{
  "description": "Example questionnaire to assess Zika virus exposure potential.",
  "_filename": "questionnaire-zika-virus-exposure-assessment.json",
  "package_name": "hl7.fhir.r5.examples",
  "subjectType": [ "Patient" ],
  "date": "2016-11-14",
  "publisher": null,
  "name": "ExampleZikaVirusExposureAssessment",
  "item": [ {
    "code": [ {
      "code": "CDE: Resident of or Frequent Traveler to Zika Area",
      "system": "http://example.org/questionnaires"
    } ],
    "text": "Are you a resident of, or do you travel frequently to, an area with active Zika transmission?",
    "type": "boolean",
    "linkId": "1",
    "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"
      }
    } ]
  }, {
    "code": [ {
      "code": "CDE: Recent Travel to Zika Area",
      "system": "http://example.org/questionnaires"
    } ],
    "text": "Have you recently traveled to an area with active Zika transmission?",
    "type": "boolean",
    "linkId": "2",
    "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"
      }
    } ],
    "enableWhen": [ {
      "operator": "=",
      "question": "1",
      "answerBoolean": false
    } ]
  }, {
    "code": [ {
      "code": "CDE: Time Since Returned From Travel",
      "system": "http://example.org/questionnaires"
    } ],
    "text": "How long has it been since you returned?",
    "type": "quantity",
    "linkId": "3",
    "enableWhen": [ {
      "operator": "=",
      "question": "2",
      "answerBoolean": true
    } ]
  }, {
    "code": [ {
      "code": "CDE: Recent Sexual Encounter with Traveler to Zika Area",
      "system": "http://example.org/questionnaires"
    } ],
    "text": "Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?",
    "type": "boolean",
    "linkId": "4",
    "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"
      }
    } ],
    "enableWhen": [ {
      "operator": "=",
      "question": "2",
      "answerBoolean": false
    } ]
  }, {
    "code": [ {
      "code": "CDE: Time Since Sexual Encounter",
      "system": "http://example.org/questionnaires"
    } ],
    "text": "How long has it been since your last condomless sexual encounter?",
    "type": "quantity",
    "linkId": "5",
    "enableWhen": [ {
      "operator": "=",
      "question": "4",
      "answerBoolean": true
    } ]
  }, {
    "code": [ {
      "code": "CDE: Planned Travel to Zika Area",
      "system": "http://example.org/questionnaires"
    } ],
    "text": "Do you plan to travel to an area with active Zika transmission?",
    "type": "boolean",
    "linkId": "6",
    "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"
      }
    } ],
    "enableWhen": [ {
      "operator": "=",
      "question": "4",
      "answerBoolean": false
    } ]
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Example Zika Virus Exposure Assessment",
  "package_version": "4.5.0",
  "status": "draft",
  "id": "26018ec9-7809-427b-b3bc-6fb56c6f2546",
  "kind": null,
  "url": "http://example.org/Questionnaire/zika-virus-exposure-assessment",
  "version": null,
  "effectivePeriod": {
    "start": "2016-11-14"
  }
}