Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1

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## : $next-question Output Parameters Example - XML Representation

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