{
  "description": null,
  "_filename": "example/Questionnaire-cdex-questionnaire-example2.json",
  "package_name": "hl7.fhir.us.davinci-cdex",
  "subjectType": [ "Patient" ],
  "date": "2022-01-17",
  "publisher": "HL7 International / Payer/Provider Information Exchange Work Group",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "HomeOxygenTherapyQuestionnaire",
  "item": [ {
    "text": "Relevant Patient Diagnoses (conditions that might be expected to improve with oxygen therapy)",
    "type": "text",
    "linkId": "1",
    "required": true
  }, {
    "text": "Order Reason",
    "type": "choice",
    "linkId": "2",
    "required": true,
    "answerOption": [ {
      "valueCoding": {
        "code": "1",
        "system": "http://example.org",
        "display": "Initial or original order for certification"
      }
    }, {
      "valueCoding": {
        "code": "2",
        "system": "http://example.org",
        "display": "Change in status"
      }
    }, {
      "valueCoding": {
        "code": "3",
        "system": "http://example.org",
        "display": "Revision or change in equipment"
      }
    }, {
      "valueCoding": {
        "code": "4",
        "system": "http://example.org",
        "display": "Replacement"
      }
    } ]
  } ],
  "copyright": "Used by permission of HL7 International all rights reserved Creative Commons License",
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Home Oxygen Therapy Questionnaire",
  "package_version": "2.1.0-snapshot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired",
    "valueCodeableConcept": {
      "coding": [ {
        "code": "1.2.840.10065.1.12.1.5",
        "system": "urn:iso-astm:E1762-95:2013",
        "display": "Verification Signature"
      } ]
    }
  } ],
  "status": "active",
  "id": "5bff2abb-c6b6-4eba-beaa-520a2f31b5c6",
  "kind": null,
  "url": "http://example.org/cdex-questionnaire-example2",
  "identifier": [ {
    "value": "urn:oid:2.16.840.1.113883.4.642.40.21.35.2",
    "system": "urn:ietf:rfc:3986"
  } ],
  "version": "2.1.0-snapshot",
  "contact": [ {
    "name": "HL7 International / Payer/Provider Information Exchange Work Group",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/claims",
      "system": "url"
    }, {
      "value": "pie@lists.hl7.org",
      "system": "email"
    } ]
  } ]
}