{
  "resourceType": "Questionnaire",
  "id": "zika-virus-exposure-assessment",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/cqf-questionnaire"
    ]
  },
  "contained": [
    {
      "resourceType": "ValueSet",
      "id": "options",
      "identifier": [
        {
          "system": "http://loinc.org",
          "value": "http://loinc.org/ValueSet/LL357-5"
        }
      ],
      "status": "active",
      "compose": {
        "include": [
          {
            "system": "http://loinc.org",
            "concept": [
              {
                "code": "LA6562-8",
                "display": "Not at all"
              },
              {
                "code": "LA6562-8",
                "display": "Several days"
              },
              {
                "code": "LA6562-8",
                "display": "More than half the days"
              },
              {
                "code": "LA6562-8",
                "display": "Nearly every day"
              }
            ]
          }
        ]
      }
    }
  ],
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      <pre>\n      </pre>\n    </div>"
  },
  "identifier": [
    {
      "use": "official",
      "value": "zika"
    }
  ],
  "version": "1.0.0",
  "title": "Example Zika Virus Exposure Assessment",
  "description": "Assess Zika virus exposure potential",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "code": [
    {
      "system": "http://loinc.org",
      "code": "44249-1",
      "display": "PHQ-9 quick depression assessment panel:-:Pt:^Patient:-:Report.PHQ-9",
      "extension": [
        {
          "url": "https://hlth.notion.site/Page-Extension-34cfaf892d3e419b98779dec422a7b19",
          "extension": [
            {
              "url": "1",
              "valueRange": {
                "low": {
                  "value": 1
                },
                "high": {
                  "value": 1
                }
              }
            },
            {
              "url": "2",
              "valueRange": {
                "low": {
                  "value": 4
                },
                "high": {
                  "value": 5
                }
              }
            },
            {
              "url": "3",
              "valueRange": {
                "low": {
                  "value": 6
                },
                "high": {
                  "value": 6
                }
              }
            }
          ]
        }
      ]
    }
  ],
  "url": "http://example.org/Questionnaire/zika-virus-exposure-assessment",
  "name": "ExampleZikaVirusExposureAssessment",
  "date": "2016-11-14",
  "effectivePeriod": {
    "start": "2016-11-14"
  },
  "item": [
    {
      "linkId": "1",
      "text": "Are you a resident of, or do you travel frequently to, an area with active Zika transmission?",
      "type": "boolean",
      "answerValueSet": "options"
    },
    {
      "linkId": "2",
      "code": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
              "valueDecimal": 1
            }
          ]
        }
      ],
      "text": "Have you recently traveled to an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "1",
          "operator": "=",
          "answerBoolean": false
        }
      ],
      "answerValueSet": "options"
    },
    {
      "linkId": "3",
      "code": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
              "valueDecimal": 0
            }
          ]
        }
      ],
      "text": "How long has it been since you returned?",
      "type": "quantity",
      "enableWhen": [
        {
          "question": "2",
          "operator": "=",
          "answerBoolean": true
        }
      ]
    },
    {
      "extension": [
        {
          "url": "http://example.org/additional-information",
          "valueAttachment": {
            "url": "http://www.cdc.gov/zika/geo/index.html",
            "title": "Areas with active Zika virus transmission/exposure risk"
          }
        }
      ],
      "linkId": "4",
      "code": [
        {
          "system": "http://example.org/questionnaires",
          "code": "CDE: Recent Sexual Encounter with Traveler to Zika Area"
        }
      ],
      "text": "Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "2",
          "operator": "=",
          "answerBoolean": false
        }
      ]
    },
    {
      "linkId": "5",
      "code": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
              "valueDecimal": 0
            }
          ]
        }
      ],
      "text": "How long has it been since your last condomless sexual encounter?",
      "type": "quantity",
      "answerValueSet": "options",
      "enableWhen": [
        {
          "question": "4",
          "operator": "=",
          "answerBoolean": true
        }
      ]
    },
    {
      "linkId": "6",
      "code": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
              "valueDecimal": 1
            }
          ]
        }
      ],
      "text": "Do you plan to travel to an area with active Zika transmission?",
      "type": "boolean",
      "answerValueSet": "options",
      "enableWhen": [
        {
          "question": "4",
          "operator": "=",
          "answerBoolean": false
        }
      ]
    }
  ]
}