US Core Implementation Guide
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US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 9.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: USCoreQuestionnaireResponseProfile - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 3

Definitions for the us-core-questionnaireresponse resource profile.

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

0. QuestionnaireResponse
Definition

Sets expectations for supported capabilities for questionnaire responses for SDC-conformant systems.


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.

ShortUS Core Profile based on SDC QuestionnaireResponseA 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.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesForm, QuestionnaireAnswers, Form Data
Invariantsdom-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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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())
sdcqr-1: Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject. (subject.exists())
sdcqr-2: When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers. ((QuestionnaireResponse|repeat(answer|item)).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue())
sdcqr-3: Can either have source or source extension, but not both (source.count() + extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-QuestionnaireResponse.source').count() <=1)
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.

ShortA 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 it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. QuestionnaireResponse.extension:adheresTo
Slice NameadheresTo
Definition

The action represented by this resource has been determined to satisfy the expectations established by the referenced Definition resource.

ShortFollows rules from
Comments

If changes are made to this event record, the determination must be made whether, with the change, the action still complies with the referenced Definition. Revisions may result in adheresTo assertions being removed, or - if the system has an algorithm for determining which targets are appropriate - being added. Adherence may be asserted after the fact. It is possible for a Request or Event to adhere to a Definition even if the author/performer of the action was not aware of the Definition at the time the action was taken/requested.

Also see the notes in the workflow extensions area for more guidance on this element.

Control0..*
This element is affected by the following invariants: ele-1
TypeExtension(adheres to) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
Is Modifierfalse
Summaryfalse
Invariantsele-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())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. QuestionnaireResponse.extension:adheresTo.extension
Definition

An Extension


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 manageable, 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.

ShortExtensionAdditional 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.

Control0..0*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-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())
SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. QuestionnaireResponse.extension:adheresTo.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-adheresTo
    10. QuestionnaireResponse.extension:adheresTo.value[x]
    Definition

    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortValue of extension
    Control10..1
    TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. QuestionnaireResponse.extension:triggeredBy
    Slice NametriggeredBy
    Definition

    This resource came into being as a result of expectations set in the referenced Definition resource. I.e. This resource represents a 'step' dictated within the protocol/order set/etc.

    ShortCreated because of following
    Comments

    See the notes in the workflow extensions area for more guidance on this element.

    Control0..1
    This element is affected by the following invariants: ele-1
    TypeExtension(Triggered by) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-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())
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    14. QuestionnaireResponse.extension:triggeredBy.extension
    Definition

    An Extension


    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 manageable, 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.

    ShortExtensionAdditional 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.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-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())
    SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. QuestionnaireResponse.extension:triggeredBy.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
      18. QuestionnaireResponse.extension:triggeredBy.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. QuestionnaireResponse.extension:signature
      Slice Namesignature
      Definition

      Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

      ShortA signature attesting to the content
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      22. QuestionnaireResponse.extension:completionMode
      Slice NamecompletionMode
      Definition

      Indicates how the individual completing the QuestionnaireResponse provided their responses.

      ShortE.g. Verbal, written, electronic
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      24. 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 manageable, 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).

      ShortExtensions 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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      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 Namesextensions, user content
      Invariantsele-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())
      26. QuestionnaireResponse.identifier
      Definition

      A business identifier assigned to a particular completed (or partially completed) questionnaire.

      ShortUnique id for this set of answers
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..1
      TypeIdentifier
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Used for tracking, registration and other business purposes.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. QuestionnaireResponse.questionnaire
      Definition

      The Questionnaire that defines and organizes the questions for which answers are being provided.

      ShortForm being answered
      Comments

      For SDC, this SHALL be the version-specific URL of the form as hosted on the Form Manager.


      If a QuestionnaireResponse references a Questionnaire, 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.).

      Control10..1
      Typecanonical(SDC Base Questionnaire, Questionnaire)
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

      Alternate NamesForm
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. QuestionnaireResponse.questionnaire.extension:questionnaireDisplay
      Slice NamequestionnaireDisplay
      Definition

      The title or other name to display when referencing a resource by canonical URL.

      ShortDisplay name for canonical reference
      Comments

      This SHALL be the title of the Questionnaire at the time the QuestionnaireResponse was originally authored.

