SGHI FHIR Profile Implementation Guide
0.1.0 - ci-build

SGHI FHIR Profile Implementation Guide, published by Kathurima Kimathi. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/savannahghi/sil_fhir_profile_ig/ and changes regularly. See the Directory of published versions

## Resource Profile: SGHIQuestionnaireResponse - Detailed Descriptions

Draft as of 2026-05-21

Definitions for the questionnaireresponse resource profile.

- Key Elements Table
- Differential Elements Table
- Snapshot Elements Table

Guidance on how to interpret the contents of this table can be foundhere

0. QuestionnaireResponse
Definition | A 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.
Short | A structured set of questions and their answers
Comments | 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.
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | Form, QuestionnaireAnswers
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty()) dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. QuestionnaireResponse.implicitRules
Definition | A 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.
Short | A set of rules under which this content was created
Comments | 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 its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. QuestionnaireResponse.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short | Contained, inline Resources
Comments | 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.
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
6. QuestionnaireResponse.modifierExtension
Definition | May 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 managable, 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).
Short | Extensions that cannot be ignored
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
Requirements | 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.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. QuestionnaireResponse.identifier
Definition | Business identifiers assigned to this questionnaire response by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server.
Short | Business identifier for this set of answers
Comments | Note: This is a business identifier, not a resource identifier (see discussion).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 10..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Allows identification of the questionnaire response as it is known by various participating systems and in a way that remains consistent across servers.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. QuestionnaireResponse.identifier.use
Definition | The purpose of this identifier.
Short | usual | official | temp | secondary | old (If known)
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control | 0..1
Binding | The codes SHALL be taken from IdentifierUse http://hl7.org/fhir/ValueSet/identifier-use|5.0.0 (required to `http://hl7.org/fhir/ValueSet/identifier-use` )
Type | code
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. QuestionnaireResponse.identifier.type
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short | Description of identifier
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control | 0..1
Binding | The codes SHALL be taken from Unless not suitable, these codes SHALL be taken from SGHI Default Identifier Types http://hl7.org/fhir/ValueSet/identifier-type|5.0.0 (required to `https://fhir.slade360.co.ke/fhir/ValueSet/default-identifier-types` )
Type | CodeableConcept(SGHI CodeableConcept)
Is Modifier | false
Summary | true
Requirements | Allows users to make use of identifiers when the identifier system is not known.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. QuestionnaireResponse.identifier.system
Definition | Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short | The namespace for the identifier value
Comments | Identifier.system is always case sensitive.
Control | 10..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Example | General: http://www.acme.com/identifiers/patient
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. QuestionnaireResponse.identifier.value
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short | The value that is unique
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control | 10..1 This element is affected by the following invariants: ident-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Example | General: 123456
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. QuestionnaireResponse.identifier.assigner
Definition | Organization that issued/manages the identifier.
Short | Organization that issued id (may be just text)
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control | 10..1
Type | Reference(SGHI Reference)(SGHI Organization, Organization)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. QuestionnaireResponse.questionnaire
Definition | The Questionnaire that defines and organizes the questions for which answers are being provided.
Short | Canonical URL of Questionnaire being answered
Comments | If a QuestionnaireResponse references a Questionnaire that can be resolved, 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.). It is possible to have a QuestionnaireResponse whose 'questionnaire' element does not resolve. It is also possible for the questionnaire element to not have a value but only extensions (e.g. conveying the title or identifier for the questionnaire). This may happen for legacy data. If there is no formally defined Questionnaire, it is undefined what the 'correct' values for the linkId elements should be and it is possible that linkIds might be inconsistent for QuestionnaireResponses for the same form if captured by distinct systems.
Control | 1..1
Type | canonical(Questionnaire)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.
Alternate Names | Form
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. QuestionnaireResponse.status
Definition | The current state of the questionnaire response.
Short | in-progress | completed | amended | entered-in-error | stopped
Comments | Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.
Control | 1..1
Binding | The codes SHALL be taken from QuestionnaireResponseStatus http://hl7.org/fhir/ValueSet/questionnaire-answers-status|5.0.0 (required to `http://hl7.org/fhir/ValueSet/questionnaire-answers-status|5.0.0` ) Lifecycle status of the questionnaire response.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. QuestionnaireResponse.subject
Definition | The 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.
