<required value="true" /> <group> <linkId value="3702891v4.0" /> <title value="Mandatory Demography Questions" /> <text value="These items must be included when this data is collected for reporting" /> <required value="true" /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/minLength"> <valueInteger value="4" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="13" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200604v3.0" /> </valueReference> </extension> <linkId value="3702892v4.0" /> <text value="Gender" /> <type value="open-choice" /> <options> <reference value="#d1e9892-vs" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/minLength"> <valueInteger value="5" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="41" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2192199v1.0" /> </valueReference> </extension> <linkId value="3702904v4.0" /> <text value="Race" /> <type value="open-choice" /> <options> <reference value="#d1e10146-vs" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#793v5.1" /> </valueReference> </extension> <linkId value="3702903v4.0" /> <text value="Patient's Date of Birth" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/minLength"> <valueInteger value="7" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="22" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2192217v2.0" /> </valueReference> </extension> <linkId value="3702898v4.0" /> <text value="Ethnicity" /> <type value="open-choice" /> <options> <reference value="#d1e10593-vs" /> </options> </question> </group> <group> <linkId value="3702912v4.0" /> <title value="Conditional Demography Questions" /> <text value="There are business rules to indicate situations under which these elements should be used on a case report form." /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="15" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2179606v2.0" /> </valueReference> </extension> <linkId value="3702914v4.0" /> <text value="ZIP Code" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="50" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2865130v1.0" /> </valueReference> </extension> <linkId value="3702916v4.0" /> <text value="Payment Method" /> <type value="open-choice" /> <options> <reference value="#d1e10923-vs" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="75" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#315v4.0" /> </valueReference> </extension> <linkId value="3702932v4.0" /> <text value="Country of Residence" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2003745v5.0" /> </valueReference> </extension> <linkId value="3702934v4.0" /> <text value="Date Completed" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="6" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200286v1.0" /> </valueReference> </extension> <linkId value="3702936v4.0" /> <text value="CDC Race Code" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="6" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200284v2.0" /> </valueReference> </extension> <linkId value="3702938v4.0" /> <text value="CDC Ethnicity Code" /> <type value="string" /> </question> </group> <group> <linkId value="3702940v4.0" /> <title value="Optional Demography Questions" /> <text value="There is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included." /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="44" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2681552v1.0" /> </valueReference> </extension> <linkId value="3702942v4.0" /> <text value="Highest Education Level" /> <type value="open-choice" /> <options> <reference value="#d1e11887-vs" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="55" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2001708v5.0" /> </valueReference> </extension> <linkId value="3702952v4.0" /> <text value="Country of Birth" /> <type value="open-choice" /> <options> <reference value="#d1e12384-vs" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="50" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2674076v2.0" /> </valueReference> </extension> <linkId value="3702957v4.0" /> <text value="Highest Education Level" /> <type value="open-choice" /> <options> <reference value="#d1e12630-vs" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="6" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/entryFormat"> <valueString value="9999.99" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2943243v1.0" /> </valueReference> </extension> <linkId value="3702984v4.0" /> <text value="Census Tract Code at Enrollment" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength"> <valueInteger value="25" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2188083v2.0" /> </valueReference> </extension> <linkId value="3702985v4.0" /> <text value="Marital Status" /> <type value="open-choice" /> <options> <reference value="#d1e14027-vs" /> </options> </question> </group> </group> </Questionnaire>

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    <required value="true" />
    <group>
      <linkId value="3702891v4.0" />
      <title value="Mandatory Demography Questions" />
      <text value="These items must be included when this data is collected for reporting" />
      <required value="true" />
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="4" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="13" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200604v3.0" />
          </valueReference>
        </extension>
        <linkId value="3702892v4.0" />
        <text value="Gender" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e9892-vs" />
        </options>
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="5" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="41" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2192199v1.0" />
          </valueReference>
        </extension>
        <linkId value="3702904v4.0" />
        <text value="Race" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e10146-vs" />
        </options>
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#793v5.1" />
          </valueReference>
        </extension>
        <linkId value="3702903v4.0" />
        <text value="Patient's Date of Birth" />
        <type value="string" />
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="7" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="22" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2192217v2.0" />
          </valueReference>
        </extension>
        <linkId value="3702898v4.0" />
        <text value="Ethnicity" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e10593-vs" />
        </options>
      </question>
    </group>
    <group>
      <linkId value="3702912v4.0" />
      <title value="Conditional Demography Questions" />
      <text value="There are business rules to indicate situations under which these elements should be used on a case report form." />
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="15" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2179606v2.0" />
          </valueReference>
        </extension>
        <linkId value="3702914v4.0" />
        <text value="ZIP Code" />
        <type value="string" />
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="50" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2865130v1.0" />
          </valueReference>
        </extension>
        <linkId value="3702916v4.0" />
        <text value="Payment Method" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e10923-vs" />
        </options>
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="75" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#315v4.0" />
          </valueReference>
        </extension>
        <linkId value="3702932v4.0" />
        <text value="Country of Residence" />
        <type value="string" />
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2003745v5.0" />
          </valueReference>
        </extension>
        <linkId value="3702934v4.0" />
        <text value="Date Completed" />
        <type value="string" />
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="6" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200286v1.0" />
          </valueReference>
        </extension>
        <linkId value="3702936v4.0" />
        <text value="CDC Race Code" />
        <type value="string" />
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="6" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200284v2.0" />
          </valueReference>
        </extension>
        <linkId value="3702938v4.0" />
        <text value="CDC Ethnicity Code" />
        <type value="string" />
      </question>
    </group>
    <group>
      <linkId value="3702940v4.0" />
      <title value="Optional Demography Questions" />
      <text value="There is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included." />
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="44" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2681552v1.0" />
          </valueReference>
        </extension>
        <linkId value="3702942v4.0" />
        <text value="Highest Education Level" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e11887-vs" />
        </options>
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="55" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2001708v5.0" />
          </valueReference>
        </extension>
        <linkId value="3702952v4.0" />
        <text value="Country of Birth" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e12384-vs" />
        </options>
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="50" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2674076v2.0" />
          </valueReference>
        </extension>
        <linkId value="3702957v4.0" />
        <text value="Highest Education Level" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e12630-vs" />
        </options>
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="6" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/entryFormat">
          <valueString value="9999.99" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2943243v1.0" />
          </valueReference>
        </extension>
        <linkId value="3702984v4.0" />
        <text value="Census Tract Code at Enrollment" />
        <type value="string" />
      </question>
      <question>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength">
          <valueInteger value="25" />
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
          <valueReference>
            <reference value="http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2188083v2.0" />
          </valueReference>
        </extension>
        <linkId value="3702985v4.0" />
        <text value="Marital Status" />
        <type value="open-choice" />
        <options>
          <reference value="#d1e14027-vs" />
        </options>
      </question>
    </group>
  </group>
</Questionnaire>