{
  "resourceType": "StructureDefinition",
  "id": "QuestionnaireResponse",
  "url": "https://fhir.centraxx.de/StructureDefinition/QuestionnaireResponse",
  "version": "2025.4.0",
  "name": "QuestionnaireResponse",
  "status": "active",
  "publisher": "Kairos an IQVIA business",
  "description": "Represents a CentraXX crf. CentraXX crfs can be updated but not created.",
  "fhirVersion": "4.0.1",
  "kind": "resource",
  "abstract": false,
  "type": "QuestionnaireResponse",
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "QuestionnaireResponse.extension",
        "path": "QuestionnaireResponse.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "5",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.extension:updateWithOverwrite",
        "path": "QuestionnaireResponse.extension",
        "sliceName": "updateWithOverwrite",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/updateWithOverwrite"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.extension:studyVisit",
        "path": "QuestionnaireResponse.extension",
        "sliceName": "studyVisit",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/study/visits/visit"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.extension:studyPhase",
        "path": "QuestionnaireResponse.extension",
        "sliceName": "studyPhase",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/study/phases/phase"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.extension:crfCreationDate",
        "path": "QuestionnaireResponse.extension",
        "sliceName": "crfCreationDate",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/crf/creationDate"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.extension:approvalState",
        "path": "QuestionnaireResponse.extension",
        "sliceName": "approvalState",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/studyVisitItem/approvalState"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.extension:surveyDueDate",
        "path": "QuestionnaireResponse.extension",
        "sliceName": "surveyDueDate",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/survey/dueDate"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.identifier",
        "path": "QuestionnaireResponse.identifier",
        "min": 0,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.identifier.value",
        "path": "QuestionnaireResponse.identifier.value",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.questionnaire",
        "path": "QuestionnaireResponse.questionnaire",
        "min": 0,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.status",
        "path": "QuestionnaireResponse.status",
        "min": 0,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.subject",
        "path": "QuestionnaireResponse.subject",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.centraxx.de/StructureDefinition/StudyMember"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.authored",
        "path": "QuestionnaireResponse.authored",
        "min": 0,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.author",
        "path": "QuestionnaireResponse.author",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Reference",
            "targetProfile": [
              "https://fhir.centraxx.de/StructureDefinition/Person"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item",
        "path": "QuestionnaireResponse.item",
        "min": 0,
        "max": "*",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.extension",
        "path": "QuestionnaireResponse.item.extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.extension:valueIndex",
        "path": "QuestionnaireResponse.item.extension",
        "sliceName": "valueIndex",
        "min": 1,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/crf/item/valueIndex"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.linkId",
        "path": "QuestionnaireResponse.item.linkId",
        "comment": "The id of the corresponding CrfTemplateField",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.text",
        "path": "QuestionnaireResponse.item.text",
        "min": 0,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer",
        "path": "QuestionnaireResponse.item.answer",
        "min": 0,
        "max": "*",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "slicing": {
          "discriminator": [
            {
              "type": "type",
              "path": "$this"
            }
          ],
          "rules": "closed"
        },
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueBoolean",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueBoolean",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "boolean"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueBoolean.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueBoolean.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueBoolean.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueAttachment",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Attachment"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.contentType",
        "path": "QuestionnaireResponse.item.answer.value[x].contentType",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.data",
        "path": "QuestionnaireResponse.item.answer.value[x].data",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.size",
        "path": "QuestionnaireResponse.item.answer.value[x].size",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.title",
        "path": "QuestionnaireResponse.item.answer.value[x].title",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueAttachment.creation",
        "path": "QuestionnaireResponse.item.answer.value[x].creation",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDecimal",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueDecimal",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "decimal"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDecimal.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDecimal.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDecimal.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueInteger",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueInteger",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "integer"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueInteger.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueInteger.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueInteger.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueCoding",
        "min": 0,
        "max": "*",
        "type": [
          {
            "code": "Coding"
          }
        ],
        "example": [
          {
            "label": "Icd Entry",
            "valueCoding": {
              "system": "urn:centraxx:CodeSystem/IcdCatalog-18",
              "version": "code",
              "code": "A32.1"
            }
          },
          {
            "label": "Ops entry",
            "valueCoding": {
              "system": "urn:centraxx:CodeSystem/OpsCatalog-3",
              "code": "1-100"
            }
          },
          {
            "label": "custom catalog entry",
            "valueCoding": {
              "system": "urn:centraxx:CodeSystem/Catalog-4",
              "code": "the custom code"
            }
          },
          {
            "label": "usage entry (controlled vocabulary)",
            "valueCoding": {
              "system": "urn:centraxx:CodeSystem/UsageEntry-3",
              "code": "THE_CODE"
            }
          }
        ],
        "constraint": [
          {
            "key": "qre-cxx-1",
            "severity": "error",
            "human": "If the catalog is an IcdCatalog, a version must be given.",
            "expression": "system.startsWith('urn:centraxx:CodeSystem/IcdCatalog-') implies version.exists()",
            "source": "https://fhir.centraxx.de/StructureDefinition/QuestionnaireResponse"
          },
          {
            "key": "qre-cxx-2",
            "severity": "error",
            "human": "The catalog system must be supported by CentraXX. The system url must start with 'urn:centraxx:CodeSystem/<catalog>' where <catalog> must be one of: IcdCatalog, OpsCatalog, Catalog, MasterDataCatalog, UsageEntry",
            "expression": "system.startsWith('urn:centraxx:CodeSystem/IcdCatalog') or system.startsWith('urn:centraxx:CodeSystem/OpsCatalog') or system.startsWith('urn:centraxx:CodeSystem/Catalog') or system.startsWith('urn:centraxx:CodeSystem/MasterDataCatalog') or system.startsWith('urn:centraxx:CodeSystem/UsageEntry') or system.startsWith('urn:centraxx:CodeSystem/ValueList')",
            "source": "https://fhir.centraxx.de/StructureDefinition/QuestionnaireResponse"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding.system",
        "path": "QuestionnaireResponse.item.answer.value[x].system",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding.version",
        "path": "QuestionnaireResponse.item.answer.value[x].version",
        "min": 0,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueCoding.code",
        "path": "QuestionnaireResponse.item.answer.value[x].code",
        "min": 1,
        "max": "1",
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDate",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueDate",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "date"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDate.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDate.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDate.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDateTime",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueDateTime",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDateTime.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDateTime.extension:lowerValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "lowerValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/lowerValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueDateTime.extension:upperValue",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "sliceName": "upperValue",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Extension",
            "profile": [
              "https://fhir.centraxx.de/extension/laborValue/upperValue"
            ]
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueQuantity",
        "path": "QuestionnaireResponse.item.answer.value[x]",
        "sliceName": "valueQuantity",
        "min": 0,
        "max": "1",
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueQuantity.extension",
        "path": "QuestionnaireResponse.item.answer.value[x].extension",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "url"
            }
          ],
          "rules": "closed"
        },
        "min": 0,
        "max": "2",
        "type": [
          {
            "code": "Extension"
          }
        ],
        "mustSupport": true
      },
      {
        "id": "QuestionnaireResponse.item.answer.value[x]:valueQuantity.extension:lowerValue",
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