QuestionnaireResponse
FHIR Profile
Before surgery, a questionnaire is used to record several measurements of the patient. A patient responding to the questionnaire results in a QuestionnaireResponse. The profile is accessible via QuestionnaireResponse and presented below.
This profile is based on the QuestionnaireResponse base profile for FHIR version R4, see also QuestionnaireResponse.
| QuestionnaireResponse | I | QuestionnaireResponse | There are no (further) constraints on this element Element idQuestionnaireResponse A structured set of questions and their answers Alternate namesForm, QuestionnaireAnswers DefinitionA structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to. The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idQuestionnaireResponse.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idQuestionnaireResponse.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idQuestionnaireResponse.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idQuestionnaireResponse.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idQuestionnaireResponse.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idQuestionnaireResponse.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idQuestionnaireResponse.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idQuestionnaireResponse.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| identifier | Σ | 0..1 | Identifier | There are no (further) constraints on this element Element idQuestionnaireResponse.identifier Unique id for this set of answers DefinitionA business identifier assigned to a particular completed (or partially completed) questionnaire. Used for tracking, registration and other business purposes.
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| basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest) | There are no (further) constraints on this element Element idQuestionnaireResponse.basedOn Request fulfilled by this QuestionnaireResponse Alternate namesorder DefinitionThe order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression. Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon. Reference(CarePlan | ServiceRequest) Constraints
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| partOf | Σ | 0..* | Reference(Observation | Procedure) | There are no (further) constraints on this element Element idQuestionnaireResponse.partOf Part of this action DefinitionA procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of. Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn. Reference(Observation | Procedure) Constraints
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| questionnaire | Σ | 0..1 | canonical(Questionnaire) | There are no (further) constraints on this element Element idQuestionnaireResponse.questionnaire Form being answered Alternate namesForm DefinitionThe Questionnaire that defines and organizes the questions for which answers are being provided. Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form. If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).
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| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idQuestionnaireResponse.status in-progress | completed | amended | entered-in-error | stopped DefinitionThe position of the questionnaire response within its overall lifecycle. The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Lifecycle status of the questionnaire response.
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| subject | Σ | 1..1 | Reference(Resource) | There are no (further) constraints on this element Element idQuestionnaireResponse.subject The subject of the questions Alternate namesPatient, Focus DefinitionThe subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information. Allows linking the answers to the individual the answers describe. May also affect access control. If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.
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| encounter | Σ | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idQuestionnaireResponse.encounter Encounter created as part of DefinitionThe Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated. Provides context for the information that was captured. May also affect access control. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.
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| authored | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idQuestionnaireResponse.authored Date the answers were gathered Alternate namesDate Created, Date published, Date Issued, Date updated DefinitionThe date and/or time that this set of answers were last changed. Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers. May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured. This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.
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| author | Σ | 0..1 | Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Element idQuestionnaireResponse.author Person who received and recorded the answers Alternate namesLaboratory, Service, Practitioner, Department, Company, Performer DefinitionPerson who received the answers to the questions in the QuestionnaireResponse and recorded them in the system. Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers. Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated. Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) Constraints
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| source | Σ | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idQuestionnaireResponse.source The person who answered the questions DefinitionThe person who answered the questions about the subject. When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions. If not specified, no inference can be made about who provided the data. Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Constraints
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| item | I | 1..* | BackboneElement | There are no (further) constraints on this element Element idQuestionnaireResponse.item Groups and questions DefinitionA group or question item from the original questionnaire for which answers are provided. Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).
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| id | 0..1 | string | There are no (further) constraints on this element Element idQuestionnaireResponse.item.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idQuestionnaireResponse.item.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idQuestionnaireResponse.item.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| linkId | 1..1 | string | There are no (further) constraints on this element Element idQuestionnaireResponse.item.linkId Pointer to specific item from Questionnaire DefinitionThe item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource. Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.
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| definition | 0..1 | uri | There are no (further) constraints on this element Element idQuestionnaireResponse.item.definition ElementDefinition - details for the item DefinitionA reference to an ElementDefinition that provides the details for the item. A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition. The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. There is no need for this element if the item pointed to by the linkId has a definition listed.
