{
  "resourceType": "QuestionnaireResponse",
  "questionnaire": "http://fhir.data4life.care/covid-19/r4/Questionnaire/covid19-recommendation|3.0.0",
  "status": "completed",
  "authored": "2020-05-04T19:15:00+00:00",
  "item": [
    {
      "linkId": "P",
      "text": "Personal information",
      "item": [
        {
          "linkId": "P0",
          "text": "How old are you?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://fhir.data4life.care/covid-19/r4/CodeSystem/age-group",
                "code": "61-70"
              }
            }
          ]
        },
        {
          "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",
          "text": "Do you work in one of the following areas?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://fhir.data4life.care/covid-19/r4/CodeSystem/occupation-class",
                "code": "community"
              }
            }
          ]
        },
        {
          "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": "S0",
          "text": "Have you had a fever (over 38°C) in the past 24 hours?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "S1",
          "text": "Have you had a fever (over 38°C) in the past 4 days?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "S2",
          "text": "What was the highest temperature, approx.?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://fhir.data4life.care/covid-19/r4/CodeSystem/fever-class",
                "code": "40C"
              }
            }
          ]
        },
        {
          "linkId": "S3",
          "text": "Have you had chills in the past 24 hours?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "S4",
          "text": "In the past 24 hours, have you felt tired or worn out?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "S5",
          "text": "In the past 24 hours, have you had body aches?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "S6",
          "text": "In the past 24 hours, have you had a persistent cough?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "S7",
          "text": "In the past 24 hours, have you had a runny nose?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "S8",
          "text": "In the past 24 hours, have you had diarrhea?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "S9",
          "text": "In the past 24 hours, have you had a sore throat?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "SA",
          "text": "In the past 24 hours, have you had a headache?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "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": "SC",
          "text": "Have you had any taste and/or smell loss in the last 24 hours?",
          "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": "2020-03-30"
            }
          ]
        }
      ]
    },
    {
      "linkId": "D",
      "text": "Chronic illnesses",
      "item": [
        {
          "linkId": "D0",
          "text": "Have you been diagnosed with chronic lung disease by a doctor?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "D1",
          "text": "Have you been diagnosed with diabetes by a doctor?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        },
        {
          "linkId": "D2",
          "text": "Have you been diagnosed with heart disease by a doctor?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        },
        {
          "linkId": "D3",
          "text": "Have you been diagnosed with obesity by a doctor?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA32-8"
              }
            }
          ]
        }
      ]
    },
    {
      "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 October 2019 and today?",
          "answer": [
            {
              "valueCoding": {
                "system": "http://loinc.org",
                "code": "LA33-6"
              }
            }
          ]
        }
      ]
    }
  ],
  "language": "en"
}