Short | The subject of the questions
Comments | If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.
Control | 10..1
Type | Reference(SGHI Reference)(SGHI Patient, SGHI Practitioner, Resource)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Links the questionnaire response to the Patient context. May also affect access control.
Alternate Names | Patient, Focus
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. QuestionnaireResponse.encounter
Definition | The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.
Short | Encounter the questionnaire response is part of
Comments | This will typically be the encounter the questionnaire response was created during, but some questionnaire responses may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission forms). A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.
Control | 10..1
Type | Reference(SGHI Reference)(SGHI Encounter, Encounter)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Links the questionnaire response to the Encounter context. May also affect access control.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. QuestionnaireResponse.authored
Definition | The date and/or time that this questionnaire response was last modified by the user - e.g. changing answers or revising status.
Short | Date the answers were gathered
Comments | 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.
Control | 10..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.
Alternate Names | Date Created, Date published, Date Issued, Date updated
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. QuestionnaireResponse.source
Definition | The individual or device that answered the questions about the subject.
Short | The individual or device that answered the questions
Comments | If not specified, no inference can be made about who provided the data. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.
Control | 10..1
Type | Reference(SGHI Reference)(SGHI Organization, SGHI Patient, SGHI Practitioner, Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson)
Is Modifier | false
Must Support | false
Summary | true
Requirements | When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. QuestionnaireResponse.item
Definition | A group or question item from the original questionnaire for which answers are provided.
Short | Groups and questions
Comments | 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).\nWhen dealing with repeating items, each group repetition will be handled by a separate item. However, repeating questions are handled with a single question item and potentially multiple answers.
Control | 10..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) qrs-1: Item cannot contain both item and answer ((answer.exists() and item.exists()).not()) qrs-2: Repeated answers are combined in the answers array of a single item (repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue())
34. QuestionnaireResponse.item.modifierExtension
Definition | May 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 managable, 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
36. QuestionnaireResponse.item.linkId
Definition | The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
Short | Pointer to specific item from Questionnaire
Control | 1..1 This element is affected by the following invariants: qrs-2
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. QuestionnaireResponse.item.text
Definition | Text that is displayed above the contents of the group or as the text of the question being answered.
Short | Name for group or question text
Comments | The text for an item SHOULD be identical to the text from the corresponding Questionnaire.item. This can't be strictly enforced because it's possible for the Questionnaire to be updated subsequent to the QuestionnaireResponse having been created, however the intention is that the text in the QuestionnaireResponse reflects what the user saw when completing the Questionnaire.
Control | 10..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Allows the questionnaire response to be read without access to the questionnaire.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. QuestionnaireResponse.item.answer
Definition | The respondent's answer(s) to the question.
Short | The response(s) to the question
Comments | The value is nested because we cannot have a repeating structure that has variable type.
Control | 0..* This element is affected by the following invariants: qrs-1, qrs-2
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. QuestionnaireResponse.item.answer.modifierExtension
Definition | May 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 managable, 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
44. QuestionnaireResponse.item.answer.value[x]
Definition | The answer (or one of the answers) provided by the respondent to the question.
Short | Single-valued answer to the question
Comments | 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. Note that a question is answered using one of the possible choices defined with answerOption, answerValueSet or some other means and the answer has a complex data type, all elements within the answer in the QuestionnaireResponse SHOULD match the elements defined corresponding choice value in the Questionnaire. However, it is possible that not all elements will be propagated. Also, some systems might use language translations resulting in different displays. Comparison of value to the values defined in the Questionnaire (whether by answerOption, answerValueSet or answerExpression) SHALL NOT pay attention to Coding.display, Reference.display, Quantity.unit unless those are the only elements present. As well, systems are not required to check for a match on any extensions (e.g. ordinal values, translations, etc.). Systems MAY enforce that if extensions such as ordinal values are present in both Questionnaire and QuestionnaireResponse, they match.
Control | 1..1 This element is affected by the following invariants: qrs-2
Binding | For example codes, see QuestionnaireAnswerCodes http://hl7.org/fhir/ValueSet/questionnaire-answers|5.0.0 (example to `http://hl7.org/fhir/ValueSet/questionnaire-answers|5.0.0` ) Binding this is problematic because one value set can't apply to both codes and quantities.
Type | Choice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity(SimpleQuantity), Reference(Resource)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Ability to retain a single-valued answer to a question.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

