<?xml version=“1.0” encoding=“UTF-8”?> <Questionnaire xmlns=“hl7.org/fhir”>
<id value="f201"/> <meta> <security> <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/> <code value="HTEST"/> <display value="test health data"/> </security> </meta> <url value="http://hl7.org/fhir/Questionnaire/f201"/> <status value="active"/> <subjectType value="Patient"/> <date value="2010"/> <code> <system value="http://example.org/system/code/lifelines/nl"/> <code value="VL 1-1, 18-65_1.2.2"/> <display value="Lifelines Questionnaire 1 part 1"/> </code> <item> <linkId value="1"/> <text value="Do you have allergies?"/> <type value="boolean"/> </item> <item> <linkId value="2"/> <text value="General questions"/> <type value="group"/> <item> <linkId value="2.1"/> <text value="What is your gender?"/> <type value="string"/> </item> <item> <linkId value="2.2"/> <text value="What is your date of birth?"/> <type value="date"/> </item> <item> <linkId value="2.3"/> <text value="What is your country of birth?"/> <type value="string"/> </item> <item> <linkId value="2.4"/> <text value="What is your marital status?"/> <type value="string"/> </item> </item> <item> <linkId value="3"/> <text value="Intoxications"/> <type value="group"/> <item> <linkId value="3.1"/> <text value="Do you smoke?"/> <type value="boolean"/> </item> <item> <linkId value="3.2"/> <text value="Do you drink alchohol?"/> <type value="boolean"/> </item> </item>
</Questionnaire>