Questionnaire-example-bluebook.xml

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

  <!--   Please not that in this questionnaire, the questions are mostly unnamed, that is, the
   questions are not identified using the &lt;name&gt; element. It will therefore

<Questionnaire xmlns="http://hl7.org/fhir">
  <!--   Please not that in this questionnaire, the questions are mostly uncoded.  That is, the
   questions are not identified using the <concept> element. It will therefore

    be hard to extract useful information in an automated way from this questionnaire.
   This is, however, quite often the case when modelling existing questionnaires   -->
  
    
    
      
        Cathy Jones, female. Birth weight 3.25 kg at 44.3 cm. 
        Injection of Vitamin K given on 1972-11-30 (first dose) and 1972-12-11 (second
         dose)
        Note: Was able to speak Chinese at birth.
      
    
  
  
  
  
    
  
  
    
  
  
    
      
    

 <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>
  <status value="draft"/>
  <date value="2013-02-19"/>
  <publisher value="New South Wales Department of Health"/>
  <subjectType value="Patient"/>
  <group>
    <linkId value="PHR"/>
    <title value="NSW Government My Personal Health Record"/>
    <required value="true"/>
    <!--   Many groups left out of this example   -->
    
      
        
          
        
        
      
      
      
        
          
          
        
        
          
          
            
          
        
              
      
        
        
          
          
        
        
          
          
        
        
          
          
            
          
          
            

    <group>
      <linkId value="birthDetails"/>
      <title value="Birth details - To be completed by health professional"/>
      <group>
        <question>
          <linkId value="nameOfChild"/>
          <text value="Name of child"/>
        </question>
        <question>
          <linkId value="sex"/>
          <text value="Sex"/>
        </question>
      </group>        
      <group>
        <linkId value="neonatalInformation"/>
        <title value="Neonatal Information"/>
        <question>
          <linkId value="birthWeight"/>
          <text value="Birth weight (kg)"/>
        </question>
        <question>
          <linkId value="birthLength"/>
          <text value="Birth length (cm)"/>
        </question>
        <question>
          <linkId value="vitaminKgiven"/>
          <text value="Vitamin K given"/>
          <group>
            <extension url="http://example.org/Profile/questionnaire#visibilityCondition">
              <!--   note: this syntax is for demonstration purposes only, will need to be finalized during
               DSTU   --> 
              

              <valueString value="HAS_VALUE(../choice/code) AND NEQ(../choice/code,'NO')"/>
            </extension>
            
              
              
            
            
              
              
            
          
        
        
          
          
          
            
              
              
            
          
        
        
          
          
        
      
    
  

            <linkId value="vitaminKgivenDoses"/>
            <question>
              <linkId value="vitaminiKDose1"/>
              <text value="1st dose"/>
            </question>
            <question>
              <linkId value="vitaminiKDose2"/>
              <text value="2nd dose"/>
            </question>
          </group>
        </question>
        <question>
          <linkId value="hepBgiven"/>
          <text value="Hep B given y / n"/>
          <group>
            <question>
              <linkId value="hepBgivenDate"/>
              <text value="Date given"/>
            </question>
          </group>
        </question>
        <question>
          <linkId value="abnormalitiesAtBirth"/>
          <text value="Abnormalities noted at birth"/>
        </question>
      </group>
    </group>
  </group>


</Questionnaire>

</

Questionnaire

>