SMARTBEAR\MOCAQuestionnaire - XML Representation

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

Draft as of 2023-08-01


<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="MOCAQuestionnaire"/>
  <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"/> MOCAQuestionnaire</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/MOCAQuestionnaire#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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" 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">Ask patient to trace the diagram in order</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-choice">choice</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">2 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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" 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">Ask patient to copy cube</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-choice">choice</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">2 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" 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">Ask patient to draw a clock (ten past eleven)</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-choice">choice</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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" 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">Ask patient to name the first animal</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-choice">choice</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">2 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" 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">Ask patient to name the second animal</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-choice">choice</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">2 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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" 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">Ask patient to name the third animal</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-choice">choice</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">2 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" 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">Read Face, Velvet, Church, Daisy, Red, and ask patient to repeat (do two trials and a recall later in exam)</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-choice">choice</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">2 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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" 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">Read list of digits (2, 1, 8, 5, 4) at 1 digit/sec and ask patient to repeat them in the forward order</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-choice">choice</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">2 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.8" 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> 8</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Read list of digits (7, 4, 2) at 1 digit/sec and ask patient to repeat them in the backward order</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-choice">choice</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.8">2 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.9" 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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> 9</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Read list of letters and ask patient to tap with their hand at each letter A: FBAC MNAA JKLB AFAK DEAA AJAM OFAAB </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-choice">choice</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.9">2 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.10" 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> 10</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ask patient to do five serial 7 subtractions starting at 100; Patient should say 93, 86, 79, 72, 65 </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-choice">choice</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.10">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.11" 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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> 11</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Read and ask patient to repeat:I only know that John is the one to help today</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-choice">choice</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.11">2 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.12" 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> 12</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Read and ask patient to repeat:The cat always hid under the couch when dogs were in the room</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-choice">choice</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.12">2 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.13" 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"/> 13</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ask patient to name maximum number of words in 1 minute that begin with the letter F</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.13">2 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.14" 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"/> 14</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ask patient similarity between train and bicycle (e.g. both are modes of transportation)</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.14">2 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.15" 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"/> 15</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ask patient similarity between watch and ruler (e.g. both are measuring tools)</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.15">2 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.16" 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"/> 16</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"> Ask patient to recall the words with no cue from the memory test previously conducted [ Face, Velvet, Church, Daisy, Red ]</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.16">6 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.17" 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"/> 17</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ask patient the date, month, year, day, place, and city</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.17">7 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.18" 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"/> 18</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"> Does patient have more than a 12th grade education?