Release 5

This page is part of the FHIR Specification (v5.0.0: R5 - STU). This is the current published version. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Example Questionnaire/zika-virus-exposure-assessment (XML)

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: No defined compartments

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

Jump past Narrative

Example instrument for assessing Zika virus exposure potential (id = "zika-virus-exposure-assessment")

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

<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 &quot;zika-virus-exposure-assessment&quot; </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 --&gt; (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.