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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
    <id value="NationalProxy-QuestionnaireResponse-ProxyAccessRequest-Example" />
    <questionnaire value="https://fhir.nhs.uk/England/Questionnaire/ProxyAccessRequest" />
    <status value="completed" />
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9000000017" />
        </identifier>
    </subject>
    <authored value="2024-10-07T15:07:55.495Z" />
    <item>
        <linkId value="relatedPerson" />
        <text value="Proxy details" />
        <item>
            <linkId value="relatedPerson_identifier" />
            <text value="NHS number" />
            <answer>
                <valueString value="9000000017" />
            </answer>
        </item>
        <item>
            <linkId value="relatedPerson_name" />
            <text value="Name" />
            <item>
                <linkId value="relatedPerson_name_first" />
                <text value="First name" />
                <answer>
                    <valueString value="Jayne" />
                </answer>
            </item>
            <item>
                <linkId value="relatedPerson_name_family" />
                <text value="Last name" />
                <answer>
                    <valueString value="Smith" />
                </answer>
            </item>
        </item>
        <item>
            <linkId value="relatedPerson_birthDate" />
            <text value="Date of birth" />
            <answer>
                <valueDate value="1970-10-16" />
            </answer>
        </item>
        <item>
            <linkId value="relatedPerson_basisForAccess" />
            <text value="Basis for Access" />
            <answer>
                <valueCoding>
                    <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
                    <code value="PRN" />
                    <display value="Parent" />
                </valueCoding>
            </answer>
        </item>
        <item>
            <linkId value="relatedPerson_relationship" />
            <text value="Relationship" />
            <answer>
                <valueCoding>
                    <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
                    <code value="PRN" />
                    <display value="Parent" />
                </valueCoding>
            </answer>
        </item>
    </item>
    <item>
        <linkId value="parentalApplicationSupplementaryDetails" />
        <text value="Parental Application Supplementary Details" />
        <item>
            <linkId value="parentalApplicationSupplementaryDetails_evidenceOfResponsibility" />
            <text value="Evidence of parental responsibility" />
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
                    <code value="BRTH" />
                    <display value="Birth certificate" />
                </valueCoding>
            </answer>
        </item>
        <item>
            <linkId value="parentalApplicationSupplementaryDetails_isCurrentAddressConfirmed" />
            <text value="Is current address confirmed?" />
            <answer>
                <valueBoolean value="true" />
            </answer>
        </item>
        <item>
            <linkId value="parentalApplicationSupplementaryDetails_newAddress" />
            <text value="New address" />
            <item>
                <linkId value="parentalApplicationSupplementaryDetails_line1" />
                <text value="Address line 1" />
                <answer>
                    <valueString value="6 Harrogate Road" />
                </answer>
            </item>
            <item>
                <linkId value="parentalApplicationSupplementaryDetails_line2" />
                <text value="Address line 2" />
                <answer>
                    <valueString value="Crossgates" />
                </answer>
            </item>
            <item>
                <linkId value="parentalApplicationSupplementaryDetails_city" />
                <text value="Town / City" />
                <answer>
                    <valueString value="Leeds" />
                </answer>
            </item>
            <item>
                <linkId value="parentalApplicationSupplementaryDetails_postalCode" />
                <text value="Postcode" />
                <answer>
                    <valueString value="LS15 9FA" />
                </answer>
            </item>
        </item>
        <item>
            <linkId value="parentalApplicationSupplementaryDetails_liveAtSameAddress" />
            <text value="Do adult and child live at the same address?" />
            <answer>
                <valueBoolean value="true" />
            </answer>
        </item>
        <item>
            <linkId value="parentalApplicationSupplementaryDetails_canChildConsent" />
            <text value="Can the child consent?" />
            <answer>
                <valueBoolean value="true" />
            </answer>
        </item>
    </item>
    <item>
        <linkId value="patient" />
        <text value="Patient details" />
        <item>
            <linkId value="patient_name" />
            <text value="Name" />
            <item>
                <linkId value="patient_name_first" />
                <text value="First name" />
                <answer>
                    <valueString value="Jane Marie Anne" />
                </answer>
            </item>
            <item>
                <linkId value="patient_name_family" />
                <text value="Last name" />
                <answer>
                    <valueString value="Smith" />
                </answer>
            </item>
        </item>
        <item>
            <linkId value="patient_birthDate" />
            <text value="Date of birth" />
            <answer>
                <valueDate value="2010-12-31" />
            </answer>
        </item>
    </item>
    <item>
        <linkId value="requestedAccess" />
        <text value="Requested access" />
        <item>
            <linkId value="requestedAccess_accessLevel" />
            <text value="Requested access level" />
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
                    <code value="APPT" />
                    <display value="Appointment Booking" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
                    <code value="CNTCT" />
                    <display value="Contacting Surgery" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
                    <code value="RECRD" />
                    <display value="Medical Records Access" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
                    <code value="TEST" />
                    <display value="Test Results" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
                    <code value="VACC" />
                    <display value="Vaccination Records" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
                    <code value="PRESCR" />
                    <display value="Request and manage repeat prescriptions" />
                </valueCoding>
            </answer>
        </item>
        <item>
            <linkId value="requestedAccess_reasonsForAccess" />
            <text value="Reason for access" />
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
                    <code value="COMB" />
                    <display value="Communication Barriers" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
                    <code value="MHEA" />
                    <display value="Mental Health Condition" />
                </valueCoding>
            </answer>
            <answer>
                <valueCoding>
                    <system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
                    <code value="PRAC" />
                    <display value="Practical Reasons" />
                </valueCoding>
            </answer>
        </item>
    </item>
</QuestionnaireResponse>

JSON View

{
    "resourceType": "QuestionnaireResponse",
    "id": "NationalProxy-QuestionnaireResponse-ProxyAccessRequest-Example",
    "questionnaire": "https://fhir.nhs.uk/England/Questionnaire/ProxyAccessRequest",
    "status": "completed",
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9000000017"
        }
    },
    "authored": "2024-10-07T15:07:55.495Z",
    "item":  [
        {
            "linkId": "relatedPerson",
            "text": "Proxy details",
            "item":  [
                {
                    "linkId": "relatedPerson_identifier",
                    "text": "NHS number",
                    "answer":  [
                        {
                            "valueString": "9000000017"
                        }
                    ]
                },
                {
                    "linkId": "relatedPerson_name",
                    "text": "Name",
                    "item":  [
                        {
                            "linkId": "relatedPerson_name_first",
