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\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource &quot;zika-virus-exposure-assessment&quot; </p></div><p><b>url</b>: <code>http://example.org/Questionnaire/zika-virus-exposure-assessment</code></p><p><b>name</b>: ExampleZikaVirusExposureAssessment</p><p><b>title</b>: Example Zika Virus Exposure Assessment</p><p><b>status</b>: draft</p><p><b>subjectType</b>: Patient</p><p><b>date</b>: 2016-11-14</p><p><b>description</b>: Example questionnaire to assess Zika virus exposure potential.</p><p><b>effectivePeriod</b>: 2016-11-14 --&gt; (ongoing)</p><blockquote><p><b>item</b></p><p><b>linkId</b>: 1</p><p><b>code</b>: CDE: Resident of or Frequent Traveler to Zika Area (Details: http://example.org/questionnaires code CDE: Resident of or Frequent Traveler to Zika Area = 'CDE: Resident of or Frequent Traveler to Zika Area', stated as 'null')</p><p><b>text</b>: Are you a resident of, or do you travel frequently to, an area with active Zika transmission?</p><p><b>type</b>: boolean</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 2</p><p><b>code</b>: CDE: Recent Travel to Zika Area (Details: http://example.org/questionnaires code CDE: Recent Travel to Zika Area = 'CDE: Recent Travel to Zika Area', stated as 'null')</p><p><b>text</b>: Have you recently traveled to an area with active Zika transmission?</p><p><b>type</b>: boolean</p><h3>EnableWhens</h3><table class=\"grid\"><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>1</td><td>=</td><td>false</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 3</p><p><b>code</b>: CDE: Time Since Returned From Travel (Details: http://example.org/questionnaires code CDE: Time Since Returned From Travel = 'CDE: Time Since Returned From Travel', stated as 'null')</p><p><b>text</b>: How long has it been since you returned?</p><p><b>type</b>: quantity</p><h3>EnableWhens</h3><table class=\"grid\"><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>2</td><td>=</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 4</p><p><b>code</b>: CDE: Recent Sexual Encounter with Traveler to Zika Area (Details: http://example.org/questionnaires code CDE: Recent Sexual Encounter with Traveler to Zika Area = 'CDE: Recent Sexual Encounter with Traveler to Zika Area', stated as 'null')</p><p><b>text</b>: Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?</p><p><b>type</b>: boolean</p><h3>EnableWhens</h3><table class=\"grid\"><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>2</td><td>=</td><td>false</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 5</p><p><b>code</b>: CDE: Time Since Sexual Encounter (Details: http://example.org/questionnaires code CDE: Time Since Sexual Encounter = 'CDE: Time Since Sexual Encounter', stated as 'null')</p><p><b>text</b>: How long has it been since your last condomless sexual encounter?</p><p><b>type</b>: quantity</p><h3>EnableWhens</h3><table class=\"grid\"><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>4</td><td>=</td><td>true</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: 6</p><p><b>code</b>: CDE: Planned Travel to Zika Area (Details: http://example.org/questionnaires code CDE: Planned Travel to Zika Area = 'CDE: Planned Travel to Zika Area', stated as 'null')</p><p><b>text</b>: Do you plan to travel to an area with active Zika transmission?</p><p><b>type</b>: boolean</p><h3>EnableWhens</h3><table class=\"grid\"><tr><td>-</td><td><b>Question</b></td><td><b>Operator</b></td><td><b>Answer[x]</b></td></tr><tr><td>*</td><td>4</td><td>=</td><td>false</td></tr></table></blockquote></div>"
  },
  "url" : "http://example.org/Questionnaire/zika-virus-exposure-assessment",
  "name" : "ExampleZikaVirusExposureAssessment",
  "title" : "Example Zika Virus Exposure Assessment",
  "status" : "draft",
  "experimental" : true,
  "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 an area with active Zika transmission?",
    "type" : "boolean",
    "enableWhen" : [{
      "question" : "1",
      "operator" : "=",
      "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",
      "operator" : "=",
      "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",
      "operator" : "=",
      "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",
      "operator" : "=",
      "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",
      "operator" : "=",
      "answerBoolean" : false
    }]
  }]
}