{
  "resourceType" : "Parameters",
  "id" : "NextQuestionInputParamsExample",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-next-question-input-parameters"]
  },
  "parameter" : [{
    "name" : "in",
    "resource" : {
      "resourceType" : "QuestionnaireResponse",
      "id" : "home-o2-questionnaireresponse",
      "meta" : {
        "profile" : ["http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"]
      },
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
        "valueReference" : {
          "reference" : "Coverage/CoverageExample"
        }
      },
      {
        "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
        "valueReference" : {
          "reference" : "ServiceRequest/ServiceRequestExample"
        }
      },
      {
        "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/intendedUse",
        "valueCodeableConcept" : {
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
            "code" : "withorder",
            "display" : "Include with order"
          }]
        }
      }],
      "questionnaire" : "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/referred-questionnaire",
      "status" : "completed",
      "subject" : {
        "reference" : "Patient/examplepatient",
        "display" : "Vlad"
      },
      "authored" : "2023-08-21",
      "item" : [{
        "linkId" : "1",
        "text" : "Patient Information",
        "item" : [{
          "linkId" : "1.1",
          "text" : "Last Name but Different This Time",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "override"
              },
              {
                "extension" : [{
                  "url" : "role",
                  "valueCodeableConcept" : {
                    "coding" : [{
                      "system" : "http://terminology.hl7.org/CodeSystem/practitioner-role",
                      "code" : "doctor",
                      "display" : "Doctor"
                    }]
                  }
                },
                {
                  "url" : "practitioner",
                  "valueReference" : {
                    "reference" : "Practitioner/PractitionerExample",
                    "display" : "Dr. Jane Doe"
                  }
                }],
                "url" : "author"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "Quinton"
          }]
        },
        {
          "linkId" : "1.2",
          "text" : "First Name",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "Vlad"
          }]
        },
        {
          "linkId" : "1.3",
          "text" : "Middle Initial",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "A, N"
          }]
        },
        {
          "linkId" : "1.4",
          "text" : "Date Of Birth",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueDate" : "1956-12-01"
          }]
        },
        {
          "linkId" : "1.5",
          "text" : "Gender",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueCoding" : {
              "system" : "http://hl7.org/fhir/administrative-gender",
              "code" : "male",
              "display" : "Male"
            }
          }]
        },
        {
          "linkId" : "1.6",
          "text" : "Medicare ID",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "10A3D58WH22"
          }]
        }]
      },
      {
        "linkId" : "2",
        "text" : "Provider who is performing face-to-face evaluation",
        "item" : [{
          "linkId" : "2.1",
          "text" : "Last Name",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "Doe"
          }]
        },
        {
          "linkId" : "2.2",
          "text" : "First Name",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "Jane"
          }]
        },
        {
          "linkId" : "2.3",
          "text" : "Middle Initial",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "B"
          }]
        },
        {
          "linkId" : "2.4",
          "text" : "NPI",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "1122334455"
          }]
        },
        {
          "linkId" : "2.5",
          "text" : "Date of Face-To-Face Evaluation",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "override"
              },
              {
                "extension" : [{
                  "url" : "role",
                  "valueCodeableConcept" : {
                    "coding" : [{
                      "system" : "http://terminology.hl7.org/CodeSystem/practitioner-role",
                      "code" : "doctor",
                      "display" : "Doctor"
                    }]
                  }
                },
                {
                  "url" : "practitioner",
                  "valueReference" : {
                    "reference" : "Practitioner/PractitionerExample",
                    "display" : "Dr. Jane Doe"
                  }
                }],
                "url" : "author"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueDate" : "2019-07-18"
          }]
        },
        {
          "linkId" : "2.6",
          "text" : "Record",
          "answer" : [{
            "extension" : [{
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/containedReference",
              "valueBoolean" : false
            }],
            "valueReference" : {
              "reference" : "Patient/examplepatient",
              "display" : "Mr. Saul Moki"
            }
          }]
        }]
      },
      {
        "linkId" : "3",
        "text" : "Coverage Requirements",
        "item" : [{
          "linkId" : "3.1",
          "text" : "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueCoding" : {
