<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <language value="en" />
  <questionnaire value="http://fhir.data4life.care/covid-19/r4/Questionnaire/covid19-recommendation|3.0.0" />
  <status value="completed" />
  <authored value="2020-05-04T14:15:00-05:00" />
  <item>
    <linkId value="P" />
    <text value="Personal information" />
    <item>
      <linkId value="P0" />
      <text value="How old are you?" />
      <answer>
        <valueCoding>
          <system value="http://fhir.data4life.care/covid-19/r4/CodeSystem/age-group" />
          <code value="61-70" />
        </valueCoding>
      </answer>
    </item>
    <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" />
      <text value="Do you work in one of the following areas?" />
      <answer>
        <valueCoding>
          <system value="http://fhir.data4life.care/covid-19/r4/CodeSystem/occupation-class" />
          <code value="community" />
        </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="S0" />
      <text value="Have you had a fever (over 38°C) in the past 24 hours?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S1" />
      <text value="Have you had a fever (over 38°C) in the past 4 days?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S2" />
      <text value="What was the highest temperature, approx.?" />
      <answer>
        <valueCoding>
          <system value="http://fhir.data4life.care/covid-19/r4/CodeSystem/fever-class" />
          <code value="40C" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S3" />
      <text value="Have you had chills in the past 24 hours?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S4" />
      <text value="In the past 24 hours, have you felt tired or worn out?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S5" />
      <text value="In the past 24 hours, have you had body aches?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S6" />
      <text value="In the past 24 hours, have you had a persistent cough?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S7" />
      <text value="In the past 24 hours, have you had a runny nose?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S8" />
      <text value="In the past 24 hours, have you had diarrhea?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="S9" />
      <text value="In the past 24 hours, have you had a sore throat?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="SA" />
      <text value="In the past 24 hours, have you had a headache?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </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="SC" />
      <text value="Have you had any taste and/or smell loss in the last 24 hours?" />
      <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="2020-03-30" />
      </answer>
    </item>
  </item>
  <item>
    <linkId value="D" />
    <text value="Chronic illnesses" />
    <item>
      <linkId value="D0" />
      <text value="Have you been diagnosed with chronic lung disease by a doctor?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="D1" />
      <text value="Have you been diagnosed with diabetes by a doctor?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="D2" />
      <text value="Have you been diagnosed with heart disease by a doctor?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="D3" />
      <text value="Have you been diagnosed with obesity by a doctor?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA32-8" />
        </valueCoding>
      </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 October 2019 and today?" />
      <answer>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA33-6" />
        </valueCoding>
      </answer>
    </item>
  </item>
</QuestionnaireResponse>