Release 4B 5

This page is part of the FHIR Specification (v4.3.0: R4B (v5.0.0: R5 - STU ). The This is the current published version which supercedes in it's permanent home (it will always be available at this version is 5.0.0 . URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R5 R4B R4 R3 R2

Questionnaire-example-gcs.xml

Example Questionnaire/gcs (XML)

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

Raw XML ( canonical form + also see XML Format Specification )

Jump past Narrative

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

<?xml version="1.0" encoding="UTF-8"?>


  
  
    
    
      
        
      
      display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px
       solid #8da1b4; border-radius: 5px; line-height: 60%
        
      
      
        : 
        
      
      
        : Glasgow Coma Score
      
      
        : draft
      
      
        : Patient
      
      
        : 2015-08-03
      
      
        : FHIR Project team
      
      
        : Glasgow coma score total (Details: LOINC code 9269-2 = 'Glasgow coma score total', stated
         as 'null')
      
      
        
          
        
        
          : 1.1
        
        
          : Glasgow coma score verbal (Details: LOINC code 9270-0 = 'Glasgow coma score verbal',
           stated as 'null')
        
        
          : choice
        
        
          : 
          
        
      
      
        
          
        
        
          : 1.2
        
        
          : Glasgow coma score motor (Details: LOINC code 9268-4 = 'Glasgow coma score motor', stated
           as 'null')
        
        
          : choice
        
        
          : 
          
        
      
      
        
          
        
        
          : 1.3
        
        
          : Glasgow coma score eye opening (Details: LOINC code 9267-6 = 'Glasgow coma score eye
           opening', stated as 'null')
        
        
          : choice
        
        
          : 
          
        
      
    
  
  
    
      
      
        
        
      
      
      
      
      
        
          
          
            
            
          
          
            
            
          
          
            
            
          
          
            
            
          
          
            
            
          
          
            
            
          
        
      
    
  
  
    
      
      
        
        
      
      
      
      
      
        
          
          
            
            
          
          
            
            
          
          
            
            
          
          
            
            
          
          
            
            
          
        
      
    
  
  
    
      
      
        
        
      
      
      
      
      
        
          
          
            
            
          
          
            
            
          
          
            
            
          
          
            
            
          
        
      
    
  
  
  
  
  
  
  
  
  
    
    
  
  
    
    
      
      
    
    
    
  
  
    
    
      
      
    
    
    
  
  
    
    
      
      
    
    
    
  

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="gcs"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: Questionnaire</b> <a name="gcs"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border:
       1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource Questionnaire &quot;gcs&quot; </p> </div> <p> <b> url</b> : <code> http://hl7.org/fhir/Questionnaire/gcs</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.20.5</p> <p> <b> name</b> : GlasgowComaScore</p> <p> <b> title</b> : Glasgow Coma Score</p> <p> <b> status</b> : draft</p> <p> <b> subjectType</b> : Patient</p> <p> <b> date</b> : 2015-08-03</p> <p> <b> publisher</b> : FHIR Project team</p> <p> <b> description</b> : Glasgow Coma Score</p> <p> <b> code</b> : Glasgow coma score total (Details: LOINC code 9269-2 = 'Glasgow coma score total',
         stated as 'null')</p> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1.1</p> <p> <b> code</b> : Glasgow coma score verbal (Details: LOINC code 9270-0 = 'Glasgow coma score verbal',
           stated as 'null')</p> <p> <b> type</b> : coding</p> <p> <b> answerValueSet</b> : <code> #verbal</code> </p> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1.2</p> <p> <b> code</b> : Glasgow coma score motor (Details: LOINC code 9268-4 = 'Glasgow coma score motor',
           stated as 'null')</p> <p> <b> type</b> : coding</p> <p> <b> answerValueSet</b> : <code> #motor</code> </p> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1.3</p> <p> <b> code</b> : Glasgow coma score eye opening (Details: LOINC code 9267-6 = 'Glasgow coma score
           eye opening', stated as 'null')</p> <p> <b> type</b> : coding</p> <p> <b> answerValueSet</b> : <code> #eye</code> </p> </blockquote> </div> </text> <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>   <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="FHIR Project team"/>   <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> 


</

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.