Guidance on how to interpret the contents of this table can be foundhere

0. QuestionnaireResponse
2. QuestionnaireResponse.identifier
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..?
4. QuestionnaireResponse.identifier.use
Binding | The codes SHALL be taken from IdentifierUse (required to `http://hl7.org/fhir/ValueSet/identifier-use` )
6. QuestionnaireResponse.identifier.type
Binding | The codes SHALL be taken from SGHI Default Identifier Types (required to `https://fhir.slade360.co.ke/fhir/ValueSet/default-identifier-types` )
Type | CodeableConcept(SGHI CodeableConcept)
8. QuestionnaireResponse.identifier.system
Control | 1..?
10. QuestionnaireResponse.identifier.value
Control | 1..?
12. QuestionnaireResponse.identifier.assigner
Control | 1..?
Type | Reference(SGHI Reference)(SGHI Organization)
14. QuestionnaireResponse.subject
Control | 1..?
Type | Reference(SGHI Reference)(SGHI Patient, SGHI Practitioner)
16. QuestionnaireResponse.encounter
Control | 1..?
Type | Reference(SGHI Reference)(SGHI Encounter)
18. QuestionnaireResponse.authored
Control | 1..?
20. QuestionnaireResponse.source
Control | 1..?
Type | Reference(SGHI Reference)(SGHI Organization, SGHI Patient, SGHI Practitioner)
22. QuestionnaireResponse.item
Control | 1..?
24. QuestionnaireResponse.item.text
Control | 1..?

