--- type: "sdc-page" title: "SDC: Examples" source: "sdc/input/pagecontent/examples.xml" --- # SDC: Examples .question { border: solid black 1px; padding-top: 10px; padding-right: 1px; padding-bottom: 10px; padding-left: 5px; width: 500px; } .example { padding-top: 10px; padding-bottom: 10px; } .xml { font-size: 10px; line-height: normal; } .tabs { position: relative; min-height: 210px; /\* TODO: better way of doing this \*/ clear: both; margin: 35px 0 25px; background: white; } .tab { float: left; } .tab label { background: #eee; padding: 10px; border: 1px solid #ccc; margin-left: -1px; position: relative; left: 1px; top: -29px; -webkit-transition: background-color .17s linear; } .tab input\[id^="tab-"\]{ display: none; } .content-in-tab { position: absolute; top: 12px; left: 0; background: white; right: 0; bottom: 0; padding: 20px; border: 1px solid #ccc; -webkit-transition: opacity .6s linear; opacity: 0; } \[type=radio\]:checked ~ label { background: white; border-bottom: 1px solid white; z-index: 2; } \[type=radio\]:checked ~ label ~ .content-in-tab { z-index: 1; opacity: 1; } pre.json,pre.xml{ height: 100%; width: 100%; -webkit-box-sizing: border-box; /\* Safari/Chrome, other WebKit \*/ -moz-box-sizing: border-box; /\* Firefox, other Gecko \*/ box-sizing: border-box; /\* Opera/IE 8+ \*/ resize: none; } .button { border: none; color: white; text-align: center; text-decoration: none; display: inline-block; cursor: pointer; background-color: #008CBA; } /\* The Modal (background) \*/ .modal { display: none; /\* Hidden by default \*/ position: fixed; /\* Stay in place \*/ /\*z-index: 1;\*/ /\*Sit on top \*/ padding-top: 100px; /\* Location of the box \*/ left: 0; top: 0; width: 100%; /\* Full width \*/ height: 100%; /\* Full height \*/ overflow: auto; /\* Enable scroll if needed \*/ background-color: rgb(0,0,0); /\* Fallback color \*/ background-color: rgba(0,0,0,0.4); /\* Black w/ opacity \*/ } /\* Modal Content \*/ .modal-content { background-color: #fefefe; margin: auto; padding: 20px; border: 1px solid #888; width: 80%; } /\* The Close Button \*/ .close { color: #aaaaaa; float: right; font-size: 28px; font-weight: bold; } .close:hover, .close:focus { color: #000; text-decoration: none; cursor: pointer; } /\* Used by collapsible example \*/ .panel-heading.collapsed .fa-chevron-down, .panel-heading .fa-chevron-right { display: none; } .panel-heading.collapsed .fa-chevron-right, .panel-heading .fa-chevron-down { display: inline-block; } i.fa { cursor: pointer; margin-right: 5px; } .collapsed ~ .panel-body { padding: 0; } Below are some examples that demonstrate how the elements and extensions in this implementation guide are intended to be used in a Questionnaire. Note: The rendering of the questions in the "Sample Question" tab are not functional (i.e. no validations after entry, perform actual computations, etc). They only provide a visual presentation of the questions and do not mimic how they will work in an actual questionnaire. ### Text Appearance #### Using rendering-style To display a question text in green. ([Example Questionnaire](http://build.fhir.org/ig/HL7/sdc/Questionnaire-questionnaire-sdc-profile-example-render.html)) Sample Question Enter your First Name JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='1.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='1.1') %} Sample Question _Please_ answer **Yes** or **No** to each of the following questions: JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='1.2b') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='1.2b') %} Sample Question _Please_ answer **Yes** or **No** to each of the following questions: JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='1.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='1.2') %} Sample Question ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL. JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='1.3') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='1.3') %} Sample Question Event ID JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='1.4.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='1.4.1') %} Sample Question If you have any other medical problems or serious injuries, please describe them here: JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='2.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='2.1') %} Sample Question Gender: Female   Male   Other   Unknown JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='2.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='2.2') %} Sample Question Rate your doctor: 0 Completely dissatisfied 100 Completely satisfied JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='2.3') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='2.3') %} Sample Question Medical History Diabetes Other Information Type 1 Hypertension Type 2 Smoker JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='2.4') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='2.4') %} Sample Question Family Member Health History_![Up](examples/arrow-up.png)_ _![Down](examples/arrow-down.png)_ Relationship to patient Father Mother Sibling Name Gender Female   Male   Other   Unknown JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='2.