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 
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<QuestionnaireResponse xmlns="http://hl7.org/fhir"> <id value="questionnaireresponse-example-dast"/> <meta> <profile value="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/argo-questionnaireresponse"/> </meta> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <h3>Response Summary</h3> <strong>Questionnaire URL:</strong> http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-dast<br /> <strong>Date Completed:</strong> 2019-02-13T00:34:57.601979Z<br /> <hr /> <br /><strong>The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months. "Drug abuse" refers to (1) the use of prescribed or over-the-counter drugs in excess of the directions, and (2) any nonmedical use of drugs. The various classes of drugs may include cannabis (marijuana, hashish), solvents (e.g., paint thinner), tranquilizers (e.g., Valium), barbiturates, cocaine, stimulants (e.g., speed), hallucinogens (e.g., LSD) or narcotics (e.g., heroin). Remember that the questions do not include alcoholic beverages. Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right.</strong><br /><br /> <strong>Question:</strong> (linkID=g1.q1) Have you used drugs other than those required for medical reasons?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q2) Do you abuse more than one drug at a time?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q3) Are you unable to stop abusing drugs when you want to?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q4) Have you ever had blackouts or flashbacks as a result of drug use?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q5) Do you ever feel bad or guilty about your drug use?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q6) Does your spouse (or parents) ever complain about your involvement with drugs?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q7) Have you neglected your family because of your use of drugs?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q8) Have you engaged in illegal activities in order to obtain drugs?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q9) Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q10) Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?<br /><strong>Response:</strong> No ( code = LA32-8 , codesystem = http://loinc.org)<br /><br /><strong>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 (this is hidden text/should not be displayed to the user)</strong><br /> <br /><br /> </div> </text> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-responsePeriod"> <valuePeriod> <start value="2019-02-13T00:34:37.842016Z"/> <end value="2019-02-13T00:34:57.601979Z"/> </valuePeriod> </extension> <identifier> <value value="questionnaireresponse-example-dast"/> </identifier> <questionnaire> <reference value="http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-dast"/> </questionnaire> <status value="completed"/> <subject> <reference value="Patient/subject1"/> </subject> <context> <reference value="Encounter/encounter1"/> </context> <authored value="2019-02-13T00:34:57.601979Z"/> <author> <reference value="Practitioner/prov-admin1"/> </author> <source> <reference value="Patient/subject1"/> </source> <item> <linkId value="g1"/> <text value="Form"/> <item> <linkId value="g1.d"/> <text value="The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months. "Drug abuse" refers to (1) the use of prescribed or over-the-counter drugs in excess of the directions, and (2) any nonmedical use of drugs. The various classes of drugs may include cannabis (marijuana, hashish), solvents (e.g., paint thinner), tranquilizers (e.g., Valium), barbiturates, cocaine, stimulants (e.g., speed), hallucinogens (e.g., LSD) or narcotics (e.g., heroin). Remember that the questions do not include alcoholic beverages. Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right."/> </item> <item> <linkId value="g1.q1"/> <text value="Have you used drugs other than those required for medical reasons?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q2"/> <text value="Do you abuse more than one drug at a time?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q3"/> <text value="Are you unable to stop abusing drugs when you want to?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q4"/> <text value="Have you ever had blackouts or flashbacks as a result of drug use?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q5"/> <text value="Do you ever feel bad or guilty about your drug use?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q6"/> <text value="Does your spouse (or parents) ever complain about your involvement with drugs?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q7"/> <text value="Have you neglected your family because of your use of drugs?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q8"/> <text value="Have you engaged in illegal activities in order to obtain drugs?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q9"/> <text value="Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q10"/> <text value="Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA32-8"/> <display value="No"/> </valueCoding> </answer> </item> </item> <item> <linkId value="g2"/> <text value="Scoring Instructions"/> <item> <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"/> </item> </item> </QuestionnaireResponse>
