<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="COVIDPublicHealthHistoryQuestionnaire"/>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire COVIDPublicHealthHistoryQuestionnaire</b></p><a name="COVIDPublicHealthHistoryQuestionnaire"> </a><a name="hcCOVIDPublicHealthHistoryQuestionnaire"> </a><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> COVIDPublicHealthHistoryQuestionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questions about a patient's recent COVID-19 history</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://fhir-ig.digital.health.nz/shared-care/Questionnaire/COVIDPublicHealthHistoryQuestionnaire#0.4.4</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.summary" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> summary</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questions about a patient's recent COVID-19 history</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item.p01" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> p01</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Public Health History</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q01-PlacesVisitedRecently" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-text.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="text" class="hierarchy"/> p01-q01-PlacesVisitedRecently</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 1. Places visited in last 14 days</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text">text</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q02-PrevPositive" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="boolean" class="hierarchy"/> p01-q02-PrevPositive</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 2. Previous positive COVID-19 test?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q02-1-PrevPositiveMonth" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p01-q02-1-PrevPositiveMonth</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 2-1. Month of positive COVID-19 test?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q02-PrevPositive">p01-q02-PrevPositive</a> = </span><br/>Options: <a href="#opt-item.p01-q02-1-PrevPositiveMonth">12 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q02-2-PrevPositiveYear" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> p01-q02-2-PrevPositiveYear</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 2-2. Year of positive COVID-19 test?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q02-PrevPositive">p01-q02-PrevPositive</a> = </span><br/>Options: <a href="#opt-item.p01-q02-2-PrevPositiveYear">11 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q03-HighSuspicionOfCOVID" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> p01-q03-HighSuspicionOfCOVID</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 3. High suspicion of prev. COVID-19?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q04-PotentialCloseContact" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="boolean" class="hierarchy"/> p01-q04-PotentialCloseContact</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 4. Potential close contact with a COVID-19 positive person in the last 14 days?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q05-COVID19Vaccine" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p01-q05-COVID19Vaccine</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 5. COVID-19 vaccine?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.p01-q05-COVID19Vaccine">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose1-date" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> p01-q06-dose1-date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 1st Dose. Date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose1-vaccine" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p01-q06-dose1-vaccine</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 1st Dose. Vaccine given</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q06-dose1-date">p01-q06-dose1-date</a> exists </span><br/>Options: <a href="#opt-item.p01-q06-dose1-vaccine">8 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose1-country" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> p01-q06-dose1-country</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 1st Dose. Country where vaccinated</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q06-dose1-date">p01-q06-dose1-date</a> exists </span><br/>Value Set: <a href="http://hl7.org/fhir/R4/valueset-iso3166-1-2.html">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose2-date" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="date" class="hierarchy"/> p01-q06-dose2-date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 2nd Dose. Date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose2-vaccine" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> p01-q06-dose2-vaccine</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 2nd Dose. Vaccine given</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q06-dose2-date">p01-q06-dose2-date</a> exists </span><br/>Options: <a href="#opt-item.p01-q06-dose2-vaccine">8 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose2-country" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p01-q06-dose2-country</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 