Neonate record from New South Wales, Australia "My Personal Health Record" example

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