Da Vinci - Documentation Templates and Rules
2.1.0 - STU 2.1

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## : Referred Questionnaire for QuestionnaireResponse - TTL Representation

Page standards status: Informative

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix sct: <http://snomed.info/id/> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:Questionnaire ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "referred-questionnaire"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">Example adaptive questionnaire contained in a QuestionnaireResposne</div>"
      ] ; #
      fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/referred-questionnaire"^^xsd:anyURI] ; #
      fhir:version [ fhir:v "2.1.0"] ; #
      fhir:title [ fhir:v "Referred Questionnaire for QuestionnaireResponse"] ; #
      fhir:derivedFrom ( [
    fhir:v "http://hl7.org/fhir/us/davinci-dtr/dtr-base-questionnaire"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/us/davinci-dtr/dtr-base-questionnaire>
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:subjectType ( [ fhir:v "Patient"] ) ; #
      fhir:date [ fhir:v "2023-08-21T00:00:00+00:00"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Clinical Decision Support"] ; #
      fhir:contact ( [
    fhir:name [ fhir:v "HL7 International / Clinical Decision Support" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/dss" ]     ] )
      ] ) ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "US" ]     ] )
      ] ) ; #
      fhir:item ( [
    fhir:linkId [ fhir:v "1" ] ;
    fhir:text [ fhir:v "Patient Information" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
    fhir:linkId [ fhir:v "1.1" ] ;
    fhir:text [ fhir:v "Last Name but Different This Time" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "1.2" ] ;
    fhir:text [ fhir:v "First Name" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "1.3" ] ;
    fhir:text [ fhir:v "Middle Initial" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "1.4" ] ;
    fhir:text [ fhir:v "Date Of Birth" ] ;
    fhir:type [ fhir:v "date" ]     ] [
    fhir:linkId [ fhir:v "1.5" ] ;
    fhir:text [ fhir:v "Gender" ] ;
    fhir:type [ fhir:v "choice" ] ;
    fhir:answerValueSet [
    fhir:v "http://hl7.org/fhir/ValueSet/administrative-gender"^^xsd:anyURI ;
    fhir:link <http://hl7.org/fhir/ValueSet/administrative-gender>       ]     ] [
    fhir:linkId [ fhir:v "1.6" ] ;
    fhir:text [ fhir:v "Medicare ID" ] ;
    fhir:type [ fhir:v "text" ]     ] )
      ] [
    fhir:linkId [ fhir:v "2" ] ;
    fhir:text [ fhir:v "Provider who is performing face-to-face evaluation" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
    fhir:linkId [ fhir:v "2.1" ] ;
    fhir:text [ fhir:v "Last Name" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "2.2" ] ;
    fhir:text [ fhir:v "First Name" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "2.3" ] ;
    fhir:text [ fhir:v "Middle Initial" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "2.4" ] ;
    fhir:text [ fhir:v "NPI" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "2.5" ] ;
    fhir:text [ fhir:v "Date of Face-To-Face Evaluation" ] ;
    fhir:type [ fhir:v "date" ]     ] [
          ( fhir:extension [
    fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource"^^xsd:anyURI ] ;
    fhir:value [ fhir:v "Patient" ]       ] ) ;
    fhir:linkId [ fhir:v "2.6" ] ;
    fhir:text [ fhir:v "Record" ] ;
    fhir:type [ fhir:v "reference" ] ;
    fhir:required [ fhir:v "true"^^xsd:boolean ]     ] )
      ] [
    fhir:linkId [ fhir:v "3" ] ;
    fhir:text [ fhir:v "Coverage Requirements" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
    fhir:linkId [ fhir:v "3.1" ] ;
    fhir:text [ fhir:v "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)" ] ;
    fhir:type [ fhir:v "choice" ] ;
          ( fhir:answerOption [
    fhir:value [
    a fhir:Coding, sct:313296004 ;
    fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "313296004" ] ;
    fhir:display [ fhir:v "Mild chronic obstructive pulmonary disease" ]         ]       ] [
    fhir:value [
    a fhir:Coding, sct:389087006 ;
    fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "389087006" ] ;
