This page is part of the Argonaut Questionnaire Implementation Guide (v1.0.0: Release) based on FHIR R3. This is the current published version. For a full list of available versions, see the Directory of published versions 
XML Format: Questionnaire-questionnaire-example-dast
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url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </option> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="1"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA33-6"/> <display value="Yes"/> </valueCoding> </option> </item> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="7"/> </extension> <linkId value="g1.q7"/> <code> <system value="http://loinc.org"/> <code value="68531-3"/> </code> <prefix value="7."/> <text value="Have you neglected your family because of your use of drugs?"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="0"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </option> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="1"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA33-6"/> <display value="Yes"/> </valueCoding> </option> </item> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="8"/> </extension> <linkId value="g1.q8"/> <code> <system value="http://loinc.org"/> <code value="68532-1"/> </code> <prefix value="8."/> <text value="Have you engaged in illegal activities in order to obtain drugs?"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="0"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </option> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="1"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA33-6"/> <display value="Yes"/> </valueCoding> </option> </item> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="9"/> </extension> <linkId value="g1.q9"/> <code> <system value="http://loinc.org"/> <code value="68533-9"/> </code> <prefix value="9."/> <text value="Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="0"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </option> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="1"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA33-6"/> <display value="Yes"/> </valueCoding> </option> </item> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="10"/> </extension> <linkId value="g1.q10"/> <code> <system value="http://loinc.org"/> <code value="68534-7"/> </code> <prefix value="10."/> <text value="Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?"/> <type value="choice"/> <repeats value="false"/> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="0"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </option> <option> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-ordinalValue"> <valueDecimal value="1"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueCoding> <system value="http://loinc.org"/> <code value="LA33-6"/> <display value="Yes"/> </valueCoding> </option> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/designNote"> <valueMarkdown value="this is hidden text/should not be displayed to the user"/> </extension> <linkId value="g2"/> <text value="Scoring Instructions"/> <type value="group"/> <required value="true"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true"/> </extension> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/designNote"> <valueMarkdown value="this is hidden text/should not be displayed to the user"/> </extension> <linkId value="g2.d"/> <text value="Scoring: Score 1 point for each question answered “Yes,” except for question 3 for which a “No” receives 1 point. Interpretation of Score: Score Degree of Problems Related to Drug Abuse Suggested Action 0 No problems reported None at this time 1‐2 Low level Monitor, re‐assess at a later date 3‐5 Moderate level Further investigation 6‐8 Substantial level Intensive assessment 9‐10 Severe level Intensive assessment"/> <type value="display"/> </item> </item> </Questionnaire>
