Questionnaire-example-bluebook.json

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

{
  "resourceType": "Questionnaire",
  "id": "bb",
  "_id": {
    "fhir_comments": [
      "  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\n    be hard to extract useful information in an automated way from this questionnaire. This is, however, quite often the case when modelling existing questionnaires  "
    ]
  },

  "text": {
    "status": "generated",
    "div": "<div>\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>"

    "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",
  "title": "NSW Government My Personal Health Record",

  "status": "draft",
  "date": "2013-02-19",
  "publisher": "New South Wales Department of Health",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "AU"
        }
      ]
    }
  ],

  "subjectType": [
    "Patient"
  ],
  "group": {
    "linkId": "PHR",
    "title": "NSW Government My Personal Health Record",
    "required": true,
    "group": [
      {
        "fhir_comments": [
          "  Many groups left out of this example  "
        ],
        "linkId": "birthDetails",
        "title": "Birth details - To be completed by health professional",
        "group": [
          {
            "question": [
              {
                "linkId": "nameOfChild",
                "text": "Name of child"
              },
              {
                "linkId": "sex",
                "text": "Sex"
              }
            ]
          },
          {
            "linkId": "neonatalInformation",
            "title": "Neonatal Information",
            "question": [
              {
                "linkId": "birthWeight",
                "text": "Birth weight (kg)"
              },
              {
                "linkId": "birthLength",
                "text": "Birth length (cm)"
              },
              {
                "linkId": "vitaminKgiven",
                "text": "Vitamin K given",
                "group": [
                  {
                    "extension": [
                      {
                        "url": "http://example.org/Profile/questionnaire#visibilityCondition",
                        "valueString": "HAS_VALUE(../choice/code) AND NEQ(../choice/code,'NO')",
                        "_valueString": {
                          "fhir_comments": [
                            "  note: this syntax is for demonstration purposes only, will need to be finalized during DSTU  "
                          ]
                        }
                      }
                    ],
                    "linkId": "vitaminKgivenDoses",
                    "question": [
                      {
                        "linkId": "vitaminiKDose1",
                        "text": "1st dose"
                      },
                      {
                        "linkId": "vitaminiKDose2",
                        "text": "2nd dose"
                      }
                    ]

  "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": "choice",
              "option": [
                {
                  "valueCoding": {
                    "code": "F"

                  }
                ]
              },
              {
                "linkId": "hepBgiven",
                "text": "Hep B given y / n",
                "group": [
                  {
                    "question": [
                      {
                        "linkId": "hepBgivenDate",
                        "text": "Date given"
                      }
                    ]

                },
                {
                  "valueCoding": {
                    "code": "M"

                  }
                ]
              },
              {
                "linkId": "abnormalitiesAtBirth",
                "text": "Abnormalities noted at birth"
              }
            ]
          }
        ]
      }
    ]
  }

                }
              ]
            }
          ]
        },
        {
          "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": "choice",
              "option": [
                {
                  "valueCoding": {
                    "code": "INJECTION"
                  }
                },
                {
                  "valueCoding": {
                    "code": "INTRAVENOUS"
                  }
                },
                {
                  "valueCoding": {
                    "code": "ORAL"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "vitaminKgivenDoses",
                  "type": "group",
                  "enableWhen": [
                    {
                      "question": "vitaminKgiven",
                      "hasAnswer": true
                    }
                  ],
                  "item": [
                    {
                      "linkId": "vitaminiKDose1",
                      "text": "1st dose",
                      "type": "dateTime"
                    },
                    {
                      "linkId": "vitaminiKDose2",
                      "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"
            }
          ]
        }
      ]
    }
  ]

}