</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.18">2 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_bck00.png)" id="item.score" 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"/> score</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Score</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">https://smart-bear.eu/fhir/CodeSystem/IntegerResp#0 (&quot;Did not complete correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IntegerResp#1 (&quot;Completed correctly&quot;)</li></ul><a name="opt-item.1"> </a><p><b>Answer options for 1</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IntegerResp#0 (&quot;Did not complete correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IntegerResp#1 (&quot;Completed correctly&quot;)</li></ul><a name="opt-item.2"> </a><p><b>Answer options for 2</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS#0 (&quot;None of the above&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS#1 (&quot;Correctly drew hands only or Correctly drew numbers only or Correctly drew contour only&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS#2 (&quot;Correctly drew two out of three features (i.e., two out of contour, numbers, and hands)&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS#3 (&quot;Correctly drew all features (i.e., contour, numbers, and hands)&quot;)</li></ul><a name="opt-item.3"> </a><p><b>Answer options for 3</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/LionName#0 (&quot;Did not name lion&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/LionName#1 (&quot;Named lion&quot;)</li></ul><a name="opt-item.4"> </a><p><b>Answer options for 4</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RhinocerosName#0 (&quot;Did not name rhinoceros&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RhinocerosName#1 (&quot;Named rhinoceros&quot;)</li></ul><a name="opt-item.5"> </a><p><b>Answer options for 5</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CamelName#0 (&quot;Did not name camel&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CamelName#1 (&quot;Named camel&quot;)</li></ul><a name="opt-item.6"> </a><p><b>Answer options for 6</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RepeatTrials#0 (&quot;Did not complete both trials correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RepeatTrials#1 (&quot;Completed both trials correctly&quot;)</li></ul><a name="opt-item.7"> </a><p><b>Answer options for 7</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#0 (&quot;Did not repeat correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#1 (&quot;Repeated correctly&quot;)</li></ul><a name="opt-item.8"> </a><p><b>Answer options for 8</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#0 (&quot;Did not repeat correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#1 (&quot;Repeated correctly&quot;)</li></ul><a name="opt-item.9"> </a><p><b>Answer options for 9</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/ReadLetterA#0 (&quot;≥2 errors&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/ReadLetterA#1 (&quot;&lt;2 errors&quot;)</li></ul><a name="opt-item.10"> </a><p><b>Answer options for 10</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FiveSerial#0 (&quot;0 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FiveSerial#1 (&quot;1 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FiveSerial#2 (&quot;2 or 3 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/FiveSerial#3 (&quot;4 or 5 correct&quot;)</li></ul><a name="opt-item.11"> </a><p><b>Answer options for 11</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#0 (&quot;Did not repeat correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#1 (&quot;Repeated correctly&quot;)</li></ul><a name="opt-item.12"> </a><p><b>Answer options for 12</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#0 (&quot;Did not repeat correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat#1 (&quot;Repeated correctly&quot;)</li></ul><a name="opt-item.13"> </a><p><b>Answer options for 13</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/MaximumNamedLetterF#0 (&quot;Named &lt;11 words&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/MaximumNamedLetterF#3 (&quot;Named ≥11 words&quot;)</li></ul><a name="opt-item.14"> </a><p><b>Answer options for 14</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered#0 (&quot;Did not answer correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered#3 (&quot;Answered correctly&quot;)</li></ul><a name="opt-item.15"> </a><p><b>Answer options for 15</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered#0 (&quot;Did not answer correctly&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered#3 (&quot;Answered correctly&quot;)</li></ul><a name="opt-item.16"> </a><p><b>Answer options for 16</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RecallWords#0 (&quot;Did not recall any words&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RecallWords#1 (&quot;Recalled 1 words&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RecallWords#2 (&quot;Recalled 2 words&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RecallWords#3 (&quot;Recalled 3 words&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RecallWords#4 (&quot;Recalled 4 words&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/RecallWords#5 (&quot;Recalled all words&quot;)</li></ul><a name="opt-item.17"> </a><p><b>Answer options for 17</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#0 (&quot;None correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#1 (&quot;1 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#2 (&quot;2 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#3 (&quot;3 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#4 (&quot;4 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#5 (&quot;5 correct&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity#6 (&quot;All correct&quot;)</li></ul><a name="opt-item.18"> </a><p><b>Answer options for 18</b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/GradeEducation#0 (&quot;No&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/GradeEducation#1 (&quot;Yes&quot;)</li></ul></div>
  </text>
  <url value="https://smart-bear.eu/fhir/Questionnaire/MOCAQuestionnaire"/>
  <version value="0.3.2"/>
  <name value="MOCAQuestionnaire"/>
  <title value="Montreal Cognitive Assessment"/>
  <status value="draft"/>
  <date value="2023-08-01T11:22:15+02:00"/>
  <item>
    <linkId value="0"/>
    <text value="Ask patient to trace the diagram in order"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IntegerResp"/>
        <code value="0"/>
        <display value="Did not complete correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IntegerResp"/>
        <code value="1"/>
        <display value="Completed correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="1"/>
    <text value="Ask patient to copy cube"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IntegerResp"/>
        <code value="0"/>
        <display value="Did not complete correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IntegerResp"/>
        <code value="1"/>
        <display value="Completed correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="2"/>
    <text value="Ask patient to draw a clock (ten past eleven)"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS"/>
        <code value="0"/>
        <display value="None of the above"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS"/>
        <code value="1"/>
        <display
                 value="Correctly drew hands only or Correctly drew numbers only or Correctly drew contour only"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS"/>
        <code value="2"/>
        <display
                 value="Correctly drew two out of three features (i.e., two out of contour, numbers, and hands)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyDrewCS"/>
        <code value="3"/>
        <display
                 value="Correctly drew all features (i.e., contour, numbers, and hands)"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="3"/>
    <text value="Ask patient to name the first animal"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/LionName"/>
        <code value="0"/>
        <display value="Did not name lion"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/LionName"/>
        <code value="1"/>
        <display value="Named lion"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="4"/>
