{
  "resourceType": "Questionnaire",
  "id": "zika-virus-exposure-assessment",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      <pre>\n      </pre>\n    </div>"
  },
  "url": "http://example.org/Questionnaire/zika-virus-exposure-assessment",
  "name": "ExampleZikaVirusExposureAssessment",
  "title": "Example Zika Virus Exposure Assessment",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "date": "2016-11-14",
  "description": "Example questionnaire to assess Zika virus exposure potential.",
  "effectivePeriod": {
    "start": "2016-11-14"
  },
  "item": [
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "1",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Resident of or Frequent Traveler to Zika Area"
        }
      ],
      "text": "Are you a resident of, or do you travel frequently to, an area with active Zika transmission?",
      "type": "boolean"
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "2",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Recent Travel to Zika Area"
        }
      ],
      "text": "Have you recently traveled to a an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "1",
          "answerBoolean": false
        }
      ]
    },
    {
      "linkId": "3",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Time Since Returned From Travel"
        }
      ],
      "text": "How long has it been since you returned?",
      "type": "quantity",
      "enableWhen": [
        {
          "question": "2",
          "answerBoolean": true
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "4",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Recent Sexual Encounter with Traveler to Zika Area"
        }
      ],
      "text": "Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "2",
          "answerBoolean": false
        }
      ]
    },
    {
      "linkId": "5",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Time Since Sexual Encounter"
        }
      ],
      "text": "How long has it been since your last condomless sexual encounter?",
      "type": "quantity",
      "enableWhen": [
        {
          "question": "4",
          "answerBoolean": true
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "6",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Planned Travel to Zika Area"
        }
      ],
      "text": "Do you plan to travel to an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "4",
          "answerBoolean": false
        }
      ]
    }
  ]
}