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

<Questionnaire xmlns="http://hl7.org/fhir">  
    <meta> 
        <security> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>  
            <code value="HTEST"/>  
            <display value="test health data"/> 
        </security> 
    </meta>  
    <text> 
        <status value="generated"/>  
        <div xmlns="http://www.w3.org/1999/xhtml">  
            <pre>Lifelines Questionnaire 1 part 1 1. Do you have allergies? 2. General Questions: 2.a) What is your gender? 2.b) What is your date of birth? 2.c) What is your country of birth? 2.d) What is your marital status? 3. Intoxications: 3.a) Do you smoke? 3.b) Do you drink alcohol?</pre> 
        </div> 
    </text>  
    <url value="http://touchstone.com/fhir/Questionnaire/N1I2kTTcyJCL-kvBiFq7wj"/>  
    <identifier> 
        <use value="official"/>  
        <system value="http://happyvalley.com/questionnaire"/>  
        <value value="N1I2kTTcyJCL-kvBiFq7wj"/> 
    </identifier>  
    <name value="NewPatientQuestionnaire"/>  
    <status value="active"/>  
    <subjectType value="Patient"/>  
    <date value="2021-03-07"/>  
    <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>