    <text value="Ask patient to name the second animal"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RhinocerosName"/>
        <code value="0"/>
        <display value="Did not name rhinoceros"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RhinocerosName"/>
        <code value="1"/>
        <display value="Named rhinoceros"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="5"/>
    <text value="Ask patient to name the third animal"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/CamelName"/>
        <code value="0"/>
        <display value="Did not name camel"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/CamelName"/>
        <code value="1"/>
        <display value="Named camel"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="6"/>
    <text
          value="Read Face, Velvet, Church, Daisy, Red, and ask patient to repeat (do two trials and a recall later in exam)"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RepeatTrials"/>
        <code value="0"/>
        <display value="Did not complete both trials correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RepeatTrials"/>
        <code value="1"/>
        <display value="Completed both trials correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="7"/>
    <text
          value="Read list of digits (2, 1, 8, 5, 4) at 1 digit/sec and ask patient to repeat them in the forward order"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="0"/>
        <display value="Did not repeat correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="1"/>
        <display value="Repeated correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="8"/>
    <text
          value="Read list of digits (7, 4, 2) at 1 digit/sec and ask patient to repeat them in the backward order"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="0"/>
        <display value="Did not repeat correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="1"/>
        <display value="Repeated correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="9"/>
    <text
          value="Read list of letters and ask patient to tap with their hand at each letter A: FBAC MNAA JKLB AFAK DEAA AJAM OFAAB "/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/ReadLetterA"/>
        <code value="0"/>
        <display value="≥2 errors"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/ReadLetterA"/>
        <code value="1"/>
        <display value="&lt;2 errors"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="10"/>
    <text
          value="Ask patient to do five serial 7 subtractions starting at 100; Patient should say 93, 86, 79, 72, 65 "/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FiveSerial"/>
        <code value="0"/>
        <display value="0 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FiveSerial"/>
        <code value="1"/>
        <display value="1 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FiveSerial"/>
        <code value="2"/>
        <display value="2 or 3 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/FiveSerial"/>
        <code value="3"/>
        <display value="4 or 5 correct"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="11"/>
    <text
          value="Read and ask patient to repeat:I only know that John is the one to help today"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="0"/>
        <display value="Did not repeat correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="1"/>
        <display value="Repeated correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="12"/>
    <text
          value="Read and ask patient to repeat:The cat always hid under the couch when dogs were in the room"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="0"/>
        <display value="Did not repeat correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyRepeat"/>
        <code value="1"/>
        <display value="Repeated correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="13"/>
    <text
          value="Ask patient to name maximum number of words in 1 minute that begin with the letter F"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/MaximumNamedLetterF"/>
        <code value="0"/>
        <display value="Named &lt;11 words"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/MaximumNamedLetterF"/>
        <code value="3"/>
        <display value="Named ≥11 words"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="14"/>
    <text
          value="Ask patient similarity between train and bicycle (e.g. both are modes of transportation)"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered"/>
        <code value="0"/>
        <display value="Did not answer correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered"/>
        <code value="3"/>
        <display value="Answered correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="15"/>
    <text
          value="Ask patient similarity between watch and ruler (e.g. both are measuring tools)"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered"/>
        <code value="0"/>
        <display value="Did not answer correctly"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/CorrectlyAnswered"/>
        <code value="3"/>
        <display value="Answered correctly"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="16"/>
    <text
          value=" Ask patient to recall the words with no cue from the memory test previously conducted [ Face, Velvet, Church, Daisy, Red ]"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RecallWords"/>
        <code value="0"/>
        <display value="Did not recall any words"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RecallWords"/>
        <code value="1"/>
        <display value="Recalled 1 words"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RecallWords"/>
        <code value="2"/>
        <display value="Recalled 2 words"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RecallWords"/>
        <code value="3"/>
        <display value="Recalled 3 words"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RecallWords"/>
        <code value="4"/>
        <display value="Recalled 4 words"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/RecallWords"/>
        <code value="5"/>
        <display value="Recalled all words"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="17"/>
    <text value="Ask patient the date, month, year, day, place, and city"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="0"/>
        <display value="None correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="1"/>
        <display value="1 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="2"/>
        <display value="2 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="3"/>
        <display value="3 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="4"/>
        <display value="4 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="5"/>
        <display value="5 correct"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/AskDatePlaceCity"/>
        <code value="6"/>
        <display value="All correct"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="18"/>
    <text value=" Does patient have more than a 12th grade education?"/>
    <type value="integer"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/GradeEducation"/>
        <code value="0"/>
        <display value="No"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/GradeEducation"/>
        <code value="1"/>
        <display value="Yes"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="score"/>
    <text value="Score"/>
    <type value="integer"/>
    <required value="true"/>
  </item>
</Questionnaire>