2nd Dose. Country where vaccinated</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q06-dose2-date">p01-q06-dose2-date</a> exists </span><br/>Value Set: <a href="http://hl7.org/fhir/R4/valueset-iso3166-1-2.html">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose3-date" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-date.png" alt="." style="background-color: white; background-color: inherit" title="date" class="hierarchy"/> p01-q06-dose3-date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 3rd Dose. Date</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date">date</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)" id="item.p01-q06-dose3-vaccine" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> p01-q06-dose3-vaccine</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 3rd Dose. Vaccine given</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q06-dose3-date">p01-q06-dose3-date</a> exists </span><br/>Options: <a href="#opt-item.p01-q06-dose3-vaccine">8 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)" id="item.p01-q06-dose3-country" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> p01-q06-dose3-country</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">question 6 - 3rd Dose. Country where vaccinated</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p01-q06-dose3-date">p01-q06-dose3-date</a> exists </span><br/>Value Set: <a href="http://hl7.org/fhir/R4/valueset-iso3166-1-2.html">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.p01-q02-1-PrevPositiveMonth"> </a><p><b>Answer options for p01-q02-1-PrevPositiveMonth </b></p><ul><li style="font-size: 11px">January</li><li style="font-size: 11px">February</li><li style="font-size: 11px">March</li><li style="font-size: 11px">April</li><li style="font-size: 11px">May</li><li style="font-size: 11px">June</li><li style="font-size: 11px">July</li><li style="font-size: 11px">August</li><li style="font-size: 11px">September</li><li style="font-size: 11px">October</li><li style="font-size: 11px">November</li><li style="font-size: 11px">December</li></ul><a name="opt-item.p01-q02-2-PrevPositiveYear"> </a><p><b>Answer options for p01-q02-2-PrevPositiveYear </b></p><ul><li style="font-size: 11px">2020</li><li style="font-size: 11px">2021</li><li style="font-size: 11px">2022</li><li style="font-size: 11px">2023</li><li style="font-size: 11px">2024</li><li style="font-size: 11px">2025</li><li style="font-size: 11px">2026</li><li style="font-size: 11px">2027</li><li style="font-size: 11px">2028</li><li style="font-size: 11px">2029</li><li style="font-size: 11px">2030</li></ul><a name="opt-item.p01-q05-COVID19Vaccine"> </a><p><b>Answer options for p01-q05-COVID19Vaccine </b></p><ul><li style="font-size: 11px">null#Full (&quot;Full&quot;)</li><li style="font-size: 11px">null#Partial (&quot;Partial&quot;)</li><li style="font-size: 11px">null#Nil (&quot;Nil&quot;)</li></ul><a name="opt-item.p01-q06-dose1-vaccine"> </a><p><b>Answer options for p01-q06-dose1-vaccine </b></p><ul><li style="font-size: 11px">null#207 (&quot;Moderna&quot;)</li><li style="font-size: 11px">null#208 (&quot;Pfizer/BioNtech&quot;)</li><li style="font-size: 11px">null#210 (&quot;AstraZeneca / Covishield&quot;)</li><li style="font-size: 11px">null#211 (&quot;Novavax&quot;)</li><li style="font-size: 11px">null#212 (&quot;Janssen&quot;)</li><li style="font-size: 11px">null#505 (&quot;Sputnik V&quot;)</li><li style="font-size: 11px">null#510 (&quot;Sinopharm&quot;)</li><li style="font-size: 11px">null#511 (&quot;CoronaVac&quot;)</li></ul><a name="opt-item.p01-q06-dose2-vaccine"> </a><p><b>Answer options for p01-q06-dose2-vaccine </b></p><ul><li style="font-size: 11px">null#207 (&quot;Moderna&quot;)</li><li style="font-size: 11px">null#208 (&quot;Pfizer/BioNtech&quot;)</li><li style="font-size: 11px">null#210 (&quot;AstraZeneca / Covishield&quot;)</li><li style="font-size: 11px">null#211 (&quot;Novavax&quot;)</li><li style="font-size: 11px">null#212 (&quot;Janssen&quot;)</li><li style="font-size: 11px">null#505 (&quot;Sputnik V&quot;)</li><li style="font-size: 11px">null#510 (&quot;Sinopharm&quot;)</li><li style="font-size: 11px">null#511 (&quot;CoronaVac&quot;)</li></ul><a name="opt-item.p01-q06-dose3-vaccine"> </a><p><b>Answer options for p01-q06-dose3-vaccine </b></p><ul><li style="font-size: 11px">null#207 (&quot;Moderna&quot;)</li><li style="font-size: 11px">null#208 (&quot;Pfizer/BioNtech&quot;)</li><li style="font-size: 11px">null#210 (&quot;AstraZeneca / Covishield&quot;)</li><li style="font-size: 11px">null#211 (&quot;Novavax&quot;)</li><li style="font-size: 11px">null#212 (&quot;Janssen&quot;)</li><li style="font-size: 11px">null#505 (&quot;Sputnik V&quot;)</li><li style="font-size: 11px">null#510 (&quot;Sinopharm&quot;)</li><li style="font-size: 11px">null#511 (&quot;CoronaVac&quot;)</li></ul></div>
  </text>
  <url value="https://fhir-ig.digital.health.nz/shared-care/Questionnaire/COVIDPublicHealthHistoryQuestionnaire"/>
  <identifier>
    <use value="official"/>
    <value value="COVIDRegularHealthCheckQuestionnaire"/>
    <period>
      <start value="2023-07-01"/>
    </period>
  </identifier>
  <version value="0.4.4"/>