                            "text": "First name",
                            "answer":  [
                                {
                                    "valueString": "Jayne"
                                }
                            ]
                        },
                        {
                            "linkId": "relatedPerson_name_family",
                            "text": "Last name",
                            "answer":  [
                                {
                                    "valueString": "Smith"
                                }
                            ]
                        }
                    ]
                },
                {
                    "linkId": "relatedPerson_birthDate",
                    "text": "Date of birth",
                    "answer":  [
                        {
                            "valueDate": "1970-10-16"
                        }
                    ]
                },
                {
                    "linkId": "relatedPerson_basisForAccess",
                    "text": "Basis for Access",
                    "answer":  [
                        {
                            "valueCoding": {
                                "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                                "code": "PRN",
                                "display": "Parent"
                            }
                        }
                    ]
                },
                {
                    "linkId": "relatedPerson_relationship",
                    "text": "Relationship",
                    "answer":  [
                        {
                            "valueCoding": {
                                "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                                "code": "PRN",
                                "display": "Parent"
                            }
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "parentalApplicationSupplementaryDetails",
            "text": "Parental Application Supplementary Details",
            "item":  [
                {
                    "linkId": "parentalApplicationSupplementaryDetails_evidenceOfResponsibility",
                    "text": "Evidence of parental responsibility",
                    "answer":  [
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
                                "code": "BRTH",
                                "display": "Birth certificate"
                            }
                        }
                    ]
                },
                {
                    "linkId": "parentalApplicationSupplementaryDetails_isCurrentAddressConfirmed",
                    "text": "Is current address confirmed?",
                    "answer":  [
                        {
                            "valueBoolean": true
                        }
                    ]
                },
                {
                    "linkId": "parentalApplicationSupplementaryDetails_newAddress",
                    "text": "New address",
                    "item":  [
                        {
                            "linkId": "parentalApplicationSupplementaryDetails_line1",
                            "text": "Address line 1",
                            "answer":  [
                                {
                                    "valueString": "6 Harrogate Road"
                                }
                            ]
                        },
                        {
                            "linkId": "parentalApplicationSupplementaryDetails_line2",
                            "text": "Address line 2",
                            "answer":  [
                                {
                                    "valueString": "Crossgates"
                                }
                            ]
                        },
                        {
                            "linkId": "parentalApplicationSupplementaryDetails_city",
                            "text": "Town / City",
                            "answer":  [
                                {
                                    "valueString": "Leeds"
                                }
                            ]
                        },
                        {
                            "linkId": "parentalApplicationSupplementaryDetails_postalCode",
                            "text": "Postcode",
                            "answer":  [
                                {
                                    "valueString": "LS15 9FA"
                                }
                            ]
                        }
                    ]
                },
                {
                    "linkId": "parentalApplicationSupplementaryDetails_liveAtSameAddress",
                    "text": "Do adult and child live at the same address?",
                    "answer":  [
                        {
                            "valueBoolean": true
                        }
                    ]
                },
                {
                    "linkId": "parentalApplicationSupplementaryDetails_canChildConsent",
                    "text": "Can the child consent?",
                    "answer":  [
                        {
                            "valueBoolean": true
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "patient",
            "text": "Patient details",
            "item":  [
                {
                    "linkId": "patient_name",
                    "text": "Name",
                    "item":  [
                        {
                            "linkId": "patient_name_first",
                            "text": "First name",
                            "answer":  [
                                {
                                    "valueString": "Jane Marie Anne"
                                }
                            ]
                        },
                        {
                            "linkId": "patient_name_family",
                            "text": "Last name",
                            "answer":  [
                                {
                                    "valueString": "Smith"
                                }
                            ]
                        }
                    ]
                },
                {
                    "linkId": "patient_birthDate",
                    "text": "Date of birth",
                    "answer":  [
                        {
                            "valueDate": "2010-12-31"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "requestedAccess",
            "text": "Requested access",
            "item":  [
                {
                    "linkId": "requestedAccess_accessLevel",
                    "text": "Requested access level",
                    "answer":  [
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
                                "code": "APPT",
                                "display": "Appointment Booking"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
                                "code": "CNTCT",
                                "display": "Contacting Surgery"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
                                "code": "RECRD",
                                "display": "Medical Records Access"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
                                "code": "TEST",
                                "display": "Test Results"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
                                "code": "VACC",
                                "display": "Vaccination Records"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
                                "code": "PRESCR",
                                "display": "Request and manage repeat prescriptions"
                            }
                        }
                    ]
                },
                {
                    "linkId": "requestedAccess_reasonsForAccess",
                    "text": "Reason for access",
                    "answer":  [
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
                                "code": "COMB",
                                "display": "Communication Barriers"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
                                "code": "MHEA",
                                "display": "Mental Health Condition"
                            }
                        },
                        {
                            "valueCoding": {
                                "system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
                                "code": "PRAC",
                                "display": "Practical Reasons"
                            }
                        }
                    ]
                }
            ]
        }
    ]
}