      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Display Name) (Extension Type: string)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      32. QuestionnaireResponse.questionnaire.extension:url
      Slice Nameurl
      Definition

      This extension is used when the survey,form, or questionnaire which is being anwered is not a FHIR Questionnaire, otherwise the canonical url for the FHIR Questionnaire is used.

      ShortThe location where a non-FHIR questionnaire/survey form can be found.
      Control0..1
      TypeExtension(US Core Extension Questionnaire URI) (Extension Type: uri)
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      34. QuestionnaireResponse.status
      Definition

      The position of the questionnaire response within its overall lifecycle.

      Shortin-progress | completed | amended | entered-in-error | stopped
      Comments

      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from QuestionnaireResponseStatushttp://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1)

      Lifecycle status of the questionnaire response.

      Typecode
      Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Requirements

      The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. 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.

      ShortThe 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.

      Control10..1
      TypeReference(US Core Patient Profile, Resource, Resource)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesReference(US Core Patient Profile)
      Summarytrue
      Requirements

      Allows linking the answers to the individual the answers describe. May also affect access control.

      Alternate NamesPatient, Focus
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. QuestionnaireResponse.authored
      Definition

      Identifies when this version of the answer set was created. Changes whenever the answers are updated.


      The date and/or time that this set of answers were last changed.

      ShortDate 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.

      Control10..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      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 NamesDate Created, Date published, Date Issued, Date updated
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. QuestionnaireResponse.author
      Definition

      Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.

      ShortPerson who 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.

      Control0..1
      TypeReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, PractitionerRole, US Core Device Profile, US Core RelatedPerson Profile, Device, Practitioner, PractitionerRole, Patient, RelatedPerson, Organization)
      Is Modifierfalse
      Must Supporttrue
      Must Support TypesReference(US Core Practitioner Profile)
      Summarytrue
      Requirements

      Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

      Alternate NamesLaboratory, Service, Practitioner, Department, Company, Performer
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. QuestionnaireResponse.item
      Definition

      A group or question item from the original questionnaire for which answers are provided.

      ShortGroups 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).

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      qrs-1: Nested item can't be beneath 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())
      qrs-1: Nested item can't be beneath both item and answer ((answer.exists() and item.exists()).not())
      44. QuestionnaireResponse.item.extension:itemMedia
      Slice NameitemMedia
      Definition

      Media to render/make available as an accompaniment to the question being asked

      ShortMedia to display
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Item Media) (Extension Type: Attachment)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      46. QuestionnaireResponse.item.extension:ItemSignature
      Slice NameItemSignature
      Definition

      Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

      ShortA signature attesting to the content
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      48. 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 manageable, 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).

      ShortExtensions 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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      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 Namesextensions, user content, modifiers
      Invariantsele-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())
      50. QuestionnaireResponse.item.linkId
      Definition

      The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.

      ShortPointer to specific item from Questionnaire
      Control1..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. QuestionnaireResponse.item.text
      Definition

      Text that is displayed above the contents of the group or as the text of the question being answered.

      ShortName for group or question text
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Allows the questionnaire response to be read without access to the questionnaire.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. QuestionnaireResponse.item.answer
      Definition

      The respondent's answer(s) to the question.

      ShortThe response(s) to the question
      Comments

      The value is nested because we cannot have a repeating structure that has variable type.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
      Slice NameitemAnswerMedia
      Definition

      Media to render/make available as an accompaniment to a specific answer option

      ShortAnswer Media to display
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Item Answer Media) (Extension Type: Attachment)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      58. QuestionnaireResponse.item.answer.extension:itemWeight
      Slice NameitemWeight
      Definition

      A numeric value that allows the comparison (less than, greater than) or other numerical manipulation of a concept (e.g. Adding up components of a score). Scores are usually a whole number, but occasionally decimals are encountered in scores. In the CodeSystem and ValueSet resources, the item weight is represented using the itemWeight property. In questionnaires, this extension goes on answerOption where possible.

      ShortAssigned Ordinal Value
      Comments

      Inclusion of weights in QRs can increase performance when calculating based on weights.

      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Item Weight) (Extension Type: decimal)
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      60. 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 manageable, 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).

      ShortExtensions 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.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      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 Namesextensions, user content, modifiers
      Invariantsele-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.answer.value[x]
      Definition

      The answer (or one of the answers) provided by the respondent to the question.

      ShortSingle-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.