              "system" : "http://snomed.info/sct",
              "code" : "313296004",
              "display" : "Mild chronic obstructive pulmonary disease"
            }
          }]
        },
        {
          "linkId" : "3.2",
          "text" : "Arterial oxygen saturation (Patient on room air while at rest and awake when tested)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueQuantity" : {
              "value" : 95,
              "system" : "http://unitsofmeasure.org",
              "code" : "mm[Hg]"
            }
          }]
        },
        {
          "linkId" : "3.3",
          "text" : "Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueQuantity" : {
              "value" : 83,
              "system" : "http://unitsofmeasure.org",
              "code" : "mm[Hg]"
            }
          }]
        },
        {
          "linkId" : "3.4",
          "text" : "Arterial oxygen saturation (Patient tested during exercise)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueQuantity" : {
              "value" : 95,
              "system" : "http://unitsofmeasure.org",
              "code" : "mm[Hg]"
            }
          }]
        },
        {
          "linkId" : "3.5",
          "text" : "Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueQuantity" : {
              "value" : 78,
              "system" : "http://unitsofmeasure.org",
              "code" : "mm[Hg]"
            }
          }]
        },
        {
          "linkId" : "3.6",
          "text" : "Is there a documented improvement of hypoxemia during exercise with oxygen?",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueBoolean" : true
          }]
        }]
      },
      {
        "linkId" : "4",
        "text" : "Prescribed Use",
        "item" : [{
          "linkId" : "4.1",
          "text" : "Start date",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueDate" : "2019-07-18"
          }]
        },
        {
          "linkId" : "4.2",
          "text" : "Length of need: (months) (99 = lifetime)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueQuantity" : {
              "value" : 99
            }
          }]
        },
        {
          "linkId" : "4.3",
          "text" : "Peak Flow Rate",
          "item" : [{
            "linkId" : "4.3.1",
            "text" : "LPM",
            "answer" : [{
              "extension" : [{
                "extension" : [{
                  "url" : "source",
                  "valueCode" : "auto"
                }],
                "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
              }],
              "valueQuantity" : {
                "value" : 2
              }
            }]
          },
          {
            "linkId" : "4.3.2",
            "text" : "oxygen %",
            "answer" : [{
              "extension" : [{
                "extension" : [{
                  "url" : "source",
                  "valueCode" : "auto"
                }],
                "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
              }],
              "valueQuantity" : {
                "value" : 98
              }
            }]
          }]
        },
        {
          "linkId" : "4.4",
          "text" : "Average Flow Rate",
          "item" : [{
            "linkId" : "4.4.1",
            "text" : "LPM",
            "answer" : [{
              "extension" : [{
                "extension" : [{
                  "url" : "source",
                  "valueCode" : "auto"
                }],
                "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
              }],
              "valueQuantity" : {
                "value" : 2
              }
            }]
          },
          {
            "linkId" : "4.4.2",
            "text" : "oxygen %",
            "answer" : [{
              "extension" : [{
                "extension" : [{
                  "url" : "source",
                  "valueCode" : "auto"
                }],
                "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
              }],
              "valueQuantity" : {
                "value" : 97
              }
            }]
          }]
        },
        {
          "linkId" : "4.5",
          "text" : "Frequency of use (choose all that apply)",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "At rest and awake"
          }]
        }]
      },
      {
        "linkId" : "5",
        "text" : "Oxygen Supply Order Details",
        "item" : [{
          "linkId" : "5.1",
          "text" : "Current Order Description",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueString" : "HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental"
          }]
        },
        {
          "linkId" : "5.1b",
          "text" : "Current Order Is For A Portable Device"
        },
        {
          "linkId" : "5.2",
          "text" : "Type",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueCoding" : {
              "system" : "http://example.org",
              "code" : "122",
              "display" : "Compressed Gas"
            }
          }]
        },
        {
          "linkId" : "5.3",
          "text" : "Means of oxygen delivery and accessories",
          "answer" : [{
            "extension" : [{
              "extension" : [{
                "url" : "source",
                "valueCode" : "auto"
              }],
              "url" : "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
            }],
            "valueCoding" : {
              "system" : "http://example.org",
              "code" : "134",
              "display" : "Mask"
            }
          }]
        }]
      }]
    }
  }]
}