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Example Questionnaire/f201 (XML)

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: No defined compartments

Raw XML (canonical form + also see XML Format Specification)

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Real-world lifelines questionnaire (fictively taken from the patient) (id = "f201")

<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="f201"/> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <pre> Lifelines Questionnaire 1 part 1
  1. Do you have allergies?
  2. General Questions:
    2.a) What is your gender?
    2.b) What is your date of birth?
    2.c) What is your country of birth?
    2.d) What is your marital status?
    3. Intoxications:
      3.a) Do you smoke?
      3.b) Do you drink alcohol?</pre> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"><valueCode value="fhir"/> </extension> 
  <url value="http://hl7.org/fhir/Questionnaire/f201"/> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.20.6"/> 
  <status value="active"/> 
  <subjectType value="Patient"/> 
  <date value="2010"/> 
  <publisher value="HL7 International / FHIR Infrastructure"/> 
      <system value="url"/> 
    <system value="http://example.org/system/code/lifelines/nl"/> 
    <code value="VL 1-1, 18-65_1.2.2"/> 
    <display value="Lifelines Questionnaire 1 part 1"/> 
    <linkId value="1"/> 
    <text value="Do you have allergies?"/> 
    <type value="boolean"/> 
    <linkId value="2"/> 
    <text value="General questions"/> 
    <type value="group"/> 
      <linkId value="2.1"/> 
      <text value="What is your gender?"/> 
      <type value="string"/> 
      <linkId value="2.2"/> 
      <text value="What is your date of birth?"/> 
      <type value="date"/> 
      <linkId value="2.3"/> 
      <text value="What is your country of birth?"/> 
      <type value="string"/> 
      <linkId value="2.4"/> 
      <text value="What is your marital status?"/> 
      <type value="string"/> 
    <linkId value="3"/> 
    <text value="Intoxications"/> 
    <type value="group"/> 
      <linkId value="3.1"/> 
      <text value="Do you smoke?"/> 
      <type value="boolean"/> 
      <linkId value="3.2"/> 
      <text value="Do you drink alchohol?"/> 
      <type value="boolean"/> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.