SMARTBEAR\IADLQuestionnaire - XML Representation

Smart Bear Implementation Guide - Local Development build (v0.3.2). See the Directory of published versions
: IADLQuestionnaire - XML Representation

Draft as of 2023-08-01


<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="IADLQuestionnaire"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" 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 : 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"/> IADLQuestionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://smart-bear.eu/fhir/Questionnaire/IADLQuestionnaire#0.3.2</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.0" 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-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Integer" class="hierarchy"/> 0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ability to Use Telephone</td><td style="vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.0">4 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.1" 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-integer.png" alt="." style="background-color: white; background-color: inherit" title="Integer" class="hierarchy"/> 1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Shopping</td><td style="vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.1">4 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.2" 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-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Integer" class="hierarchy"/> 2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Food Preparation</td><td style="vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2">4 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.3" 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-integer.png" alt="." style="background-color: white; background-color: inherit" title="Integer" class="hierarchy"/> 3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Housekeeping</td><td style="vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.3">5 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.4" 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-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Integer" class="hierarchy"/> 4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Laundry</td><td style="vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.4">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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.5" 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-integer.png" alt="." style="background-color: white; background-color: inherit" title="Integer" class="hierarchy"/> 5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Mode of Transportation</td><td style="vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.5">5 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.6" 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-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Integer" class="hierarchy"/> 6</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Responsibility for own medications</td><td style="vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.6">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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.7" 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-integer.png" alt="." style="background-color: white; background-color: inherit" title="Integer" class="hierarchy"/> 7</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ability to Handle Finances</td><td style="vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.7">3 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.globalScore" 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-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Integer" class="hierarchy"/> globalScore</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.ptScore" 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-integer.png" alt="." style="background-color: white; background-color: inherit" title="Integer" class="hierarchy"/> ptScore</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Option Sets</b></p><a name="opt-item.0"> </a><p><b>Answer options for 0</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>3</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.1"> </a><p><b>Answer options for 1</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>3</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.2"> </a><p><b>Answer options for 2</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>3</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.3"> </a><p><b>Answer options for 3</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>4</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>3</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.4"> </a><p><b>Answer options for 4</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.5"> </a><p><b>Answer options for 5</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>4</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>3</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.6"> </a><p><b>Answer options for 6</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul><a name="opt-item.7"> </a><p><b>Answer options for 7</b></p><ul><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>2</li><li style="font-size: 11px"><img src="icon-not-selected.png" alt="icon"/>1</li><li style="font-size: 11px"><img src="icon-selected.png" alt="icon"/>0</li></ul></div>
  </text>
  <url value="https://smart-bear.eu/fhir/Questionnaire/IADLQuestionnaire"/>
  <version value="0.3.2"/>
  <name value="IADLQuestionnaire"/>
  <title value="Clinical response questionnaire at baseline"/>
  <status value="draft"/>
  <date value="2023-08-01T11:22:15+02:00"/>
  <item>
    <linkId value="0"/>
    <text value="Ability to Use Telephone"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="1"/>
    <text value="Shopping"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="2"/>
    <text value="Food Preparation"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="3"/>
    <text value="Housekeeping"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="4"/>
    </answerOption>
    <answerOption>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="4"/>
    <text value="Laundry"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="5"/>
    <text value="Mode of Transportation"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="4"/>
    </answerOption>
    <answerOption>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="6"/>
    <text value="Responsibility for own medications"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="7"/>
    <text value="Ability to Handle Finances"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <valueInteger value="1"/>
    </answerOption>
    <answerOption>
      <valueInteger value="0"/>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="globalScore"/>
    <type value="integer"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="ptScore"/>
    <type value="integer"/>
    <required value="true"/>
  </item>
</Questionnaire>