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='2.5') %} Sample Question Availability Pick the time-slot that works best for you: 9-10am 11am-12pm 2-3pm 10-11am 1-2pm 3-4pm JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.9') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.9') %} Sample Question Have you traveled outside the country within the last 14 days? More info Yes No JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.1') %} Sample Question Select Platelet: CODE            DESCRIPTION LA11165-0    Platelet anisocytosis LA11166-8    Platelet satellitism LA11167-6    Platelet large fragments LA11167-6    Platelet large fragments LA11168-4    Platelet clump LA11169-2    Platelets.agranular LA11170-0    Platelets.giant LA11172-8    Platelets.small LA11172-6    Platelets.large JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.2') %} Sample Question Gender: (a) Female   (b) Male   (c) Other   (d) Unknown JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.3') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.3') %} Sample Question Enter timing of harm assessment:  A. Within 24 hours   B. After 24 hours but before 3 days   C. Three days or later   D. Unknown JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.4') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.4') %} Sample Question Birth Date JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.5') %} Sample Question **IMPORTANT: _Please_ complete questionnaire.** JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.6') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.6') %} Sample Question Annual family income JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='1.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='1.2') %} Sample Question Enter your First Name JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='1.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='1.1') %} Sample Question Enter your Last Name JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='1.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='1.2') %} Sample Question Enter your weight in kg JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='1.4') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='1.4') %} Sample Question Body Weight kg lb\_av g JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='1.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='1.5') %} Sample Question Attach Proof of Citizenship JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='1.6') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='1.6') %} Sample Question (I/We) worried whether (my/our) food would run out before (I/we) got money to buy more. Often true Sometimes true Never true JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.1') %} Sample Question How are you feeling today? ![Sad Image](examples/sad.png) ![OK Image](examples/ok.png) ![Happy Image](examples/happy.png) JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-image-options JSON BASE:select(item).where(linkId='1.0') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-image-options XML BASE:select(item).where(linkId='1.0') %} Sample Question Activity Level Often Rarely Sometimes Never Always JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.3') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.3') %} Sample Question Applicable health conditions : Hypertension Diabetes Erectile disfunction JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.5') %} Sample Question Applicable health conditions : Hypertension Diabetes Pregnancy Erectile disfunction JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.5') %} Sample Question Email\* JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.6') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.6') %} Sample Question Current Date: JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.7') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.7') %} Sample Question Heart History (check all that applies): Heart attack Heart surgery Cardiac catheterization Coronary angioplasty (PTCA) Cardiac pacemaker Other event (specify): JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.8') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.8') %} Sample Question Heart History (check at least 2): Heart attack Heart surgery Cardiac catheterization Coronary angioplasty (PTCA) Cardiac pacemaker JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.9') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.9') %} Sample Question Heart History (check no more than 3): Heart attack Heart surgery Cardiac catheterization Coronary angioplasty (PTCA) Cardiac pacemaker JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.10') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.10') %} Sample Question What treatments do you now have for heart disease? (select all that applies) No treatment Aspirin Other medicines, tablets, or pills Diet Exercise None of the above JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.11') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.11') %} Sample Question Dosage g L ml mg (some other code1) (some other code2) ... JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.12') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.12') %} Sample Question Specify age: minutes hours days weeks months years JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.13') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.13') %} Sample Question Select your preferred practitioner: Hamilton, Bill Saunders, Theresa Smith, Paul JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='2.14') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='2.14') %} Sample Question Deadline for submission (7 days from now) JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='3.