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Questionnaire-example-gcs.xml

Example Questionnaire/gcs (XML)

Maturity Level : N/A
Responsible Owner: FHIR Infrastructure Work Group Ballot Standards Status : Informative Compartments : Not linked to any No defined compartments

Raw XML ( canonical form ) Jump past Narrative + also see XML Format Specification )

Glasgow Coma Score example form (id = "gcs")

: Glasgow coma score total (Details: LOINC code 9269-2 = 'Glasgow coma score total', stated as 'null'): Glasgow coma score verbal (Details: LOINC code 9270-0 = 'Glasgow coma score verbal', stated as 'null'): id: verbal; http://loinc.org/ValueSet/LL356-7; name: GCS Verbal Value Set; status: active; description: LOINC ANSWER LIST (LL356-7): Glasgow coma score motor (Details: LOINC code 9268-4 = 'Glasgow coma score motor', stated as 'null'): id: motor; http://loinc.org/ValueSet/LL357-5; name: GCS Motor Value Set; status: active; description: LOINC ANSWER LIST (LL357-5): Glasgow coma score eye opening (Details: LOINC code 9267-6 = 'Glasgow coma score eye opening', stated as 'null'): id: eye; http://loinc.org/ValueSet/LL355-9; name: GCS Eye Value Set; status: active; description: LOINC ANSWER LIST (LL355-9) 
<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">  <id value="gcs"/>   <contained>     <ValueSet>       <id value="motor"/>       <identifier>         <system value="http://loinc.org"/>         <value value="http://loinc.org/ValueSet/LL357-5"/>       </identifier>       <name value="GCS Motor Value Set"/>       <status value="active"/>       <description value="LOINC ANSWER LIST    (LL357-5)"/>       <compose>         <include>           <system value="http://loinc.org"/>           <concept>             <code value="LA6562-8"/>             <display value="No motor response"/>           </concept>           <concept>             <code value="LA6563-6"/>             <display value="Extension to pain"/>           </concept>           <concept>             <code value="LA6564-4"/>             <display value="Flexion to pain"/>           </concept>           <concept>             <code value="LA6565-1"/>             <display value="Withdrawl from pain"/>           </concept>           <concept>             <code value="LA6566-9"/>             <display value="Localizing pain"/>           </concept>           <concept>             <code value="LA6567-7"/>             <display value="Obeys commands"/>           </concept>         </include>       </compose>     </ValueSet>   </contained>   <contained>     <ValueSet>       <id value="verbal"/>       <identifier>         <system value="http://loinc.org"/>         <value value="http://loinc.org/ValueSet/LL356-7"/>       </identifier>       <name value="GCS Verbal Value Set"/>       <status value="active"/>       <description value="LOINC ANSWER LIST    (LL356-7)"/>       <compose>         <include>           <system value="http://loinc.org"/>           <concept>             <code value="LA6557-8"/>             <display value="No verbal response (&gt;2yrs); no vocal response (&lt;=2yrs)"/>           </concept>           <concept>             <code value="LA6558-6"/>             <display value="Incomprehensible sounds"/>           </concept>           <concept>             <code value="LA6559-4"/>             <display value="Inappropriate words"/>           </concept>           <concept>             <code value="LA6560-2"/>             <display value="Confused"/>           </concept>           <concept>             <code value="LA6561-0"/>             <display value="Oriented"/>           </concept>         </include>       </compose>     </ValueSet>   </contained>   <contained>     <ValueSet>       <id value="eye"/>       <identifier>         <system value="http://loinc.org"/>         <value value="http://loinc.org/ValueSet/LL355-9"/>       </identifier>       <name value="GCS Eye Value Set"/>       <status value="active"/>       <description value="LOINC ANSWER LIST    (LL355-9)"/>       <compose>         <include>           <system value="http://loinc.org"/>           <concept>             <code value="LA6553-7"/>             <display value="No eye opening"/>           </concept>           <concept>             <code value="LA6554-5"/>             <display value="Eye opening to pain"/>           </concept>           <concept>             <code value="LA6555-2"/>             <display value="Eye opening to verbal command"/>           </concept>           <concept>             <code value="LA6556-0"/>             <display value="Eyes open spontaneously"/>           </concept>         </include>       </compose>     </ValueSet>   </contained>   <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">    <valueCode value="fhir"/>   </extension>   <url value="http://hl7.org/fhir/Questionnaire/gcs"/>   <identifier>     <system value="urn:ietf:rfc:3986"/>     <value value="urn:oid:2.16.840.1.113883.4.642.20.5"/>   </identifier>   <name value="GlasgowComaScore"/>   <title value="Glasgow Coma Score"/>   <status value="draft"/>   <subjectType value="Patient"/>   <date value="2015-08-03"/>   <publisher value="HL7 International / FHIR Infrastructure"/>   <contact>     <telecom>       <system value="url"/>       <value value="http://www.hl7.org/Special/committees/fiwg"/>     </telecom>   </contact>   <description value="Glasgow Coma Score"/>   <code>     <system value="http://loinc.org"/>     <code value="9269-2"/>   </code>   <item>     <linkId value="1.1"/>     <code>       <system value="http://loinc.org"/>       <code value="9270-0"/>     </code>     <type value="coding"/>     <answerValueSet value="#verbal"/>   </item>   <item>     <linkId value="1.2"/>     <code>       <system value="http://loinc.org"/>       <code value="9268-4"/>     </code>     <type value="coding"/>     <answerValueSet value="#motor"/>   </item>   <item>     <linkId value="1.3"/>     <code>       <system value="http://loinc.org"/>       <code value="9267-6"/>     </code>     <type value="coding"/>     <answerValueSet value="#eye"/>   </item> 


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Questionnaire

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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.