Da Vinci - Documentation Templates and Rules
1.0.0 - STU 1

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## : DTR Home Oxygen Therapy Questionnaire - R4 - XML Representation

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    <Questionnaire xmlns="http://hl7.org/fhir">
      <id value="home-o2-questionnaire"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaire-r4"/>
      </meta>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p>This form is used to collect information from the provider on Home Oxygen Therapy.</p></div>
      </text>
      <extension url="http://hl7.org/fhir/StructureDefinition/cqf-library">
        <valueCanonical value="#HomeOxygenTherapy-prepopulation"/>
      </extension>
      <url
           value="http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-questionnaire"/>
      <version value="1.0.0"/>
      <name value="HomeOxygenTherapyQuestionnaire"/>
      <title value="Home Oxygen Therapy Order Template"/>
      <status value="draft"/>
      <subjectType value="Patient"/>
      <date value="2019-03-11T00:00:00+00:00"/>
      <publisher value="HL7 Clinical Decision Support Work Group"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/dss"/>
        </telecom>
      </contact>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
        </coding>
      </jurisdiction>
      <item>
        <linkId value="1"/>
        <text value="Patient Information"/>
        <type value="group"/>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <language value="text/cql"/>
              <expression value="PatientLastName"/>
            </valueExpression>
          </extension>
          <linkId value="1.1"/>
          <text value="Last Name"/>
          <type value="string"/>
          <required value="true"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <language value="text/cql"/>
              <expression value="PatientMiddleInitial"/>
            </valueExpression>
          </extension>
          <linkId value="1.3"/>
          <text value="Middle Initial"/>
          <type value="text"/>
          <required value="false"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <language value="text/cql"/>
              <expression value="PatientFirstName"/>
            </valueExpression>
          </extension>
          <linkId value="1.2"/>
          <text value="First Name"/>
          <type value="string"/>
          <enableWhen>
            <question value="1.3"/>
            <operator value="="/>
            <answerString value="S"/>
          </enableWhen>
          <required value="true"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <language value="text/cql"/>
              <expression value="PatientDateOfBirth"/>
            </valueExpression>
          </extension>
          <linkId value="1.4"/>
          <text value="Date Of Birth"/>
          <type value="date"/>
          <required value="true"/>
        </item>
        <item>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <language value="text/cql"/>
              <expression value="PatientGender"/>
            </valueExpression>
          </extension>
          <linkId value="1.5"/>
          <text value="Gender"/>
          <type value="choice"/>
          <required value="true"/>
          <answerValueSet value="http://hl7.org/fhir/ValueSet/administrative-gender"/>
        </item>
      </item>
    </Questionnaire>