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"/> 
  display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border:
       1px solid #8da1b4; border-radius: 5px; line-height: 60%: CDE: Resident of or Frequent Traveler to Zika Area (Details: http://example.org/questionnai
          res code CDE: Resident of or Frequent Traveler to Zika Area = 'CDE: Resident of
           or Frequent Traveler to Zika Area', stated as 'null'): Are you a resident of, or do you travel frequently to, an area with active Zika
           transmission?: 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'): 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'): CDE: Recent Sexual Encounter with Traveler to Zika Area (Details: http://example.org/questi
          onnaires code CDE: Recent Sexual Encounter with Traveler to Zika Area = 'CDE: Recent
           Sexual Encounter with Traveler to Zika Area', stated as 'null'): Have you recently had condomless sex with a partner that has travelled in an
           area with active Zika transmission?: CDE: Time Since Sexual Encounter (Details: http://example.org/questionnaires
           code CDE: Time Since Sexual Encounter = 'CDE: Time Since Sexual Encounter', stated
           as 'null'): 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')

  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fhir"/> 
  </extension> 
  <url value="http://example.org/Questionnaire/zika-virus-exposure-assessment"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.20.1"/> 
  </identifier> 
  <name value="ExampleZikaVirusExposureAssessment"/> 
  <title value="Example Zika Virus Exposure Assessment"/> 
  <status value="draft"/> 
  <subjectType value="Patient"/> 
  <date value="2016-11-14"/> 
  <publisher value="HL7 International / FHIR Infrastructure"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://www.hl7.org/Special/committees/fiwg"/> 
    </telecom> 
  </contact> 
  <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

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