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| FHIR Infrastructure Work Group | Maturity Level : N/A | Standards Status : Informative |
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Raw XML ( canonical form + also see XML Format Specification )
Example instrument for assessing Zika virus exposure potential (id = "zika-virus-exposure-assessment")
<?xml version="1.0" encoding="UTF-8"?>Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?<Questionnaire xmlns="http://hl7.org/fhir"> <id value="zika-virus-exposure-assessment"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: Questionnaire</b> <a name="zika-virus-exposure-assessment"> </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 "zika-virus-exposure-assessment" </p> </div> <p> <b> url</b> : <code> http://example.org/Questionnaire/zika-virus-exposure-assessment</code> </p> <p> <b> identifier</b> : id: urn:oid:2.16.840.1.113883.4.642.20.1</p> <p> <b> name</b> : ExampleZikaVirusExposureAssessment</p> <p> <b> title</b> : Example Zika Virus Exposure Assessment</p> <p> <b> status</b> : draft</p> <p> <b> subjectType</b> : Patient</p> <p> <b> date</b> : 2016-11-14</p> <p> <b> description</b> : Example questionnaire to assess Zika virus exposure potential.</p> <p> <b> effectivePeriod</b> : 2016-11-14 --> (ongoing)</p> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 1</p> <p> <b> code</b> : 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')</p> <p> <b> text</b> : Are you a resident of, or do you travel frequently to, an area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 2</p> <p> <b> code</b> : 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')</p> <p> <b> text</b> : Have you recently traveled to an area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td> -</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td> *</td> <td> 1</td> <td> =</td> <td> false</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 3</p> <p> <b> code</b> : 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')</p> <p> <b> text</b> : How long has it been since you returned?</p> <p> <b> type</b> : quantity</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td> -</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td> *</td> <td> 2</td> <td> =</td> <td> true</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 4</p> <p> <b> code</b> : 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')</p> <p> <b> text</b> : Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td> -</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td> *</td> <td> 2</td> <td> =</td> <td> false</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 5</p> <p> <b> code</b> : CDE: Time Since Sexual Encounter (Details: http://example.org/questionnaires code CDE: Time Since Sexual Encounter = 'CDE: Time Since Sexual Encounter', stated as 'null')</p> <p> <b> text</b> : How long has it been since your last condomless sexual encounter?</p> <p> <b> type</b> : quantity</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td> -</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td> *</td> <td> 4</td> <td> =</td> <td> true</td> </tr> </table> </blockquote> <blockquote> <p> <b> item</b> </p> <p> <b> linkId</b> : 6</p> <p> <b> code</b> : 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')</p> <p> <b> text</b> : Do you plan to travel to an area with active Zika transmission?</p> <p> <b> type</b> : boolean</p> <h3> EnableWhens</h3> <table class="grid"><tr> <td> -</td> <td> <b> Question</b> </td> <td> <b> Operator</b> </td> <td> <b> Answer[x]</b> </td> </tr> <tr> <td> *</td> <td> 4</td> <td> =</td> <td> false</td> </tr> </table> </blockquote> </div> </text> <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"/> <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 >
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.
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