SampleQuestionnaire.json

{
  "resourceType" : "Questionnaire",
  "id" : "zika-virus-exposure-assessment",
  "url" : "http://example.org/Questionnaire/zika-virus-exposure-assessment",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.20.1"
  }],
  "name" : "ExampleZikaVirusExposureAssessment",
  "title" : "Example Zika Virus Exposure Assessment",
  "status" : "draft",
  "subjectType" : ["Patient"],
  "date" : "2016-11-14",
  "description" : "Example questionnaire to assess Zika virus exposure potential.",
  "effectivePeriod" : {
    "start" : "2016-11-14"
  },
  "item" : [{
    "extension" : [{
      "url" : "http://example.org/additional-information",
      "valueAttachment" : {
        "url" : "http://www.cdc.gov/zika/geo/index.html",
        "title" : "Areas with active Zika virus transmission/exposure risk"
      }
    }],
    "linkId" : "1",
    "code" : [{
      "system" : "http://example.org/questionnaires",
      "code" : "CDE: Resident of or Frequent Traveler to Zika Area"
    }],
    "text" : "Are you a resident of, or do you travel frequently to, an area with active Zika transmission?",
    "type" : "boolean"
  },
  {
    "extension" : [{
      "url" : "http://example.org/additional-information",
      "valueAttachment" : {
        "url" : "http://www.cdc.gov/zika/geo/index.html",
        "title" : "Areas with active Zika virus transmission/exposure risk"
      }
    }],
    "linkId" : "2",
    "code" : [{
      "system" : "http://example.org/questionnaires",
      "code" : "CDE: Recent Travel to Zika Area"
    }],
    "text" : "Have you recently traveled to an area with active Zika transmission?",
    "type" : "boolean",
    "enableWhen" : [{
      "question" : "1",
      "operator" : "=",
      "answerBoolean" : false
    }]
  },
  {
    "linkId" : "3",
    "code" : [{
      "system" : "http://example.org/questionnaires",
      "code" : "CDE: Time Since Returned From Travel"
    }],
    "text" : "How long has it been since you returned?",
    "type" : "quantity",
    "enableWhen" : [{
      "question" : "2",
      "operator" : "=",
      "answerBoolean" : true
    }]
  },
  {
    "extension" : [{
      "url" : "http://example.org/additional-information",
      "valueAttachment" : {
        "url" : "http://www.cdc.gov/zika/geo/index.html",
        "title" : "Areas with active Zika virus transmission/exposure risk"
      }
    }],
    "linkId" : "4",
    "code" : [{
      "system" : "http://example.org/questionnaires",
      "code" : "CDE: Recent Sexual Encounter with Traveler to Zika Area"
    }],
    "text" : "Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?",
    "type" : "boolean",
    "enableWhen" : [{
      "question" : "2",
      "operator" : "=",
      "answerBoolean" : false
    }]
  },
  {
    "linkId" : "5",
    "code" : [{
      "system" : "http://example.org/questionnaires",
      "code" : "CDE: Time Since Sexual Encounter"
    }],
    "text" : "How long has it been since your last condomless sexual encounter?",
    "type" : "quantity",
    "enableWhen" : [{
      "question" : "4",
      "operator" : "=",
      "answerBoolean" : true
    }]
  },
  {
    "extension" : [{
      "url" : "http://example.org/additional-information",
      "valueAttachment" : {
        "url" : "http://www.cdc.gov/zika/geo/index.html",
        "title" : "Areas with active Zika virus transmission/exposure risk"
      }
    }],
    "linkId" : "6",
    "code" : [{
      "system" : "http://example.org/questionnaires",
      "code" : "CDE: Planned Travel to Zika Area"
    }],
    "text" : "Do you plan to travel to an area with active Zika transmission?",
    "type" : "boolean",
    "enableWhen" : [{
      "question" : "4",
      "operator" : "=",
      "answerBoolean" : false
    }]
  }]
}