FHIR IG analytics| Package | hl7.fhir.us.davinci-dtr.r4 |
| Resource Type | QuestionnaireResponse |
| Id | QuestionnaireResponse-home-o2-questionnaireresponse.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: QuestionnaireResponse home-o2-questionnaireresponse
Profile: DTR Questionnaire Response
| LinkID | Text | Definition | Answer |
|---|---|---|---|
  home-o2-questionnaireresponse | Questionnaire:Referred Questionnaire for QuestionnaireResponse | ||
  1 | Patient Information | ||
  1.1 | Last Name but Different This Time | Quinton | |
| 1.2 | First Name | Vlad | |
| 1.3 | Middle Initial | A, N | |
| 1.4 | Date Of Birth | 1956-12-01 | |
| 1.5 | Gender | AdministrativeGender male: Male | |
 1.6 | Medicare ID | 10A3D58WH22 | |
| 2 | Provider who is performing face-to-face evaluation | ||
| 2.1 | Last Name | Doe | |
| 2.2 | First Name | Jane | |
| 2.3 | Middle Initial | B | |
| 2.4 | NPI | 1122334455 | |
| 2.5 | Date of Face-To-Face Evaluation | 2019-07-18 | |
| 2.6 | Record | Mr. Saul Moki | |
| 3 | Coverage Requirements | ||
| 3.1 | Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy) | SNOMED CT 313296004: Mild chronic obstructive pulmonary disease | |
| 3.2 | Arterial oxygen saturation (Patient on room air while at rest and awake when tested) | 95 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]') | |
| 3.3 | Arterial Partial Pressure of Oxygen (PO2) (Patient on room air while at rest and awake when tested) | 83 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]') | |
| 3.4 | Arterial oxygen saturation (Patient tested during exercise) | 95 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]') | |
| 3.5 | Arterial Partial Pressure of Oxygen (PO2) (Patient tested during exercise) | 78 mm[Hg] (Details: UCUM codemm[Hg] = 'mm[Hg]') | |
| 3.6 | Is there a documented improvement of hypoxemia during exercise with oxygen? | true | |
| 4 | Prescribed Use | ||
| 4.1 | Start date | 2019-07-18 | |
| 4.2 | Length of need: (months) (99 = lifetime) | 99 | |
| 4.3 | Peak Flow Rate | ||
| 4.3.1 | LPM | 2 | |
| 4.3.2 | oxygen % | 98 | |
| 4.4 | Average Flow Rate | ||
| 4.4.1 | LPM | 2 | |
| 4.4.2 | oxygen % | 97 | |
| 4.5 | Frequency of use (choose all that apply) | At rest and awake | |
| 5 | Oxygen Supply Order Details | ||
 5.1 | Current Order Description | HCPCS E0424 - Stationary Compressed Gaseous Oxygen System, Rental | |
| 5.1b | Current Order Is For A Portable Device | ||
| 5.2 | Type | example.org 122: Compressed Gas | |
| 5.3 | Means of oxygen delivery and accessories | example.org 134: Mask | |
| Documentation for this format | |||
FHIR
FHIRsmith{
"resourceType": "QuestionnaireResponse",
"id": "home-o2-questionnaireresponse",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-dtr/StructureDefinition/dtr-questionnaireresponse"
]
},
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"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/temp",
"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"
}
],
"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"
}
}
]
}
]
}
]
}