{
  "resourceType": "Questionnaire",
  "status": "active",
  "item": [
    {
      "linkId": "apgar",
      "text": "Apgar Score",
      "type": "group",
      "item": [
        {
          "linkId": "apgar1",
          "text": "1 minute after birth",
          "type": "group",
          "item": [
            {
              "linkId": "apgar1-color",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32406-1"
                }
              ],
              "text": "Color (appearance)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6722-8",
                    "display": "The baby's whole body is completely bluish-gray or pale"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6723-6",
                    "display": "Good color in body with bluish hands or feet"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6724-4",
                    "display": "Good color all over"
                  }
                }
              ]
            },
            {
              "linkId": "apgar1-heart-rate",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32407-9"
                }
              ],
              "text": "Heart rate (pulse)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6716-0",
                    "display": "No heart rate"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6717-8",
                    "display": "Fewer than 100 beats per minute"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6718-6",
                    "display": "At least 100 beats per minute"
                  }
                }
              ]
            },
            {
              "linkId": "apgar1-tone",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32408-7"
                }
              ],
              "text": "Muscle tone (activity)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6713-7",
                    "display": "Limp; no movement"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6714-5",
                    "display": "Some flexion of arms and legs"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6715-2",
                    "display": "Active motion"
                  }
                }
              ]
            },
            {
              "linkId": "apgar1-reflex",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32409-5"
                }
              ],
              "text": "Reflex irritability (grimace)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6719-4",
                    "display": "No response to airways being suctioned"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6720-2",
                    "display": "Grimace during suctioning"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6721-0",
                    "display": "Grimace and pulling away, cough, or sneeze during suctioning"
                  }
                }
              ]
            },
            {
              "linkId": "apgar1-respiration",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32410-3"
                }
              ],
              "text": "Respiratory effort",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6725-1",
                    "display": "Not breathing"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6726-9",
                    "display": "Weak cry; may sound like whimpering, slow or irregular breathing"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6727-7",
                    "display": "Good, strong cry; normal rate and effort of breathing"
                  }
                }
              ]
            },
            {
              "linkId": "apgar1-total",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "9272-6"
                }
              ],
              "text": "Apgar score (0–10)",
              "type": "decimal",
              "readOnly": true,
              "extension": [
                {
                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "iif(%resource.repeat(item).where(linkId in ('apgar1-color' | 'apgar1-heart-rate' | 'apgar1-tone' | 'apgar1-reflex' | 'apgar1-respiration')).answer.valueCoding.extension('http://hl7.org/fhir/StructureDefinition/ordinalValue').valueDecimal.count() = 5, %resource.repeat(item).where(linkId in ('apgar1-color' | 'apgar1-heart-rate' | 'apgar1-tone' | 'apgar1-reflex' | 'apgar1-respiration')).answer.valueCoding.extension('http://hl7.org/fhir/StructureDefinition/ordinalValue').valueDecimal.sum(), {})"
                  }
                }
              ]
            },
            {
              "linkId": "apgar1-band",
              "text": "Result",
              "type": "string",
              "readOnly": true,
              "extension": [
                {
                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "iif(%resource.repeat(item).where(linkId='apgar1-total').answer.valueDecimal.exists(), iif(%resource.repeat(item).where(linkId='apgar1-total').answer.valueDecimal < 4, 'Low (0–3)', iif(%resource.repeat(item).where(linkId='apgar1-total').answer.valueDecimal < 7, 'Moderately abnormal (4–6)', 'Reassuring (7–10)')), {})"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId": "apgar5",
          "text": "5 minutes after birth",
          "type": "group",
          "item": [
            {
              "linkId": "apgar5-color",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32411-1"
                }
              ],
              "text": "Color (appearance)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6722-8",
                    "display": "The baby's whole body is completely bluish-gray or pale"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6723-6",
                    "display": "Good color in body with bluish hands or feet"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6724-4",
                    "display": "Good color all over"
                  }
                }
              ]
            },
            {
              "linkId": "apgar5-heart-rate",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32412-9"
                }
              ],
              "text": "Heart rate (pulse)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6716-0",
                    "display": "No heart rate"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6717-8",
                    "display": "Fewer than 100 beats per minute"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6718-6",
                    "display": "At least 100 beats per minute"
                  }
                }
              ]
            },
            {
              "linkId": "apgar5-tone",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32413-7"
                }
              ],
              "text": "Muscle tone (activity)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6713-7",
                    "display": "Limp; no movement"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6714-5",
                    "display": "Some flexion of arms and legs"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6715-2",
                    "display": "Active motion"
                  }
                }
              ]
            },
            {
              "linkId": "apgar5-reflex",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32414-5"
                }
              ],
              "text": "Reflex irritability (grimace)",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6719-4",
                    "display": "No response to airways being suctioned"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6720-2",
                    "display": "Grimace during suctioning"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6721-0",
                    "display": "Grimace and pulling away, cough, or sneeze during suctioning"
                  }
                }
              ]
            },
            {
              "linkId": "apgar5-respiration",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "32415-2"
                }
              ],
              "text": "Respiratory effort",
              "type": "choice",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "radio-button"
                      }
                    ]
                  }
                }
              ],
              "required": true,
              "answerOption": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6725-1",
                    "display": "Not breathing"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6726-9",
                    "display": "Weak cry; may sound like whimpering, slow or irregular breathing"
                  }
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ],
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6727-7",
                    "display": "Good, strong cry; normal rate and effort of breathing"
                  }
                }
              ]
            },
            {
              "linkId": "apgar5-total",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "9274-2"
                }
              ],
              "text": "Apgar score (0–10)",
              "type": "decimal",
              "readOnly": true,
              "extension": [
                {
                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "iif(%resource.repeat(item).where(linkId in ('apgar5-color' | 'apgar5-heart-rate' | 'apgar5-tone' | 'apgar5-reflex' | 'apgar5-respiration')).answer.valueCoding.extension('http://hl7.org/fhir/StructureDefinition/ordinalValue').valueDecimal.count() = 5, %resource.repeat(item).where(linkId in ('apgar5-color' | 'apgar5-heart-rate' | 'apgar5-tone' | 'apgar5-reflex' | 'apgar5-respiration')).answer.valueCoding.extension('http://hl7.org/fhir/StructureDefinition/ordinalValue').valueDecimal.sum(), {})"
                  }
                }
              ]
            },
            {
              "linkId": "apgar5-band",
              "text": "Result",
              "type": "string",
              "readOnly": true,
              "extension": [
                {
                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
                  "valueExpression": {
                    "language": "text/fhirpath",
                    "expression": "iif(%resource.repeat(item).where(linkId='apgar5-total').answer.valueDecimal.exists(), iif(%resource.repeat(item).where(linkId='apgar5-total').answer.valueDecimal < 4, 'Low (0–3)', iif(%resource.repeat(item).where(linkId='apgar5-total').answer.valueDecimal < 7, 'Moderately abnormal (4–6)', 'Reassuring (7–10)')), {})"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}