<QuestionnaireResponse xmlns="http://hl7.org/fhir"><id value="f201"/><questionnaire><extension url="http://hl7.org/fhir/StructureDefinition/display"><valueString value="Lifelines"/></extension></questionnaire><status value="completed"/><subject><reference value="Patient/f201"/><display value="Roel"/></subject><authored value="2013-06-18T00:00:00+01:00"/><author><reference value="Practitioner/f201"/></author><source><reference value="Practitioner/f201"/></source><item><linkId value="1"/><text value="Do you have allergies?"/><answer><valueBoolean value="true"/></answer></item><item><linkId value="2"/><text value="General questions"/><item><linkId value="2.1"/><text value="What is your gender?"/><answer><valueString value="Male"/></answer></item><item><linkId value="2.2"/><text value="What is your date of birth?"/><answer><valueDate value="1960-03-13"/></answer></item><item><linkId value="2.3"/><text value="What is your country of birth?"/><answer><valueString value="The Netherlands"/></answer></item><item><linkId value="2.4"/><text value="What is your marital status?"/><answer><valueString value="married"/></answer></item></item><item><linkId value="3"/><text value="Intoxications"/><item><linkId value="3.1"/><text value="Do you smoke?"/><answer><valueBoolean value="false"/></answer></item><item><linkId value="3.2"/><text value="Do you drink alchohol?"/><answer><valueBoolean value="false"/></answer></item></item></QuestionnaireResponse>