<?xml version=“1.0” encoding=“UTF-8”?><Questionnaire xmlns=“hl7.org/fhir”>

<id value="bb"/>
<text>
  <status value="generated"/>
  <div xmlns="http://www.w3.org/1999/xhtml">
    <pre>
      <b>Birth details - To be completed by health professional</b>
Name of child: ____________________________________
          Sex: __

Neonatal Information
  Birth Weight (kg): ___________
  Birth Length (cm): ___________
  Vitamin K given  : __
           1st dose: ___________
           2nd dose: ___________
  Hep B given      : __
    Date given     : ___________
  Abnormalities noted at birth:
    _______________________________________________
    </pre>
  </div>
</text>
<url value="http://hl7.org/fhir/Questionnaire/bb"/>
<title value="NSW Government My Personal Health Record"/>
<status value="draft"/>
<date value="2013-02-19"/>
<publisher value="New South Wales Department of Health"/>
<jurisdiction>
  <coding>
    <system value="urn:iso:std:iso:3166"/>
    <code value="AU"/>
  </coding>
</jurisdiction>
<subjectType value="Patient"/>
<item>
  <linkId value="birthDetails"/>
  <text value="Birth details - To be completed by health professional"/>
  <type value="group"/>
  <item>
    <linkId value="group"/>
    <type value="group"/>
    <item>
      <linkId value="nameOfChild"/>
      <text value="Name of child"/>
      <type value="string"/>
    </item>
    <item>
      <linkId value="sex"/>
      <text value="Sex"/>
      <type value="choice"/>
      <option>
        <valueCoding>
          <code value="F"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <code value="M"/>
        </valueCoding>
      </option>
    </item>
  </item>
  <item>
    <linkId value="neonatalInformation"/>
    <text value="Neonatal Information"/>
    <type value="group"/>
    <item>
      <linkId value="birthWeight"/>
      <text value="Birth weight (kg)"/>
      <type value="decimal"/>
    </item>
    <item>
      <linkId value="birthLength"/>
      <text value="Birth length (cm)"/>
      <type value="decimal"/>
    </item>
    <item>
      <linkId value="vitaminKgiven"/>
      <text value="Vitamin K given"/>
      <type value="choice"/>
      <option>
        <valueCoding>
          <code value="INJECTION"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <code value="INTRAVENOUS"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <code value="ORAL"/>
        </valueCoding>
      </option>
      <item>
        <linkId value="vitaminKgivenDoses"/>
        <type value="group"/>
        <enableWhen>
          <question value="vitaminKgiven"/>
          <hasAnswer value="true"/>
        </enableWhen>
        <item>
          <linkId value="vitaminiKDose1"/>
          <text value="1st dose"/>
          <type value="dateTime"/>
        </item>
        <item>
          <linkId value="vitaminiKDose2"/>
          <text value="2nd dose"/>
          <type value="dateTime"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="hepBgiven"/>
      <text value="Hep B given y / n"/>
      <type value="boolean"/>
      <item>
        <linkId value="hepBgivenDate"/>
        <text value="Date given"/>
        <type value="date"/>
      </item>
    </item>
    <item>
      <linkId value="abnormalitiesAtBirth"/>
      <text value="Abnormalities noted at birth"/>
      <type value="string"/>
    </item>
  </item>
</item>

</Questionnaire>