{
  "resourceType": "QuestionnaireResponse",
  "questionnaire": "http://fhir.data4life.care/covid-19/r4/Questionnaire/covid19-recommendation|4.0.0",
  "status": "completed",
  "authored": "2020-05-04T19:15:00+00:00",
  "item": [
    {
      "linkId": "P",
      "text": "Personal information",
      "item": [
        {
          "linkId": "P1",
          "text": "Are you 65 years old or older?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "P2",
          "text": "What is your current living situation?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA6255-9"
              }
            }
          ]
        },
        {
          "linkId": "P3",
          "text": "At least once a week, do you privately care for people with age-related conditions, chronic illnesses, or frailty?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "P4-revised",
          "text": "Do you work or are you cared for/accommodated in one of the following areas?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://fhir.data4life.care/covid-19/r4/CodeSystem/accommodation-class",
                "code": "community-accommodation"
              }
            }
          ]
        },
        {
          "linkId": "P5",
          "text": "Do you smoke?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "P6",
          "text": "Are you pregnant?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA26683-5"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId": "C",
      "text": "Contact with COVID-19 cases",
      "item": [
        {
          "linkId": "C0",
          "text": "Have you had close contact with a confirmed case?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "CZ",
          "text": "What day was the last contact?",
          "answer": [
            {
              "valueDate": "2020-03-27"
            }
          ]
        }
      ]
    },
    {
      "linkId": "S",
      "text": "Symptoms",
      "item": [
        {
          "linkId": "X0",
          "text": "In the past 24 hours, which of the following symptoms have you had? (multiple selection possible)",
          "answer": [
            {
              "valueCoding": {
                "code": "386661006",
                "system": "http://snomed.info/sct",
                "display": "Fever above 38°C"
              }
            },
            {
              "valueCoding": {
                "code": "43724002",
                "system": "http://snomed.info/sct",
                "display": "Chills"
              }
            }
          ]
        },
        {
          "linkId": "X2",
          "text": "In the past 24 hours, which of the following symptoms have you had? (multiple selection possible)",
          "answer": [
            {
              "valueCoding": {
                "code": "62315008",
                "system": "http://snomed.info/sct",
                "display": "Diarrhea"
              }
            },
            {
              "valueCoding": {
                "code": "162397003",
                "system": "http://snomed.info/sct",
                "display": "Sore throat"
              }
            }
          ]
        },
        {
          "linkId": "SB",
          "text": "In the past 24 hours, did you feel that you were more quickly out of breath than usual?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "SZ",
          "text": "With regard to all questions about symptoms: since when have you had the symptoms you specified?",
          "answer": [
            {
              "valueDate": "2021-01-30"
            }
          ]
        }
      ]
    },
    {
      "linkId": "D",
      "text": "Chronic illnesses",
      "item": [
        {
          "linkId": "X3",
          "text": "Has a doctor diagnosed you with any of the following illnesses?",
          "answer": [
            {
              "valueCoding": {
                "code": "73211009",
                "system": "http://snomed.info/sct",
                "display": "Diabetes"
              }
            },
            {
              "valueCoding": {
                "code": "56265001",
                "system": "http://snomed.info/sct",
                "display": "Heart disease"
              }
            }
          ]
        },
        {
          "linkId": "D6",
          "text": "What's your height? (in cm)",
          "answer": [
            {
              "valueInteger": 160
            }
          ]
        },
        {
          "linkId": "D5",
          "text": "What's your weight? (in kg)",
          "answer": [
            {
              "valueInteger": 65
            }
          ]
        }
      ]
    },
    {
      "linkId": "M",
      "text": "Medication",
      "item": [
        {
          "linkId": "M0",
          "text": "Are you currently taking steroids?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "M1",
          "text": "Are you currently taking immunosuppressants?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "M2",
          "text": "Have you been vaccinated against flu between August 1, 2020 and today?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        }
      ]
    }
  ],
  "language": "en"
}