  <name value="COVIDPublicHealthHistoryQuestionnaire"/>
  <title value="COVID19 Public Health History Questionnaire"/>
  <status value="draft"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2023-07-19"/>
  <publisher value="Te Whatu Ora"/>
  <contact>
    <name value="Te Whatu Ora"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.tewhatuora.govt.nz/"/>
    </telecom>
  </contact>
  <contact>
    <name value="Te Whatu Ora Integration Team"/>
    <telecom>
      <system value="email"/>
      <value value="integration@tewhatuora.govt.nz"/>
      <use value="work"/>
    </telecom>
  </contact>
  <description value="Questions about a patient's recent COVID-19 history"/>
  <useContext>
    <code>
      <system value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="workflow"/>
      <display value="Workflow Setting"/>
    </code>
    <valueCodeableConcept>
      <text value="COVID Public Health History Questionnaire"/>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="NZ"/>
      <display value="New Zealand"/>
    </coding>
  </jurisdiction>
  <purpose value="For assessing patient's recent history of COVID-19 for public health purposes"/>
  <code>
    <system value="http://snomed.info/sct"/>
    <code value="292508471000119105"/>
    <display value="History of disease caused by severe acute respiratory syndrome coronavirus 2 (situation)"/>
  </code>
  <item>
    <linkId value="summary"/>
    <text value="Questions about a patient's recent COVID-19 history"/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="p01"/>
    <text value="Public Health History"/>
    <type value="group"/>
    <item>
      <linkId value="p01-q01-PlacesVisitedRecently"/>
      <prefix value="question 1"/>
      <text value="Places visited in last 14 days"/>
      <type value="text"/>
      <required value="false"/>
    </item>
    <item>
      <linkId value="p01-q02-PrevPositive"/>
      <prefix value="question 2"/>
      <text value="Previous positive COVID-19 test?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p01-q02-1-PrevPositiveMonth"/>
      <prefix value="question 2-1"/>
      <text value="Month of positive COVID-19 test?"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q02-PrevPositive"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="true"/>
      <answerOption>
        <valueString value="January"/>
      </answerOption>
      <answerOption>
        <valueString value="February"/>
      </answerOption>
      <answerOption>
        <valueString value="March"/>
      </answerOption>
      <answerOption>
        <valueString value="April"/>
      </answerOption>
      <answerOption>
        <valueString value="May"/>
      </answerOption>
      <answerOption>
        <valueString value="June"/>
      </answerOption>
      <answerOption>
        <valueString value="July"/>
      </answerOption>
      <answerOption>
        <valueString value="August"/>
      </answerOption>
      <answerOption>
        <valueString value="September"/>
      </answerOption>
      <answerOption>
        <valueString value="October"/>
      </answerOption>
      <answerOption>
        <valueString value="November"/>
      </answerOption>
      <answerOption>
        <valueString value="December"/>
      </answerOption>
    </item>
    <item>
      <linkId value="p01-q02-2-PrevPositiveYear"/>
      <prefix value="question 2-2"/>
      <text value="Year of positive COVID-19 test?"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q02-PrevPositive"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="true"/>
      <answerOption>
        <valueDate value="2020"/>
      </answerOption>
      <answerOption>
        <valueDate value="2021"/>
      </answerOption>
      <answerOption>
        <valueDate value="2022"/>
      </answerOption>
      <answerOption>
        <valueDate value="2023"/>
      </answerOption>
      <answerOption>
        <valueDate value="2024"/>
      </answerOption>
      <answerOption>
        <valueDate value="2025"/>
      </answerOption>
      <answerOption>
        <valueDate value="2026"/>
      </answerOption>
      <answerOption>
        <valueDate value="2027"/>
      </answerOption>
      <answerOption>
        <valueDate value="2028"/>
      </answerOption>
      <answerOption>
        <valueDate value="2029"/>
      </answerOption>
      <answerOption>
        <valueDate value="2030"/>
      </answerOption>
    </item>
    <item>
      <linkId value="p01-q03-HighSuspicionOfCOVID"/>
      <prefix value="question 3"/>
      <text value="High suspicion of prev. COVID-19?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p01-q04-PotentialCloseContact"/>
      <prefix value="question 4"/>
      <text value="Potential close contact with a COVID-19 positive person in the last 14 days?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p01-q05-COVID19Vaccine"/>
      <prefix value="question 5"/>
      <text value="COVID-19 vaccine?"/>
      <type value="choice"/>
      <required value="true"/>
      <answerOption>
        <valueCoding>
          <code value="Full"/>
          <display value="Full"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="Partial"/>
          <display value="Partial"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="Nil"/>