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='3.1') %} Sample Question **Last Name:** Hamilton **First Name:** William **Gender:** male JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='3.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='3.2') %} Sample Question Weight (kg) Body Height (inches) Your Body Mass Index (BMI) is JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='3.3') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='3.3') %} Sample Question Enter weight in kg Enter email address JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='3.4') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='3.4') %} Sample Display Your last immunization was on 2021-01-05. JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='3.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='3.5') %} Sample Question Marital Status Single Married Divorced Widowed JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='4.1') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='4.1') %} Sample Question Choose Gender Male Female Other Unknown Are you pregnant? (enableWhen gender = Female, disableDisplay=protected) Yes No Don't know Are you diabetic? (enableWhen gender = Female, disableDisplay=hidden) Yes No Don't know Have you been diagnosed with Gestational Diabetes? (enableBehavior = only when pregnant and diabetic, disableDisplay=protected) Yes No Don't know Enter your birthdate (YYYY/MM/DD) Have you had mammogram before?(enableWhenExpression = only when gender is female and age > 40, disableDisplay=protected) Yes No Don't know JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='4.2') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='4.2') %} Sample Question You should answer at least three questions. Over the last 2 weeks, how often have you been bothered by any of the following problems? 1\. Little interest or pleasure in doing things Not at all (0) Several Days (1) More than half the days (2) Nearly every day (3) 2\. Feeling down, depressed, or hopeless Not at all (0) Several Days (1) More than half the days (2) Nearly every day (3) 3\. Trouble falling or staying asleep, or sleeping too much Not at all (0) Several Days (1) More than half the days (2) Nearly every day (3) 4\. Feeling tired or having little energy Not at all (0) Several Days (1) More than half the days (2) Nearly every day (3) Total Score: 0 JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-item-weight JSON BASE:select(item).where(linkId='1.0') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-item-weight XML BASE:select(item).where(linkId='1.0') %} Sample Question Postal Code (A1A 1A1) JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='1.3') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='1.3') %} Sample Question Signature of Patient: \[only show signature pad when capturing data\] JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='4.4') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='4.4') %} Sample Question \[Not applicable to a question item - this extension is part of a base Questionnaire's metadata\] JSON { "resourceType": "Questionnaire", ... "extension": \[ { "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-endpoint", "valueUri": "http://example.org/QuestionnaireResponse/create" } \] ... } XML ... ... Sample Question \[Not applicable to a question item - this extension is part of a base Questionnaire's metadata\] JSON { "resourceType": "Questionnaire", ... "extension": \[ { "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode", "valueCode": "sequential" } \] ... } XML ... ... Sample Question All the practitioners below can speak your language. Choose all preferred practioners: **Last Name** First Name Gender Smith John Male Moseley Henry Male Upton Isaac Male Williams Amy Female JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='4.5') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='4.5') %} Sample Question Instruction: Click on "Review Previous Visits" button to view all the visits of this patient in the past year. Has the patient been admitted for this issue on any visits in the past year? Review Previous Visits Yes  No  Don't know JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-context-expression JSON BASE:select(item).where(linkId='1.0') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-context-expression XML BASE:select(item).where(linkId='1.0') %} Sample Question Home Address Address: City: Province: Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Postal Code: JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior JSON BASE:descendants().select(item).where(linkId='4.6') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-form-behavior XML BASE:descendants().select(item).where(linkId='4.6') %} Sample Question Select a condition: Hypertension Diabetes Asthma Options retrieved using terminology server: **https://tx.fhir.org/r4** JSON {% fragment Questionnaire/questionnaire-sdc-profile-example-render JSON BASE:descendants().select(item).where(linkId='3.10') %} XML {% fragment Questionnaire/questionnaire-sdc-profile-example-render XML BASE:descendants().select(item).where(linkId='3.10') %} Sample Question TODO: html JSON "item": \[ TODO: json \] XML TODO: xml x **Date** Visit Reason - Details May 1, 2020 Acute bronchitis (disorder) - Encounter for check up (procedure) Apr 1, 2020 Hyperlipidemia - Follow-up encounter Feb 15, 2020 Overlapping malignant neoplasm of colon - Follow-up encounter Feb 1, 2020 Overlapping malignant neoplasm of colon - Encounter for problem