Guidance on how to interpret the contents of this table can be foundhere

0. QuestionnaireResponse
Definition | A 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.
Short | A structured set of questions and their answers
Comments | 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.
Control | 0..*
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | Form, QuestionnaireAnswers
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()`) dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (`contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`) dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (`contained.meta.security.empty()`) dom-6: A resource should have narrative for robust management (`text.`div`.exists()`)
2. QuestionnaireResponse.id
Definition | The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Short | Logical id of this artifact
Comments | Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.
Control | 0..1
Type | id
Is Modifier | false
Must Support | false
Summary | true
4. QuestionnaireResponse.meta
Definition | The 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.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. QuestionnaireResponse.implicitRules
Definition | A 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.
Short | A set of rules under which this content was created
Comments | 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 its narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. QuestionnaireResponse.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | 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).
Control | 0..1
Binding | The codes SHALL be taken from AllLanguages (required to `http://hl7.org/fhir/ValueSet/all-languages|5.0.0` ) IETF language tag for a human language
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. QuestionnaireResponse.text
Definition | A 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.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have a 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.
Control | 0..1 This element is affected by the following invariants: dom-6
Type | Narrative
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. QuestionnaireResponse.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.
Short | Contained, inline Resources
Comments | 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.
Control | 0..* This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
Type | Resource
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. QuestionnaireResponse.extension
Definition | May 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 managable, 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.
Short | Additional content defined by implementations
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | false
Must Support | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
16. QuestionnaireResponse.modifierExtension
Definition | May 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 managable, 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).
Short | Extensions that cannot be ignored
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Support | false
Summary | true
Requirements | 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.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
18. QuestionnaireResponse.identifier
Definition | Business identifiers assigned to this questionnaire response by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server.
Short | Business identifier for this set of answers
Comments | Note: This is a business identifier, not a resource identifier (see discussion).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 1..*
Type | Identifier
Is Modifier | false
Must Support | false
Summary | true
Requirements | Allows identification of the questionnaire response as it is known by various participating systems and in a way that remains consistent across servers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
20. QuestionnaireResponse.identifier.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | id
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
22. QuestionnaireResponse.identifier.extension
Definition | May 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 managable, 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.
Short | Additional content defined by implementations
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.identifier.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
24. QuestionnaireResponse.identifier.use
Definition | The purpose of this identifier.
Short | usual | official | temp | secondary | old (If known)
Comments | Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Control | 0..1
Binding | The codes SHALL be taken from IdentifierUse (required to `http://hl7.org/fhir/ValueSet/identifier-use` )
Type | code
Is Modifier | true because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. QuestionnaireResponse.identifier.type
Definition | A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Short | Description of identifier
Comments | This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Control | 0..1
Binding | The codes SHALL be taken from SGHI Default Identifier Types (required to `https://fhir.slade360.co.ke/fhir/ValueSet/default-identifier-types` )
Type | CodeableConcept(SGHI CodeableConcept)
Is Modifier | false
Summary | true
Requirements | Allows users to make use of identifiers when the identifier system is not known.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
28. QuestionnaireResponse.identifier.system
Definition | Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.
Short | The namespace for the identifier value
Comments | Identifier.system is always case sensitive.
Control | 1..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Requirements | There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Example | General: http://www.acme.com/identifiers/patient
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
30. QuestionnaireResponse.identifier.value
Definition | The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Short | The value that is unique
Comments | If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Control | 1..1 This element is affected by the following invariants: ident-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Example | General: 123456
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
32. QuestionnaireResponse.identifier.period
Definition | Time period during which identifier is/was valid for use.
Short | Time period when id is/was valid for use
Control | 0..1
Type | Period
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
34. QuestionnaireResponse.identifier.assigner
Definition | Organization that issued/manages the identifier.
Short | Organization that issued id (may be just text)
Comments | The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Control | 1..1
Type | Reference(SGHI Reference)(SGHI Organization)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. QuestionnaireResponse.basedOn
Definition | A plan, proposal or order that is fulfilled in whole or in part by this questionnaire response. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.
Short | Request fulfilled by this QuestionnaireResponse
Control | 0..*
Type | Reference(CarePlan, ServiceRequest)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Supports traceability of responsibility for the questionnaire response and allows linkage of the response to the proposals/recommendations acted upon.
Alternate Names | order
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
38. QuestionnaireResponse.partOf
Definition | A 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.
Short | Part of referenced event
Comments | Not to be used to link an questionnaire response to an Encounter - use 'context' for that. Composition of questionnaire responses will be handled using the Assemble operation defined in the SDC IG. For relationships to referrals, and other types of requests, use basedOn.
Control | 0..*
Type | Reference(Observation, Procedure)
Is Modifier | false
Must Support | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
40. QuestionnaireResponse.questionnaire
Definition | The Questionnaire that defines and organizes the questions for which answers are being provided.
Short | Canonical URL of Questionnaire being answered
Comments | If a QuestionnaireResponse references a Questionnaire that can be resolved, 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.). It is possible to have a QuestionnaireResponse whose 'questionnaire' element does not resolve. It is also possible for the questionnaire element to not have a value but only extensions (e.g. conveying the title or identifier for the questionnaire). This may happen for legacy data. If there is no formally defined Questionnaire, it is undefined what the 'correct' values for the linkId elements should be and it is possible that linkIds might be inconsistent for QuestionnaireResponses for the same form if captured by distinct systems.
Control | 1..1
Type | canonical(Questionnaire)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.
Alternate Names | Form
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
42. QuestionnaireResponse.status
Definition | The current state of the questionnaire response.
Short | in-progress | completed | amended | entered-in-error | stopped
Comments | Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.
Control | 1..1
Binding | The codes SHALL be taken from QuestionnaireResponseStatus (required to `http://hl7.org/fhir/ValueSet/questionnaire-answers-status|5.0.0` ) Lifecycle status of the questionnaire response.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
44. QuestionnaireResponse.subject
Definition | The 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.
