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Questionnaire-zika-virus-exposure-assessment.xml

FHIR Infrastructure Work Group
Maturity Level: N/A
Standards Status: Informative
Compartments: Not linked to any defined compartments
Raw XML (canonical form + also see XML Format Specification)
Jump past Narrative
Example instrument for assessing Zika virus exposure potential (id = "zika-virus-exposure-assessment")
<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="zika-virus-exposure-assessment"/> 
  <text> 
    <status value="generated"/> 
    <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/questionnaire
          s 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> 
  </text> 
  <url value="http://example.org/Questionnaire/zika-virus-exposure-assessment"/> 
  <name value="ExampleZikaVirusExposureAssessment"/> 
  <title value="Example Zika Virus Exposure Assessment"/> 
  <status value="draft"/> 
  <experimental value="true"/> 
  <subjectType value="Patient"/> 
  <date value="2016-11-14"/> 
  <description value="Example questionnaire to assess Zika virus exposure potential."/> 
  <effectivePeriod> 
    <start value="2016-11-14"/> 
  </effectivePeriod> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="1"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Resident of or Frequent Traveler to Zika Area"/> 
    </code> 
    <text value="Are you a resident of, or do you travel frequently to, an area with active Zika transmission?"/> 
    <type value="boolean"/> 
  </item> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="2"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Recent Travel to Zika Area"/> 
    </code> 
    <text value="Have you recently traveled to an area with active Zika transmission?"/> 
    <type value="boolean"/> 
    <enableWhen> 
      <question value="1"/> 
      <operator value="="/> 
      <answerBoolean value="false"/> 
    </enableWhen> 
  </item> 
  <item> 
    <linkId value="3"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Time Since Returned From Travel"/> 
    </code> 
    <text value="How long has it been since you returned?"/> 
    <type value="quantity"/> 
    <enableWhen> 
      <question value="2"/> 
      <operator value="="/> 
      <answerBoolean value="true"/> 
    </enableWhen> 
  </item> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="4"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Recent Sexual Encounter with Traveler to Zika Area"/> 
    </code> 
    <text value="Have you recently had condomless sex with a partner that has travelled in an area with
     active Zika transmission?"/> 
    <type value="boolean"/> 
    <enableWhen> 
      <question value="2"/> 
      <operator value="="/> 
      <answerBoolean value="false"/> 
    </enableWhen> 
  </item> 
  <item> 
    <linkId value="5"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Time Since Sexual Encounter"/> 
    </code> 
    <text value="How long has it been since your last condomless sexual encounter?"/> 
    <type value="quantity"/> 
    <enableWhen> 
      <question value="4"/> 
      <operator value="="/> 
      <answerBoolean value="true"/> 
    </enableWhen> 
  </item> 
  <item> 
    <extension url="http://example.org/additional-information">
      <valueAttachment> 
        <url value="http://www.cdc.gov/zika/geo/index.html"/> 
        <title value="Areas with active Zika virus transmission/exposure risk"/> 
      </valueAttachment> 
    </extension> 
    <linkId value="6"/> 
    <code> 
      <system value="http://example.org/questionnaires"/> 
      <code value="CDE: Planned Travel to Zika Area"/> 
    </code> 
    <text value="Do you plan to travel to an area with active Zika transmission?"/> 
    <type value="boolean"/> 
    <enableWhen> 
      <question value="4"/> 
      <operator value="="/> 
      <answerBoolean value="false"/> 
    </enableWhen> 
  </item> 
</Questionnaire>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.