    fhir:display [ fhir:v "Hypoxemia (disorder)" ]         ]       ] )     ] [
    fhir:linkId [ fhir:v "3.2" ] ;
    fhir:text [ fhir:v "Arterial oxygen saturation (Patient on room air while at rest and awake when tested)" ] ;
    fhir:type [ fhir:v "quantity" ]     ] [
    fhir:linkId [ fhir:v "3.3" ] ;
    fhir:text [ fhir:v "Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested)" ] ;
    fhir:type [ fhir:v "quantity" ]     ] [
    fhir:linkId [ fhir:v "3.4" ] ;
    fhir:text [ fhir:v "Arterial oxygen saturation (Patient tested during exercise)" ] ;
    fhir:type [ fhir:v "quantity" ]     ] [
    fhir:linkId [ fhir:v "3.5" ] ;
    fhir:text [ fhir:v "Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise)" ] ;
    fhir:type [ fhir:v "quantity" ]     ] [
    fhir:linkId [ fhir:v "3.6" ] ;
    fhir:text [ fhir:v "Is there a documented improvement of hypoxemia during exercise with oxygen?" ] ;
    fhir:type [ fhir:v "boolean" ]     ] )
      ] [
    fhir:linkId [ fhir:v "4" ] ;
    fhir:text [ fhir:v "Prescribed Use" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
    fhir:linkId [ fhir:v "4.1" ] ;
    fhir:text [ fhir:v "Start date" ] ;
    fhir:type [ fhir:v "date" ]     ] [
    fhir:linkId [ fhir:v "4.2" ] ;
    fhir:text [ fhir:v "Length of need: (months) (99 = lifetime)" ] ;
    fhir:type [ fhir:v "quantity" ]     ] [
    fhir:linkId [ fhir:v "4.3" ] ;
    fhir:text [ fhir:v "Peak Flow Rate" ] ;
    fhir:type [ fhir:v "group" ] ;
          ( fhir:item [
    fhir:linkId [ fhir:v "4.3.1" ] ;
    fhir:text [ fhir:v "LPM" ] ;
    fhir:type [ fhir:v "quantity" ]       ] [
    fhir:linkId [ fhir:v "4.3.2" ] ;
    fhir:text [ fhir:v "oxygen %" ] ;
    fhir:type [ fhir:v "quantity" ]       ] )     ] [
    fhir:linkId [ fhir:v "4.4" ] ;
    fhir:text [ fhir:v "Average Flow Rate" ] ;
    fhir:type [ fhir:v "group" ] ;
          ( fhir:item [
    fhir:linkId [ fhir:v "4.4.1" ] ;
    fhir:text [ fhir:v "LPM" ] ;
    fhir:type [ fhir:v "quantity" ]       ] [
    fhir:linkId [ fhir:v "4.4.2" ] ;
    fhir:text [ fhir:v "oxygen %" ] ;
    fhir:type [ fhir:v "quantity" ]       ] )     ] [
    fhir:linkId [ fhir:v "4.5" ] ;
    fhir:text [ fhir:v "Frequency of use (choose all that apply)" ] ;
    fhir:type [ fhir:v "text" ]     ] )
      ] [
    fhir:linkId [ fhir:v "5" ] ;
    fhir:text [ fhir:v "Oxygen Supply Order Details" ] ;
    fhir:type [ fhir:v "group" ] ;
        ( fhir:item [
    fhir:linkId [ fhir:v "5.1" ] ;
    fhir:text [ fhir:v "Current Order Description" ] ;
    fhir:type [ fhir:v "text" ]     ] [
    fhir:linkId [ fhir:v "5.1b" ] ;
    fhir:text [ fhir:v "Current Order Is For A Portable Device" ] ;
    fhir:type [ fhir:v "boolean" ]     ] [
    fhir:linkId [ fhir:v "5.2" ] ;
    fhir:text [ fhir:v "Type" ] ;
    fhir:type [ fhir:v "choice" ] ;
          ( fhir:answerOption [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "121" ] ;
    fhir:display [ fhir:v "Liquid" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "122" ] ;
    fhir:display [ fhir:v "Compressed Gas" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "123" ] ;
    fhir:display [ fhir:v "Concentrator" ]         ]       ] )     ] [
    fhir:linkId [ fhir:v "5.3" ] ;
    fhir:text [ fhir:v "Means of oxygen delivery and accessories" ] ;
    fhir:type [ fhir:v "choice" ] ;
          ( fhir:answerOption [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "131" ] ;
    fhir:display [ fhir:v "Nasal cannula" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "132" ] ;
    fhir:display [ fhir:v "Non-rebreather" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "133" ] ;
    fhir:display [ fhir:v "Ventilator" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "134" ] ;
    fhir:display [ fhir:v "Mask" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "135" ] ;
    fhir:display [ fhir:v "PAP bleed in" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "136" ] ;
    fhir:display [ fhir:v "Oxygen conserving device" ]         ]       ] [
    fhir:value [
    a fhir:Coding ;
    fhir:system [ fhir:v "http://example.org"^^xsd:anyURI ] ;
    fhir:code [ fhir:v "137" ] ;
    fhir:display [ fhir:v "High flow oxygen therapy" ]         ]       ] )     ] )
      ] ) . #