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

<id value="zika-virus-exposure-assessment"/>
<meta>
  <security>
    <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
    <code value="HTEST"/>
    <display value="test health data"/>
  </security>
</meta>

<url value="http://example.org/Questionnaire/zika-virus-exposure-assessment"/>
<name value="ExampleZikaVirusExposureAssessment"/>
<title value="Example Zika Virus Exposure Assessment"/>
<status value="draft"/>
<subjectType value="Patient"/>
<date value="2016-11-14"/>
<description value="Example questionnaire to assess Zika virus exposure potential."/>
<effectivePeriod>
  <start value="2016-11-14"/>
</effectivePeriod>

<item>
      <extension url="http://example.org/additional-information">
        <valueAttachment>
                <url value="http://www.cdc.gov/zika/geo/index.html"/>
                <title value="Areas with active Zika virus transmission/exposure risk"/>
        </valueAttachment>
      </extension>
  <linkId value="1"/>
  <code>
    <system value="http://example.org/questionnaires"/>
    <code value="CDE: Resident of or Frequent Traveler to Zika Area"/>
  </code>
  <text value="Are you a resident of, or do you travel frequently to, an area with active Zika transmission?"/>
  <type value="boolean"/>
</item>

<item>
      <extension url="http://example.org/additional-information">
        <valueAttachment>
                <url value="http://www.cdc.gov/zika/geo/index.html"/>
                <title value="Areas with active Zika virus transmission/exposure risk"/>
        </valueAttachment>
      </extension>
  <linkId value="2"/>
  <code>
              <system value="http://example.org/questionnaires"/>
              <code value="CDE: Recent Travel to Zika Area"/>
  </code>
      <text value="Have you recently traveled to an area with active Zika transmission?"/>
      <type value="boolean"/>
      <enableWhen>
              <question value="1"/>
  <operator value="="/>
              <answerBoolean value="false"/>
      </enableWhen>
</item>
<item>
  <linkId value="3"/>
  <code>
              <system value="http://example.org/questionnaires"/>
              <code value="CDE: Time Since Returned From Travel"/>
  </code>
      <text value="How long has it been since you returned?"/>
      <type value="quantity"/>
      <enableWhen>
              <question value="2"/>
  <operator value="="/>
              <answerBoolean value="true"/>
      </enableWhen>
</item>
<item>
      <extension url="http://example.org/additional-information">
        <valueAttachment>
                <url value="http://www.cdc.gov/zika/geo/index.html"/>
                <title value="Areas with active Zika virus transmission/exposure risk"/>
        </valueAttachment>
      </extension>
  <linkId value="4"/>
  <code>
              <system value="http://example.org/questionnaires"/>
              <code value="CDE: Recent Sexual Encounter with Traveler to Zika Area"/>
  </code>
      <text value="Have you recently had condomless sex with a partner that has travelled in an area with active Zika transmission?"/>
      <type value="boolean"/>
      <enableWhen>
              <question value="2"/>
  <operator value="="/>
              <answerBoolean value="false"/>
      </enableWhen>
</item>
<item>
  <linkId value="5"/>
  <code>
              <system value="http://example.org/questionnaires"/>
              <code value="CDE: Time Since Sexual Encounter"/>
  </code>
      <text value="How long has it been since your last condomless sexual encounter?"/>
      <type value="quantity"/>
      <enableWhen>
              <question value="4"/>
  <operator value="="/>
              <answerBoolean value="true"/>
      </enableWhen>
</item>
<item>
      <extension url="http://example.org/additional-information">
        <valueAttachment>
                <url value="http://www.cdc.gov/zika/geo/index.html"/>
                <title value="Areas with active Zika virus transmission/exposure risk"/>
        </valueAttachment>
      </extension>
  <linkId value="6"/>
  <code>
    <system value="http://example.org/questionnaires"/>
    <code value="CDE: Planned Travel to Zika Area"/>
  </code>
  <text value="Do you plan to travel to an area with active Zika transmission?"/>
      <type value="boolean"/>
      <enableWhen>
              <question value="4"/>
  <operator value="="/>
              <answerBoolean value="false"/>
      </enableWhen>
</item>

</Questionnaire>