Short | The subject of the questions
Comments | If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.
Control | 1..1
Type | Reference(SGHI Reference)(SGHI Patient, SGHI Practitioner)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Links the questionnaire response to the Patient context. May also affect access control.
Alternate Names | Patient, Focus
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
46. QuestionnaireResponse.encounter
Definition | The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.
Short | Encounter the questionnaire response is part of
Comments | This will typically be the encounter the questionnaire response was created during, but some questionnaire responses may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission forms). A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.
Control | 1..1
Type | Reference(SGHI Reference)(SGHI Encounter)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Links the questionnaire response to the Encounter context. May also affect access control.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
48. QuestionnaireResponse.authored
Definition | The date and/or time that this questionnaire response was last modified by the user - e.g. changing answers or revising status.
Short | Date the answers were gathered
Comments | 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.
Control | 1..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | true
Requirements | Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.
Alternate Names | Date Created, Date published, Date Issued, Date updated
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
50. QuestionnaireResponse.author
Definition | The individual or device that received the answers to the questions in the QuestionnaireResponse and recorded them in the system.
Short | The individual or device that received and recorded the answers
Comments | 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. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.
Control | 0..1
Type | Reference(Device, Practitioner, PractitionerRole, Patient, RelatedPerson, Organization)
Is Modifier | false
Must Support | false
Summary | true
Requirements | Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.
Alternate Names | Laboratory, Service, Practitioner, Department, Company, Performer
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. QuestionnaireResponse.source
Definition | The individual or device that answered the questions about the subject.
Short | The individual or device that answered the questions
Comments | If not specified, no inference can be made about who provided the data. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.
Control | 1..1
Type | Reference(SGHI Reference)(SGHI Organization, SGHI Patient, SGHI Practitioner)
Is Modifier | false
Must Support | false
Summary | true
Requirements | When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. QuestionnaireResponse.item
Definition | A group or question item from the original questionnaire for which answers are provided.
Short | Groups and questions
Comments | 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).\nWhen dealing with repeating items, each group repetition will be handled by a separate item. However, repeating questions are handled with a single question item and potentially multiple answers.
Control | 1..*
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) qrs-1: Item cannot contain both item and answer (`(answer.exists() and item.exists()).not()`) qrs-2: Repeated answers are combined in the answers array of a single item (`repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()`)
56. QuestionnaireResponse.item.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
58. QuestionnaireResponse.item.extension
Definition | May 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 managable, 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.
Short | Additional content defined by implementations
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
60. QuestionnaireResponse.item.modifierExtension
Definition | May 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 managable, 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
62. QuestionnaireResponse.item.linkId
Definition | The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
Short | Pointer to specific item from Questionnaire
Control | 1..1 This element is affected by the following invariants: qrs-2
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
64. QuestionnaireResponse.item.definition
Definition | A reference to an ElementDefinition that provides the details for the item.
Short | ElementDefinition - details for the item
Comments | 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.
Control | 0..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | 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.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
66. QuestionnaireResponse.item.text
Definition | Text that is displayed above the contents of the group or as the text of the question being answered.
Short | Name for group or question text
Comments | The text for an item SHOULD be identical to the text from the corresponding Questionnaire.item. This can't be strictly enforced because it's possible for the Questionnaire to be updated subsequent to the QuestionnaireResponse having been created, however the intention is that the text in the QuestionnaireResponse reflects what the user saw when completing the Questionnaire.
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Allows the questionnaire response to be read without access to the questionnaire.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
68. QuestionnaireResponse.item.answer
Definition | The respondent's answer(s) to the question.
Short | The response(s) to the question
Comments | The value is nested because we cannot have a repeating structure that has variable type.
Control | 0..* This element is affected by the following invariants: qrs-1, qrs-2
Type | BackboneElement
Is Modifier | false
Must Support | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. QuestionnaireResponse.item.answer.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1 This element is affected by the following invariants: ele-1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
72. QuestionnaireResponse.item.answer.extension
Definition | May 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 managable, 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.
Short | Additional content defined by implementations
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
74. QuestionnaireResponse.item.answer.modifierExtension
Definition | May 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 managable, 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | 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.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | 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.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
76. QuestionnaireResponse.item.answer.value[x]
Definition | The answer (or one of the answers) provided by the respondent to the question.
Short | Single-valued answer to the question
Comments | 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. Note that a question is answered using one of the possible choices defined with answerOption, answerValueSet or some other means and the answer has a complex data type, all elements within the answer in the QuestionnaireResponse SHOULD match the elements defined corresponding choice value in the Questionnaire. However, it is possible that not all elements will be propagated. Also, some systems might use language translations resulting in different displays. Comparison of value to the values defined in the Questionnaire (whether by answerOption, answerValueSet or answerExpression) SHALL NOT pay attention to Coding.display, Reference.display, Quantity.unit unless those are the only elements present. As well, systems are not required to check for a match on any extensions (e.g. ordinal values, translations, etc.). Systems MAY enforce that if extensions such as ordinal values are present in both Questionnaire and QuestionnaireResponse, they match.
Control | 1..1 This element is affected by the following invariants: qrs-2
Binding | For example codes, see QuestionnaireAnswerCodes (example to `http://hl7.org/fhir/ValueSet/questionnaire-answers|5.0.0` ) Binding this is problematic because one value set can't apply to both codes and quantities.
Type | Choice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity(SimpleQuantity), Reference(Resource)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | false
Summary | false
Requirements | Ability to retain a single-valued answer to a question.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. QuestionnaireResponse.item.answer.item
Definition | Nested groups and/or questions found within this particular answer.
Short | Child items of question
Comments | Only used when nesting beneath a question - see item.item for nesting beneath groups
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
Is Modifier | false
Must Support | false
Summary | false
Requirements | It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
80. QuestionnaireResponse.item.item
Definition | Sub-questions, sub-groups or display items nested beneath a group.
Short | Child items of group item
Comments | Only used when nesting beneath a group - see item.answer.item for nesting beneath questions
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
Is Modifier | false
Must Support | false
Summary | false
Requirements | Reports can consist of complex nested groups.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)