Da Vinci - Documentation Templates and Rules
1.0.0 - STU 1

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

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