<?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>