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| text | 0..1 | string | There are no (further) constraints on this element Element idQuestionnaireResponse.item.text Name for group or question text DefinitionText that is displayed above the contents of the group or as the text of the question being answered. Allows the questionnaire response to be read without access to the questionnaire.
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| answer | 0..* | BackboneElement | There are no (further) constraints on this element Element idQuestionnaireResponse.item.answer The response(s) to the question DefinitionThe respondent's answer(s) to the question. The value is nested because we cannot have a repeating structure that has variable type.
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| id | 0..1 | string | There are no (further) constraints on this element Element idQuestionnaireResponse.item.answer.id Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idQuestionnaireResponse.item.answer.extension Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idQuestionnaireResponse.item.answer.modifierExtension Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
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| value[x] | 1..1 | There are no (further) constraints on this element Element idQuestionnaireResponse.item.answer.value[x] Single-valued answer to the question DefinitionThe answer (or one of the answers) provided by the respondent to the question. Ability to retain a single-valued answer to a question. More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.
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| valueReference | Reference(Resource) | Data type | ||
| item | 0..* | see (item) | There are no (further) constraints on this element Element idQuestionnaireResponse.item.answer.item Nested groups and questions DefinitionNested groups and/or questions found within this particular answer. It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.
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| item | 0..* | see (item) | There are no (further) constraints on this element Element idQuestionnaireResponse.item.item Nested questionnaire response items DefinitionQuestions or sub-groups nested beneath a question or group. Reports can consist of complex nested groups.
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Mapping
This FHIR Profile does not use a mapping. Instead, the pointer to the specific item in the corresponding Questionnaire is stated in QuestionnaireResponse.item.linkid. The QuestionnaireResponse should at least equal a linkid and corresponding answer for the following DBIR variables:
- surgasa
- nicotineabuse
- ptheight
- ptweight
- prevradio
Other linkid values can be used if additional questions are required for this questionnaire.
Constraints
Constraints can refer to the cardinality of an element, required value or type of value.
The following constraints apply:
- The questionnaire response should includes at least the five above-mentioned questions.
- For question surgasa, nicotineabuse, ptheight, ptweight: each question should refer to the id of an Observation that represents the measurement for this question.
- For question prevradio, refer to the Procedure resource which states whether radiotherapy to the breast or chest wall occurred at any time prior to the performed surgery.
- The questionnaire response should contain a status using one of the following values:
- in-progress
- completed
- amended
- entered-in-error
- stopped
- The questionnaire response should include a reference to the Questionnaire on which the QuestionnaireResponse is based, which is stated in the QuestionnaireResponse.questionnaire data element.
- The questionnaire response should include a reference to the patient, which is stated in the QuestionnaireResponse.subject data element.
Example QuestionnaireResponse
{
"resourceType":"QuestionnaireResponse",
"id":"dbir-questionnaire-response",
"meta":{
"profile":[
"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/QuestionnaireResponse"
]
},
"questionnaire": "Questionnaire/dbir-intake",
"subject":{
"reference":"Patient/f201"
},
"status":"completed",
"item":[
{
"linkId":"surgasa",
"text":"What is the ASA classification before operation",
"answer":[
{
"valueReference":{
"reference":"Observation/456"
}
}
]
},
{
"linkId":"nicotineabuse",
"text":"Nicotine abuse",
"answer":[
{
"valueReference":{
"reference":"Observation/457"
}
}
]
},
{
"linkId":"ptheight",
"text":"Height in centimeters",
"answer":[
{
"valueReference":{
"reference":"Observation/458"
}
}
]
},
{
"linkId":"ptweight",
"text":"Weight in kilograms",
"answer":[
{
"valueReference":{
"reference":"Observation/459"
}
}
]
},
{
"linkId":"prevradio",
"text":"Previous radiotherapy",
"answer":[
{
"valueReference":{
"reference":"Procedure/12"
}
}
]
}
]
}