FHIR IG analytics| Package | hl7.fhir.us.davinci-dtr |
| Resource Type | Parameters |
| Id | Parameters-QuestionnairePackageOutputParamsExample.json |
| FHIR Version | R4 |
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FHIR
FHIRsmith{
"resourceType": "Parameters",
"id": "QuestionnairePackageOutputParamsExample",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-qpackage-output-parameters"
]
},
"language": "en",
"parameter": [
{
"name": "packagebundle",
"resource": {
"resourceType": "Bundle",
"id": "home-o2-questionnairepackage-bundle",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/DTR-QPackageBundle"
]
},
"type": "collection",
"entry": [
{
"fullUrl": "http://example.org/fhir/home-o2-questionnairepackage",
"resource": {
"resourceType": "Questionnaire",
"id": "home-o2-std-questionnaire",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-std-questionnaire"
]
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
"valueCoding": {
"system": "http://hl7.org/fhir/version-algorithm",
"code": "semver"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/questionnaireAudience",
"valueCode": "clinical"
},
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/request-specific",
"valueBoolean": false
},
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive",
"valueBoolean": false
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
"valueCode": "sequential"
},
{
"extension": [
{
"url": "totalTime",
"valueCode": "over-5min"
},
{
"url": "clinicalTime",
"valueCode": "under-3min"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/estimated-completion-time"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/Questionnaire/home-o2-std-questionnaire",
"name": "HomeOxygenTherapyStdQuestionnaire",
"title": "Home Oxygen Therapy Order Template",
"status": "draft",
"subjectType": [
"Patient"
],
"date": "2020-01-13T00:00:00+00:00",
"publisher": "Da Vinci DTR",
"contact": [
{
"name": "Example Author"
}
],
"item": [
{
"linkId": "1",
"text": "Patient Information",
"type": "group",
"item": [
{
"linkId": "1.1",
"text": "Last Name",
"type": "string",
"required": true
},
{
"linkId": "1.2",
"text": "Fist Name",
"type": "string",
"required": true
},
{
"linkId": "1.3",
"text": "Middle Name",
"type": "string",
"required": false
},
{
"linkId": "1.gender",
"definition": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-question-library#Demographics.sex",
"text": "What is this person's gender?",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype"
},
{
"linkId": "1.4",
"text": "Date Of Birth",
"type": "date"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueDecimal": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueDecimal": 400
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxDecimalPlaces",
"valueInteger": 2
}
],
"linkId": "1.5",
"text": "Enter your weight in lb",
"type": "decimal"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/jpeg"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal": 1048576
}
],
"linkId": "1.6",
"text": "Attach latest x-ray",
"type": "attachment"
}
]
},
{
"linkId": "2",
"text": "Calculation",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/alternativeExpression",
"valueExpression": {
"language": "application/elm+json",
"expression": "corresponding elm data"
}
}
],
"description": "deadline for submission",
"language": "text/fhirpath",
"expression": "today() + 7 days"
}
}
],
"linkId": "2.1",
"text": "Deadline for submission (7 days from now)",
"type": "date",
"readOnly": true
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/home-o2-questionnaireresponse",
"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-coverage",
"valueReference": {
"reference": "Coverage/CoverageExample"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/intendedUse",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes",
"code": "withorder",
"display": "Include with order"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/qr-context",
"valueReference": {
"reference": "ServiceRequest/ServiceRequestExample"
}
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"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-client"
}
],
"url": "http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/information-origin"
}
],
"valueCoding": {
"system": "http://example.org",
"code": "134",
"display": "Mask"
}
}
]
}
]
}
]
}
}
]
}
}
]
}