<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <language value="en" />
  <questionnaire value="http://fhir.data4life.care/covid-19/r4/Questionnaire/covid19-recommendation|4.0.0" />
  <status value="completed" />
  <authored value="2020-05-04T14:15:00-05:00" />
  <item>
    <linkId value="P" />
    <text value="Personal information" />
    <item>
      <linkId value="P1" />
      <text value="Are you 65 years old or older?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="P2" />
      <text value="What is your current living situation?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA6255-9" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="P3" />
      <text value="At least once a week, do you privately care for people with age-related conditions, chronic illnesses, or frailty?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="P4-revised" />
      <text value="Do you work or are you cared for/accommodated in one of the following areas?" />
      <answer>
        <valueCoding>
          <system value="http://fhir.data4life.care/covid-19/r4/CodeSystem/accommodation-class" />
          <code value="community-accommodation" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="P5" />
      <text value="Do you smoke?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="P6" />
      <text value="Are you pregnant?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA26683-5" />
        </valueCoding>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="C" />
    <text value="Contact with COVID-19 cases" />
    <item>
      <linkId value="C0" />
      <text value="Have you had close contact with a confirmed case?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="CZ" />
      <text value="What day was the last contact?" />
      <answer>
        <valueDate value="2020-03-27" />
      </answer>
    </item>
  </item>
  <item>
    <linkId value="S" />
    <text value="Symptoms" />
    <item>
      <linkId value="X0" />
      <text value="In the past 24 hours, which of the following symptoms have you had? (multiple selection possible)" />
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="386661006" />
          <display value="Fever above 38°C" />
        </valueCoding>
      </answer>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="43724002" />
          <display value="Chills" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="X2" />
      <text value="In the past 24 hours, which of the following symptoms have you had? (multiple selection possible)" />
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="62315008" />
          <display value="Diarrhea" />
        </valueCoding>
      </answer>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="162397003" />
          <display value="Sore throat" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="SB" />
      <text value="In the past 24 hours, did you feel that you were more quickly out of breath than usual?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="SZ" />
      <text value="With regard to all questions about symptoms: since when have you had the symptoms you specified?" />
      <answer>
        <valueDate value="2021-01-30" />
      </answer>
    </item>
  </item>
  <item>
    <linkId value="D" />
    <text value="Chronic illnesses" />
    <item>
      <linkId value="X3" />
      <text value="Has a doctor diagnosed you with any of the following illnesses?" />
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="73211009" />
          <display value="Diabetes" />
        </valueCoding>
      </answer>
      <answer>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="56265001" />
          <display value="Heart disease" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="D6" />
      <text value="What's your height? (in cm)" />
      <answer>
        <valueInteger value="160" />
      </answer>
    </item>
    <item>
      <linkId value="D5" />
      <text value="What's your weight? (in kg)" />
      <answer>
        <valueInteger value="65" />
      </answer>
    </item>
  </item>
  <item>
    <linkId value="M" />
    <text value="Medication" />
    <item>
      <linkId value="M0" />
      <text value="Are you currently taking steroids?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="M1" />
      <text value="Are you currently taking immunosuppressants?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="M2" />
      <text value="Have you been vaccinated against flu between August 1, 2020 and today?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
  </item>
</QuestionnaireResponse>