<status value="draft" /> <subjectType value="Patient" /> <date value="2021-01-28" /> <publisher value="D4L data4life gGmbH" /> <contact> <name value="ITTM Solutions" /> <telecom> <system value="url" /> <value value="https://www.ittm-solutions.com/" /> </telecom> </contact> <contact> <name value="D4L data4life gGmbH" /> <telecom> <system value="url" /> <value value="https://www.data4life.care" /> </telecom> </contact> <description value="Pre-session treatment questionnaire" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://fhir.smart4health.eu/CodeSystem/questionnaire-ui-codes" /> <code value="painscalewithlabels" /> </coding> </valueCodeableConcept> </extension> <linkId value="current_back_pain_level" /> <code> <system value="http://loinc.org" /> <code value="72514-3" /> <display value="Pain severity 0-10 Score Reported" /> </code> <text value="Please indicate your current pain level" /> <type value="choice" /> <enableBehavior value="any" /> <required value="true" /> <answerValueSet value="http://loinc.org/vs/LL2335-9" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://fhir.smart4health.eu/CodeSystem/questionnaire-ui-codes" /> <code value="painscalewithlabels" /> </coding> </valueCodeableConcept> </extension> <linkId value="average_back_pain_level" /> <code> <system value="http://loinc.org" /> <code value="72514-3" /> <display value="Pain severity 0-10 Score Reported" /> </code> <text value="Please indicate your average pain level during the past four weeks" /> <type value="choice" /> <enableBehavior value="any" /> <required value="true" /> <answerValueSet value="http://loinc.org/vs/LL2335-9" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://fhir.smart4health.eu/CodeSystem/questionnaire-ui-codes" /> <code value="painscalewithlabels" /> </coding> </valueCodeableConcept> </extension> <linkId value="max_back_pain_level_4w" /> <code> <system value="http://loinc.org" /> <code value="72514-3" /> <display value="Pain severity 0-10 Score Reported" /> </code> <text value="Please indicate your maximum pain level during the past four weeks" /> <type value="choice" /> <enableBehavior value="any" /> <required value="true" /> <answerValueSet value="http://loinc.org/vs/LL2335-9" /> </item> <item> <linkId value="taking_painkillers" /> <text value="Are you taking painkillers at the moment?" /> <type value="choice" /> <enableBehavior value="any" /> <required value="true" /> <answerValueSet value="http://fhir.smart4health.eu/ValueSet/yesno" /> </item> </Questionnaire>