      Control0..1
      BindingFor example codes, see QuestionnaireAnswerCodeshttp://hl7.org/fhir/ValueSet/questionnaire-answers|4.0.1
      (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.0.1)

      Code indicating the response provided for a question.

      TypeChoice of: boolean, date, dateTime, time, decimal, integer, string, Coding, uri, Quantity, Attachment, Reference(Resource)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesChoice of: decimal, string, Coding
      Summaryfalse
      Requirements

      Ability to retain a single-valued answer to a question.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. QuestionnaireResponse.item.answer.item
      Definition

      Nested groups and/or questions found within this particular answer.

      ShortNested groups and questions
      Control0..*
      TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. QuestionnaireResponse.item.item
      Definition

      Questions or sub-groups nested beneath a question or group.

      ShortNested questionnaire response items
      Control0..*
      TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Requirements

      Reports can consist of complex nested groups.

      Invariantsele-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
      ShortUS Core Profile based on SDC QuestionnaireResponse
      2. QuestionnaireResponse.questionnaire
      Must Supporttrue
      4. QuestionnaireResponse.questionnaire.extension:url
      Slice Nameurl
      ShortThe location where a non-FHIR questionnaire/survey form can be found.
      Control0..1
      TypeExtension(US Core Extension Questionnaire URI) (Extension Type: uri)
      Must Supporttrue
      6. QuestionnaireResponse.status
      Must Supporttrue
      8. QuestionnaireResponse.subject
      Control1..?
      TypeReference(US Core Patient Profile, Resource)
      Must Supporttrue
      Must Support TypesReference(US Core Patient Profile)
      10. QuestionnaireResponse.authored
      Must Supporttrue
      12. QuestionnaireResponse.author
      TypeReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, PractitionerRole, US Core Device Profile, US Core RelatedPerson Profile)
      Must Supporttrue
      Must Support TypesReference(US Core Practitioner Profile)
      14. QuestionnaireResponse.item
      Must Supporttrue
      16. QuestionnaireResponse.item.linkId
      Must Supporttrue
      18. QuestionnaireResponse.item.answer
      20. QuestionnaireResponse.item.answer.value[x]
      Control0..1
      TypeChoice of: boolean, date, dateTime, time, decimal, integer, string, Coding, uri, Quantity, Attachment, Reference
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesChoice of: decimal, string, Coding

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

      0. QuestionnaireResponse
      Definition

      Sets expectations for supported capabilities for questionnaire responses for SDC-conformant systems.

      ShortUS Core Profile based on SDC QuestionnaireResponse
      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.

      Control0..*
      Is Modifierfalse
      Must Supporticon Removed:false
      Summaryfalse
      Alternate NamesForm, QuestionnaireAnswers, Form Data
      Invariantsdom-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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(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())
      sdcqr-1: Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject. (subject.exists())
      sdcqr-2: When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers. ((QuestionnaireResponse|repeat(answer|item)).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue())
      sdcqr-3: Can either have source or source extension, but not both (source.count() + extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-QuestionnaireResponse.source').count() <=1)
      2. QuestionnaireResponse.id
      Definition

      The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

      ShortLogical id of this artifact
      Comments

      The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      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.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-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.

      ShortA 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 it's narrative along with other profiles, value sets, etc.

      Control0..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-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.

      ShortLanguage 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).

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages|4.0.1)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-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.

      ShortText summary of the resource, for human interpretation
      Comments

      Contained resources do not have 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.

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-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, and nor can they have their own independent transaction scope.

      ShortContained, 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.

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. QuestionnaireResponse.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Invariantsele-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())
      SlicingThis element introduces a set of slices on QuestionnaireResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. QuestionnaireResponse.extension:adheresTo
        Slice NameadheresTo
        Definition

        The action represented by this resource has been determined to satisfy the expectations established by the referenced Definition resource.

        ShortFollows rules from
        Comments

        If changes are made to this event record, the determination must be made whether, with the change, the action still complies with the referenced Definition. Revisions may result in adheresTo assertions being removed, or - if the system has an algorithm for determining which targets are appropriate - being added. Adherence may be asserted after the fact. It is possible for a Request or Event to adhere to a Definition even if the author/performer of the action was not aware of the Definition at the time the action was taken/requested.

        Also see the notes in the workflow extensions area for more guidance on this element.

