An example to illustrate a questionnaire regarding an in-patient survey

Table View

Questionnaire.id[0]UKCore-Questionnaire-InpatientSurvey-Example
Questionnaire.url[0]https://example.com/base/Questionnaire/UKCore-Questionnaire-InpatientSurvey-Example
Questionnaire.identifier[0].value[0]dbba41f5-2905-4a5f-baba-e5987cbd9cca
Questionnaire.identifier[0].assigner[0].reference[0]Organization/UKCore-Organization-LeedsTeachingHospital-Example
Questionnaire.status[0]active
Questionnaire.experimental[0]False
Questionnaire.subjectType[0]Patient
Questionnaire.date[0]2021-02-15T13:50:00+00:00
Questionnaire.publisher[0]Leeds Teaching Hospitals NHS Trust
Questionnaire.contact[0].name[0]Leeds Teaching Hospitals NHS Trust
Questionnaire.contact[0].telecom[0].system[0]phone
Questionnaire.contact[0].telecom[0].value[0]01132433144
Questionnaire.contact[0].telecom[0].use[0]work
Questionnaire.contact[0].telecom[0].rank[0]1
Questionnaire.purpose[0]A questionnaire used as part of a survey of new patient admissions to Acute Medicine.
Questionnaire.effectivePeriod[0].start[0]2021-02-15T13:50:00+00:00
Questionnaire.effectivePeriod[0].end[0]2021-05-15T13:50:00+00:00
Questionnaire.item[0].linkId[0]1
Questionnaire.item[0].text[0]Do you have allergies?
Questionnaire.item[0].type[0]string
Questionnaire.item[1].linkId[0]2
Questionnaire.item[1].text[0]General questions
Questionnaire.item[1].type[0]group
Questionnaire.item[1].item[0].linkId[0]2.1
Questionnaire.item[1].item[0].text[0]What is your gender?
Questionnaire.item[1].item[0].type[0]string
Questionnaire.item[1].item[1].linkId[0]2.2
Questionnaire.item[1].item[1].text[0]What is your date of birth?
Questionnaire.item[1].item[1].type[0]date
Questionnaire.item[1].item[2].linkId[0]2.3
Questionnaire.item[1].item[2].text[0]What is your country of birth?
Questionnaire.item[1].item[2].type[0]string
Questionnaire.item[1].item[3].linkId[0]2.4
Questionnaire.item[1].item[3].text[0]What is your marital status?
Questionnaire.item[1].item[3].type[0]string
Questionnaire.item[2].linkId[0]3
Questionnaire.item[2].text[0]Intoxications
Questionnaire.item[2].type[0]group
Questionnaire.item[2].item[0].linkId[0]3.1
Questionnaire.item[2].item[0].text[0]Do you smoke?
Questionnaire.item[2].item[0].type[0]boolean
Questionnaire.item[2].item[1].linkId[0]3.2
Questionnaire.item[2].item[1].text[0]Do you drink alcohol?
Questionnaire.item[2].item[1].type[0]boolean

XML View

<Questionnaire xmlns="http://hl7.org/fhir">
    <id value="UKCore-Questionnaire-InpatientSurvey-Example" />
    <url value="https://example.com/base/Questionnaire/UKCore-Questionnaire-InpatientSurvey-Example" />
    <identifier>
        <value value="dbba41f5-2905-4a5f-baba-e5987cbd9cca" />
        <assigner>
            <reference value="Organization/UKCore-Organization-LeedsTeachingHospital-Example" />
        </assigner>
    </identifier>
    <status value="active" />
    <experimental value="false" />
    <subjectType value="Patient" />
    <date value="2021-02-15T13:50:00+00:00" />
    <publisher value="Leeds Teaching Hospitals NHS Trust" />
    <contact>
        <name value="Leeds Teaching Hospitals NHS Trust" />
        <telecom>
            <system value="phone" />
            <value value="01132433144" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <purpose value="A questionnaire used as part of a survey of new patient admissions to Acute Medicine." />
    <effectivePeriod>
        <start value="2021-02-15T13:50:00+00:00" />
        <end value="2021-05-15T13:50:00+00:00" />
    </effectivePeriod>
    <item>
        <linkId value="1" />
        <text value="Do you have allergies?" />
        <type value="string" />
    </item>
    <item>
        <linkId value="2" />
        <text value="General questions" />
        <type value="group" />
        <item>
            <linkId value="2.1" />
            <text value="What is your gender?" />
            <type value="string" />
        </item>
        <item>
            <linkId value="2.2" />
            <text value="What is your date of birth?" />
            <type value="date" />
        </item>
        <item>
            <linkId value="2.3" />
            <text value="What is your country of birth?" />
            <type value="string" />
        </item>
        <item>
            <linkId value="2.4" />
            <text value="What is your marital status?" />
            <type value="string" />
        </item>
    </item>
    <item>
        <linkId value="3" />
        <text value="Intoxications" />
        <type value="group" />
        <item>
            <linkId value="3.1" />
            <text value="Do you smoke?" />
            <type value="boolean" />
        </item>
        <item>
            <linkId value="3.2" />
            <text value="Do you drink alcohol?" />
            <type value="boolean" />
        </item>
    </item>
</Questionnaire>

JSON View

{
    "resourceType": "Questionnaire",
    "id": "UKCore-Questionnaire-InpatientSurvey-Example",
    "url": "https://example.com/base/Questionnaire/UKCore-Questionnaire-InpatientSurvey-Example",
    "identifier":  [
        {
            "value": "dbba41f5-2905-4a5f-baba-e5987cbd9cca",
            "assigner": {
                "reference": "Organization/UKCore-Organization-LeedsTeachingHospital-Example"
            }
        }
    ],
    "status": "active",
    "experimental": false,
    "subjectType":  [
        "Patient"
    ],
    "date": "2021-02-15T13:50:00+00:00",
    "publisher": "Leeds Teaching Hospitals NHS Trust",
    "contact":  [
        {
            "name": "Leeds Teaching Hospitals NHS Trust",
            "telecom":  [
                {
                    "system": "phone",
                    "value": "01132433144",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "purpose": "A questionnaire used as part of a survey of new patient admissions to Acute Medicine.",
    "effectivePeriod": {
        "start": "2021-02-15T13:50:00+00:00",
        "end": "2021-05-15T13:50:00+00:00"
    },
    "item":  [
        {
            "linkId": "1",
            "text": "Do you have allergies?",
            "type": "string"
        },
        {
            "linkId": "2",
            "text": "General questions",
            "type": "group",
            "item":  [
                {
                    "linkId": "2.1",
                    "text": "What is your gender?",
                    "type": "string"
                },
                {
                    "linkId": "2.2",
                    "text": "What is your date of birth?",
                    "type": "date"
                },
                {
                    "linkId": "2.3",
                    "text": "What is your country of birth?",
                    "type": "string"
                },
                {
                    "linkId": "2.4",
                    "text": "What is your marital status?",
                    "type": "string"
                }
            ]
        },
        {
            "linkId": "3",
            "text": "Intoxications",
            "type": "group",
            "item":  [
                {
                    "linkId": "3.1",
                    "text": "Do you smoke?",
                    "type": "boolean"
                },
                {
                    "linkId": "3.2",
                    "text": "Do you drink alcohol?",
                    "type": "boolean"
                }
            ]
        }
    ]
}