Neonate record from New South Wales, Australia "My Personal Health Record" example (id = "bb")

<?xml version="1.0" encoding="UTF-8"?>


  
  
    
    
      
        
  Name of child: ____________________________________
            Sex: __
            
  Neonatal Information
    Birth Weight (kg): ___________
    Birth Length (cm): ___________
    Vitamin K given  : __
             1st dose: ___________
             2nd dose: ___________
    Hep B given      : __
      Date given     : ___________
    Abnormalities noted at birth:
      _______________________________________________
      
    
  
  
  
  
  
  
  
  
    
      
      
    
  
  
    
    
    
    
      
      
      
        
        
        
      
      
        
        
        
        
          
            
          
        
        
          
            
          
        
      
    
    
      
      
      
      
        
        
        
      
      
        
        
        
      
      
        
        
        
        
          
            
          
        
        
          
            
          
        
        
          
            
          
        
        
          
          
          
            
            
            
          
          
            
            
            
          
          
            
            
            
          
        
      
      
        
        
        
        
          
          
          
        
      
      
        
        
        
      
    
  

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="bb"/> 
  <text> 
    <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">
      
      <pre> 
        
        <b> Birth details - To be completed by health professional</b> 
  Name of child: ____________________________________
            Sex: __
            
  Neonatal Information
    Birth Weight (kg): ___________
    Birth Length (cm): ___________
    Vitamin K given  : __
             1st dose: ___________
             2nd dose: ___________
    Hep B given      : __
      Date given     : ___________
    Abnormalities noted at birth:
      _______________________________________________
      
      </pre> 
    
    </div>   </text>   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">    <valueCode value="fhir"/>   </extension>   <url value="http://hl7.org/fhir/Questionnaire/bb"/>   <identifier>     <system value="urn:ietf:rfc:3986"/>     <value value="urn:oid:2.16.840.1.113883.4.642.20.4"/>   </identifier>   <name value="NSWGovernmentMyPersonalHealthRecord"/>   <title value="NSW Government My Personal Health Record"/>   <status value="draft"/>   <subjectType value="Patient"/>   <date value="2013-02-19"/>   <publisher value="HL7 International / FHIR Infrastructure"/>   <contact>     <telecom>       <system value="url"/>       <value value="http://www.hl7.org/Special/committees/fiwg"/>     </telecom>   </contact>   <description value="NSW Government My Personal Health Record"/>   <jurisdiction>     <coding>       <system value="urn:iso:std:iso:3166"/>       <code value="AU"/>     </coding>   </jurisdiction>   <item>     <linkId value="birthDetails"/>     <text value="Birth details - To be completed by health professional"/>     <type value="group"/>     <item>       <linkId value="group"/>       <type value="group"/>       <item>         <linkId value="nameOfChild"/>         <text value="Name of child"/>         <type value="string"/>       </item>       <item>         <linkId value="sex"/>         <text value="Sex"/>         <type value="coding"/>         <answerOption>           <valueCoding>             <code value="F"/>           </valueCoding>         </answerOption>         <answerOption>           <valueCoding>             <code value="M"/>           </valueCoding>         </answerOption>       </item>     </item>     <item>       <linkId value="neonatalInformation"/>       <text value="Neonatal Information"/>       <type value="group"/>       <item>         <linkId value="birthWeight"/>         <text value="Birth weight (kg)"/>         <type value="decimal"/>       </item>       <item>         <linkId value="birthLength"/>         <text value="Birth length (cm)"/>         <type value="decimal"/>       </item>       <item>         <linkId value="vitaminKgiven"/>         <text value="Vitamin K given"/>         <type value="coding"/>         <answerOption>           <valueCoding>             <code value="INJECTION"/>           </valueCoding>         </answerOption>         <answerOption>           <valueCoding>             <code value="INTRAVENOUS"/>           </valueCoding>         </answerOption>         <answerOption>           <valueCoding>             <code value="ORAL"/>           </valueCoding>         </answerOption>         <item>           <linkId value="vitaminKgivenDoses"/>           <type value="group"/>           <enableWhen>             <question value="vitaminKgiven"/>             <operator value="exists"/>             <answerBoolean value="true"/>           </enableWhen>           <item>             <linkId value="vitaminKDose1"/>             <text value="1st dose"/>             <type value="dateTime"/>           </item>           <item>             <linkId value="vitaminKDose2"/>             <text value="2nd dose"/>             <type value="dateTime"/>           </item>         </item>       </item>       <item>         <linkId value="hepBgiven"/>         <text value="Hep B given y / n"/>         <type value="boolean"/>         <item>           <linkId value="hepBgivenDate"/>           <text value="Date given"/>           <type value="date"/>         </item>       </item>       <item>         <linkId value="abnormalitiesAtBirth"/>         <text value="Abnormalities noted at birth"/>         <type value="string"/>       </item>     </item>   </item> 


</

Questionnaire

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