<?xml version=“1.0” encoding=“UTF-8”?> <Questionnaire xmlns=“hl7.org/fhir”>

<id value="bb"/>
<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/bb"/>
<title value="NSW Government My Personal Health Record"/>
<status value="draft"/>
<subjectType value="Patient"/>
<date value="2013-02-19"/>
<publisher value="New South Wales Department of Health"/>
<jurisdiction>
  <coding>
    <system value="urn:iso:std:iso:3166"/>
    <code value="AU"/>
  </coding>
</jurisdiction>
<item>
  <linkId value="birthDetails"/>
  <text value="Birth details - To be completed by health professional"/>
  <type value="group"/>
  <item>
    <linkId value="group"/>
    <type value="group"/>
    <item>
      <linkId value="nameOfChild"/>
      <text value="Name of child"/>
      <type value="string"/>
    </item>
    <item>
      <linkId value="sex"/>
      <text value="Sex"/>
      <type value="choice"/>
      <answerOption>
        <valueCoding>
          <code value="F"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="M"/>
        </valueCoding>
      </answerOption>
    </item>
  </item>
  <item>
    <linkId value="neonatalInformation"/>
    <text value="Neonatal Information"/>
    <type value="group"/>
    <item>
      <linkId value="birthWeight"/>
      <text value="Birth weight (kg)"/>
      <type value="decimal"/>
    </item>
    <item>
      <linkId value="birthLength"/>
      <text value="Birth length (cm)"/>
      <type value="decimal"/>
    </item>
    <item>
      <linkId value="vitaminKgiven"/>
      <text value="Vitamin K given"/>
      <type value="choice"/>
      <answerOption>
        <valueCoding>
          <code value="INJECTION"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="INTRAVENOUS"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="ORAL"/>
        </valueCoding>
      </answerOption>
      <item>
        <linkId value="vitaminKgivenDoses"/>
        <type value="group"/>
        <enableWhen>
          <question value="vitaminKgiven"/>
          <operator value="exists"/>
          <answerBoolean value="true"/>
        </enableWhen>
        <item>
          <linkId value="vitaminiKDose1"/>
          <text value="1st dose"/>
          <type value="dateTime"/>
        </item>
        <item>
          <linkId value="vitaminiKDose2"/>
          <text value="2nd dose"/>
          <type value="dateTime"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="hepBgiven"/>
      <text value="Hep B given y / n"/>
      <type value="boolean"/>
      <item>
        <linkId value="hepBgivenDate"/>
        <text value="Date given"/>
        <type value="date"/>
      </item>
    </item>
    <item>
      <linkId value="abnormalitiesAtBirth"/>
      <text value="Abnormalities noted at birth"/>
      <type value="string"/>
    </item>
  </item>
</item>

</Questionnaire>