An example to illustrate a questionnaire regarding a fitness for work survey

Table View

Questionnaire.id[0]UKCore-Questionnaire-FitnessForWork-Example
Questionnaire.url[0]https://example.com/base/Questionnaire/UKCore-Questionnaire-FitnessForWork-Example
Questionnaire.title[0]Statement of Fitness for Work (Mock up)
Questionnaire.status[0]draft
Questionnaire.experimental[0]True
Questionnaire.subjectType[0]Patient
Questionnaire.description[0]This is based on Med 3 from DWP purely for demonstration purposes
Questionnaire.code[0].system[0]http://snomed.info/sct
Questionnaire.code[0].code[0]18381000000107
Questionnaire.code[0].display[0]Sickness certificates
Questionnaire.item[0].linkId[0]Q1
Questionnaire.item[0].text[0]Assessment Date
Questionnaire.item[0].type[0]date
Questionnaire.item[0].required[0]True
Questionnaire.item[1].linkId[0]Q2
Questionnaire.item[1].text[0]Condition(s)
Questionnaire.item[1].type[0]group
Questionnaire.item[1].item[0].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].code[0]autocomplete
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].display[0]Auto-complete
Questionnaire.item[1].item[0].linkId[0]Q2g
Questionnaire.item[1].item[0].text[0]Condition (Coded)
Questionnaire.item[1].item[0].type[0]choice
Questionnaire.item[1].item[0].repeats[0]True
Questionnaire.item[1].item[0].answerValueSet[0]https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode
Questionnaire.item[2].linkId[0]Q3
Questionnaire.item[2].code[0].system[0]http://snomed.info/sct
Questionnaire.item[2].code[0].code[0]365524007
Questionnaire.item[2].code[0].display[0]Fitness for work - finding
Questionnaire.item[2].text[0]I find you
Questionnaire.item[2].type[0]choice
Questionnaire.item[2].required[0]True
Questionnaire.item[2].answerOption[0].value[0].system[0]http://snomed.info/sct
Questionnaire.item[2].answerOption[0].value[0].code[0]160910001
Questionnaire.item[2].answerOption[0].value[0].display[0]Unfit for work
Questionnaire.item[2].answerOption[1].value[0].system[0]http://snomed.info/sct
Questionnaire.item[2].answerOption[1].value[0].code[0]225891002
Questionnaire.item[2].answerOption[1].value[0].display[0]Fit for work with restrictions

XML View

<Questionnaire xmlns="http://hl7.org/fhir">
    <id value="UKCore-Questionnaire-FitnessForWork-Example" />
    <url value="https://example.com/base/Questionnaire/UKCore-Questionnaire-FitnessForWork-Example" />
    <title value="Statement of Fitness for Work (Mock up)" />
    <status value="draft" />
    <experimental value="true" />
    <subjectType value="Patient" />
    <description value="This is based on Med 3 from DWP purely for demonstration purposes" />
    <code>
        <system value="http://snomed.info/sct" />
        <code value="18381000000107" />
        <display value="Sickness certificates" />
    </code>
    <item>
        <linkId value="Q1" />
        <text value="Assessment Date" />
        <type value="date" />
        <required value="true" />
    </item>
    <item>
        <linkId value="Q2" />
        <text value="Condition(s)" />
        <type value="group" />
        <item>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                    <coding>
                        <system value="http://hl7.org/fhir/questionnaire-item-control" />
                        <code value="autocomplete" />
                        <display value="Auto-complete" />
                    </coding>
                </valueCodeableConcept>
            </extension>
            <linkId value="Q2g" />
            <text value="Condition (Coded)" />
            <type value="choice" />
            <repeats value="true" />
            <answerValueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode" />
        </item>
    </item>
    <item>
        <linkId value="Q3" />
        <code>
            <system value="http://snomed.info/sct" />
            <code value="365524007" />
            <display value="Fitness for work - finding" />
        </code>
        <text value="I find you" />
        <type value="choice" />
        <required value="true" />
        <answerOption>
            <valueCoding>
                <system value="http://snomed.info/sct" />
                <code value="160910001" />
                <display value="Unfit for work" />
            </valueCoding>
        </answerOption>
        <answerOption>
            <valueCoding>
                <system value="http://snomed.info/sct" />
                <code value="225891002" />
                <display value="Fit for work with restrictions" />
            </valueCoding>
        </answerOption>
    </item>
</Questionnaire>

JSON View

{
    "resourceType": "Questionnaire",
    "id": "UKCore-Questionnaire-FitnessForWork-Example",
    "url": "https://example.com/base/Questionnaire/UKCore-Questionnaire-FitnessForWork-Example",
    "title": "Statement of Fitness for Work (Mock up)",
    "status": "draft",
    "experimental": true,
    "subjectType":  [
        "Patient"
    ],
    "description": "This is based on Med 3 from DWP purely for demonstration purposes",
    "code":  [
        {
            "system": "http://snomed.info/sct",
            "code": "18381000000107",
            "display": "Sickness certificates"
        }
    ],
    "item":  [
        {
            "linkId": "Q1",
            "text": "Assessment Date",
            "type": "date",
            "required": true
        },
        {
            "linkId": "Q2",
            "text": "Condition(s)",
            "type": "group",
            "item":  [
                {
                    "linkId": "Q2g",
                    "extension":  [
                        {
                            "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                            "valueCodeableConcept": {
                                "coding":  [
                                    {
                                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                                        "code": "autocomplete",
                                        "display": "Auto-complete"
                                    }
                                ]
                            }
                        }
                    ],
                    "text": "Condition (Coded)",
                    "type": "choice",
                    "repeats": true,
                    "answerValueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode"
                }
            ]
        },
        {
            "linkId": "Q3",
            "code":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "365524007",
                    "display": "Fitness for work - finding"
                }
            ],
            "text": "I find you",
            "type": "choice",
            "required": true,
            "answerOption":  [
                {
                    "valueCoding": {
                        "system": "http://snomed.info/sct",
                        "code": "160910001",
                        "display": "Unfit for work"
                    }
                },
                {
                    "valueCoding": {
                        "system": "http://snomed.info/sct",
                        "code": "225891002",
                        "display": "Fit for work with restrictions"
                    }
                }
            ]
        }
    ]
}