{
  "resourceType": "Questionnaire",
  "status": "active",
  "item": [
    {
      "linkId": "cci",
      "text": "Charlson Comorbidity Index",
      "type": "group",
      "item": [
        {
          "linkId": "cci-mi",
          "text": "Myocardial infarction",
          "type": "boolean"
        },
        {
          "linkId": "cci-chf",
          "text": "Congestive heart failure",
          "type": "boolean"
        },
        {
          "linkId": "cci-pvd",
          "text": "Peripheral vascular disease",
          "type": "boolean"
        },
        {
          "linkId": "cci-cvd",
          "text": "Cerebrovascular disease",
          "type": "boolean"
        },
        {
          "linkId": "cci-dementia",
          "text": "Dementia",
          "type": "boolean"
        },
        {
          "linkId": "cci-copd",
          "text": "Chronic pulmonary disease",
          "type": "boolean"
        },
        {
          "linkId": "cci-rheum",
          "text": "Rheumatologic disease",
          "type": "boolean"
        },
        {
          "linkId": "cci-ulcer",
          "text": "Peptic ulcer disease",
          "type": "boolean"
        },
        {
          "linkId": "cci-hemiplegia",
          "text": "Hemiplegia or paraplegia",
          "type": "boolean"
        },
        {
          "linkId": "cci-renal",
          "text": "Renal disease",
          "type": "boolean"
        },
        {
          "linkId": "cci-leukemia",
          "text": "Leukemia",
          "type": "boolean"
        },
        {
          "linkId": "cci-lymphoma",
          "text": "Lymphoma",
          "type": "boolean"
        },
        {
          "linkId": "cci-aids",
          "text": "AIDS",
          "type": "boolean"
        },
        {
          "linkId": "cci-liver",
          "text": "Liver disease",
          "type": "choice",
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button"
                  }
                ]
              }
            }
          ],
          "answerOption": [
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "none",
                "display": "None"
              }
            },
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "mild",
                "display": "Mild"
              }
            },
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "severe",
                "display": "Moderate or severe"
              }
            }
          ]
        },
        {
          "linkId": "cci-diabetes",
          "text": "Diabetes",
          "type": "choice",
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button"
                  }
                ]
              }
            }
          ],
          "answerOption": [
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "none",
                "display": "None"
              }
            },
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "uncomplicated",
                "display": "Without end-organ damage"
              }
            },
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "end-organ",
                "display": "With end-organ damage"
              }
            }
          ]
        },
        {
          "linkId": "cci-tumor",
          "text": "Solid tumor",
          "type": "choice",
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "radio-button"
                  }
                ]
              }
            }
          ],
          "answerOption": [
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "none",
                "display": "None"
              }
            },
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "localized",
                "display": "Localized"
              }
            },
            {
              "valueCoding": {
                "system": "https://fhirbuilder.com/CodeSystem/templates",
                "code": "metastatic",
                "display": "Metastatic"
              }
            }
          ]
        },
        {
          "linkId": "cci-age",
          "text": "Age (years)",
          "type": "integer",
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
              "valueCoding": {
                "system": "http://unitsofmeasure.org",
                "code": "a",
                "display": "years"
              }
            }
          ]
        },
        {
          "linkId": "cci-index",
          "text": "Charlson Comorbidity Index (age-adjusted)",
          "type": "integer",
          "readOnly": true,
          "extension": [
            {
              "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
              "valueExpression": {
                "language": "text/fhirpath",
                "expression": "iif(%resource.item.where(linkId='cci').item.where(linkId='cci-age').answer.valueInteger.exists(), (((iif(%resource.item.where(linkId='cci').item.where(linkId='cci-mi').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-chf').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-pvd').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-cvd').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-dementia').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-copd').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-rheum').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-ulcer').answer.valueBoolean, 1, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-hemiplegia').answer.valueBoolean, 2, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-renal').answer.valueBoolean, 2, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-leukemia').answer.valueBoolean, 2, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-lymphoma').answer.valueBoolean, 2, 0)) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-aids').answer.valueBoolean, 6, 0)) + (iif((%resource.item.where(linkId='cci').item.where(linkId='cci-liver').answer.valueCoding.code = 'mild'), 1, 0)) + (iif((%resource.item.where(linkId='cci').item.where(linkId='cci-liver').answer.valueCoding.code = 'severe'), 3, 0)) + (iif((%resource.item.where(linkId='cci').item.where(linkId='cci-diabetes').answer.valueCoding.code = 'uncomplicated'), 1, 0)) + (iif((%resource.item.where(linkId='cci').item.where(linkId='cci-diabetes').answer.valueCoding.code = 'end-organ'), 2, 0)) + (iif((%resource.item.where(linkId='cci').item.where(linkId='cci-tumor').answer.valueCoding.code = 'localized'), 2, 0)) + (iif((%resource.item.where(linkId='cci').item.where(linkId='cci-tumor').answer.valueCoding.code = 'metastatic'), 6, 0))) + (iif(%resource.item.where(linkId='cci').item.where(linkId='cci-age').answer.valueInteger.exists(), iif(%resource.item.where(linkId='cci').item.where(linkId='cci-age').answer.valueInteger < 50, 0, iif(%resource.item.where(linkId='cci').item.where(linkId='cci-age').answer.valueInteger < 60, 1, iif(%resource.item.where(linkId='cci').item.where(linkId='cci-age').answer.valueInteger < 70, 2, iif(%resource.item.where(linkId='cci').item.where(linkId='cci-age').answer.valueInteger < 80, 3, 4)))), {}))), {})"
              }
            }
          ]
        }
      ]
    }
  ]
}