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(v3.0.2:
STU
3).
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Questionnaire-example-f201-lifelines.xml
Example
Questionnaire/f201
(XML)
Raw
XML
(
canonical
form
+
also
see
XML
Format
Specification
)
Jump
past
Narrative
Real-world
lifelines
questionnaire
(fictively
taken
from
the
patient)
(id
=
"f201")
Lifelines Questionnaire 1 part 1
1. Do you have allergies?
2. General Questions:
2.a) What is your gender?
2.b) What is your date of birth?
2.c) What is your country of birth?
2.d) What is your marital status?
3. Intoxications:
3.a) Do you smoke?
3.b) Do you drink alcohol?
<?xml version="1.0" encoding="UTF-8"?>
<Questionnaire xmlns="http://hl7.org/fhir"> <id value="f201"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">
<pre> Lifelines Questionnaire 1 part 1
1. Do you have allergies?
2. General Questions:
2.a) What is your gender?
2.b) What is your date of birth?
2.c) What is your country of birth?
2.d) What is your marital status?
3. Intoxications:
3.a) Do you smoke?
3.b) Do you drink alcohol?</pre>
</div> </text> <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"> <valueCode value="fhir"/> </extension> <url value="http://hl7.org/fhir/Questionnaire/f201"/> <identifier> <system value="urn:ietf:rfc:3986"/> <value value="urn:oid:2.16.840.1.113883.4.642.20.6"/> </identifier> <status value="active"/> <subjectType value="Patient"/> <date value="2010"/> <publisher value="HL7 International / FHIR Infrastructure"/> <contact> <telecom> <system value="url"/> <value value="http://www.hl7.org/Special/committees/fiwg"/> </telecom> </contact> <code> <system value="http://example.org/system/code/lifelines/nl"/> <code value="VL 1-1, 18-65_1.2.2"/> <display value="Lifelines Questionnaire 1 part 1"/> </code> <item> <linkId value="1"/> <text value="Do you have allergies?"/> <type value="boolean"/> </item> <item> <linkId value="2"/> <text value="General questions"/> <type value="group"/> <item> <linkId value="2.1"/> <text value="What is your gender?"/> <type value="string"/> </item> <item> <linkId value="2.2"/> <text value="What is your date of birth?"/> <type value="date"/> </item> <item> <linkId value="2.3"/> <text value="What is your country of birth?"/> <type value="string"/> </item> <item> <linkId value="2.4"/> <text value="What is your marital status?"/> <type value="string"/> </item> </item> <item> <linkId value="3"/> <text value="Intoxications"/> <type value="group"/> <item> <linkId value="3.1"/> <text value="Do you smoke?"/> <type value="boolean"/> </item> <item> <linkId value="3.2"/> <text value="Do you drink alchohol?"/> <type value="boolean"/> </item> </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.