          <display value="Nil"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p01-q06-dose1-date"/>
      <prefix value="question 6 - 1st Dose"/>
      <text value="Date"/>
      <type value="date"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="p01-q06-dose1-vaccine"/>
      <prefix value="question 6 - 1st Dose"/>
      <text value="Vaccine given"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q06-dose1-date"/>
        <operator value="exists"/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerOption>
        <valueCoding>
          <code value="207"/>
          <display value="Moderna"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="208"/>
          <display value="Pfizer/BioNtech"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="210"/>
          <display value="AstraZeneca / Covishield"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="211"/>
          <display value="Novavax"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="212"/>
          <display value="Janssen"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="505"/>
          <display value="Sputnik V"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="510"/>
          <display value="Sinopharm"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="511"/>
          <display value="CoronaVac"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p01-q06-dose1-country"/>
      <prefix value="question 6 - 1st Dose"/>
      <text value="Country where vaccinated"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q06-dose1-date"/>
        <operator value="exists"/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerValueSet value="http://hl7.org/fhir/ValueSet/iso3166-1-2"/>
    </item>
    <item>
      <linkId value="p01-q06-dose2-date"/>
      <prefix value="question 6 - 2nd Dose"/>
      <text value="Date"/>
      <type value="date"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="p01-q06-dose2-vaccine"/>
      <prefix value="question 6 - 2nd Dose"/>
      <text value="Vaccine given"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q06-dose2-date"/>
        <operator value="exists"/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerOption>
        <valueCoding>
          <code value="207"/>
          <display value="Moderna"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="208"/>
          <display value="Pfizer/BioNtech"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="210"/>
          <display value="AstraZeneca / Covishield"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="211"/>
          <display value="Novavax"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="212"/>
          <display value="Janssen"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="505"/>
          <display value="Sputnik V"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="510"/>
          <display value="Sinopharm"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="511"/>
          <display value="CoronaVac"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p01-q06-dose2-country"/>
      <prefix value="question 6 - 2nd Dose"/>
      <text value="Country where vaccinated"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q06-dose2-date"/>
        <operator value="exists"/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerValueSet value="http://hl7.org/fhir/ValueSet/iso3166-1-2"/>
    </item>
    <item>
      <linkId value="p01-q06-dose3-date"/>
      <prefix value="question 6 - 3rd Dose"/>
      <text value="Date"/>
      <type value="date"/>
      <required value="false"/>
      <repeats value="false"/>
    </item>
    <item>
      <linkId value="p01-q06-dose3-vaccine"/>
      <prefix value="question 6 - 3rd Dose"/>
      <text value="Vaccine given"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q06-dose3-date"/>
        <operator value="exists"/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerOption>
        <valueCoding>
          <code value="207"/>
          <display value="Moderna"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="208"/>
          <display value="Pfizer/BioNtech"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="210"/>
          <display value="AstraZeneca / Covishield"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="211"/>
          <display value="Novavax"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="212"/>
          <display value="Janssen"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="505"/>
          <display value="Sputnik V"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="510"/>
          <display value="Sinopharm"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <code value="511"/>
          <display value="CoronaVac"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p01-q06-dose3-country"/>
      <prefix value="question 6 - 3rd Dose"/>
      <text value="Country where vaccinated"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p01-q06-dose3-date"/>
        <operator value="exists"/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="any"/>
      <required value="false"/>
      <repeats value="false"/>
      <answerValueSet value="http://hl7.org/fhir/ValueSet/iso3166-1-2"/>
    </item>
  </item>
</Questionnaire>