        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(adheres to) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
        Is Modifierfalse
        Summaryfalse
        Invariantsele-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.extension:adheresTo.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typestring
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        20. QuestionnaireResponse.extension:adheresTo.extension
        Definition

        An Extension

        ShortExtension
        Control0..0
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Invariantsele-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())
        SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 22. QuestionnaireResponse.extension:adheresTo.url
          Definition

          Source of the definition for the extension code - a logical name or a URL.

          Shortidentifies the meaning of the extension
          Comments

          The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

          Control1..1
          Typeuri
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-adheresTo
          24. QuestionnaireResponse.extension:adheresTo.value[x]
          Definition

          Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

          ShortValue of extension
          Control1..1
          TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          26. QuestionnaireResponse.extension:triggeredBy
          Slice NametriggeredBy
          Definition

          This resource came into being as a result of expectations set in the referenced Definition resource. I.e. This resource represents a 'step' dictated within the protocol/order set/etc.

          ShortCreated because of following
          Comments

          See the notes in the workflow extensions area for more guidance on this element.

          Control0..1
          This element is affected by the following invariants: ele-1
          TypeExtension(Triggered by) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-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())
          28. QuestionnaireResponse.extension:triggeredBy.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          30. QuestionnaireResponse.extension:triggeredBy.extension
          Definition

          An Extension

          ShortExtension
          Control0..0
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-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())
          SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 32. QuestionnaireResponse.extension:triggeredBy.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
            34. QuestionnaireResponse.extension:triggeredBy.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control1..1
            TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. QuestionnaireResponse.extension:signature
            Slice Namesignature
            Definition

            Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

            ShortA signature attesting to the content
            Control0..*
            This element is affected by the following invariants: ele-1
            TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-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())
            38. QuestionnaireResponse.extension:completionMode
            Slice NamecompletionMode
            Definition

            Indicates how the individual completing the QuestionnaireResponse provided their responses.

            ShortE.g. Verbal, written, electronic
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-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())
            40. 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 manageable, 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).

            ShortExtensions 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.

            Control0..*
            TypeExtension
            Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
            Summaryfalse
            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 Namesextensions, user content
            Invariantsele-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())
            42. QuestionnaireResponse.identifier
            Definition

            A business identifier assigned to a particular completed (or partially completed) questionnaire.

            ShortUnique id for this set of answers
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control0..1
            TypeIdentifier
            Is Modifierfalse
            Must Supporttrue
            Summarytrue
            Requirements

            Used for tracking, registration and other business purposes.

            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            44. QuestionnaireResponse.basedOn
            Definition

            The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.

            ShortRequest fulfilled by this QuestionnaireResponse
            Control0..*
            TypeReference(CarePlan, ServiceRequest)
            Is Modifierfalse
            Must Supporticon Removed:false
            Summarytrue
            Requirements

            Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.

            Alternate Namesorder
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            46. 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.

            ShortPart of this action
            Comments

            Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.

            Control0..*
            TypeReference(Observation, Procedure)
            Is Modifierfalse
            Must Supporticon Removed:false
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            48. QuestionnaireResponse.questionnaire
            Definition

            The Questionnaire that defines and organizes the questions for which answers are being provided.

            ShortForm being answered
            Comments

            For SDC, this SHALL be the version-specific URL of the form as hosted on the Form Manager.

            Control1..1
            Typecanonical(SDC Base Questionnaire)
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Must Supporttrue
            Summarytrue
            Requirements

            Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

            Alternate NamesForm
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            50. QuestionnaireResponse.questionnaire.id
            Definition

            unique id for the element within a resource (for internal references)

            Shortxml:id (or equivalent in JSON)
            Control0..1
            Typestring
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            52. QuestionnaireResponse.questionnaire.extension
            Definition

            An Extension

            ShortExtension
            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-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())
            SlicingThis element introduces a set of slices on QuestionnaireResponse.questionnaire.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 54. QuestionnaireResponse.questionnaire.extension:questionnaireDisplay
              Slice NamequestionnaireDisplay
              Definition

              The title or other name to display when referencing a resource by canonical URL.

              ShortDisplay name for canonical reference
              Comments

              This SHALL be the title of the Questionnaire at the time the QuestionnaireResponse was originally authored.

              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Display Name) (Extension Type: string)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-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())
              56. QuestionnaireResponse.questionnaire.extension:url
              Slice Nameurl
              Definition

              This extension is used when the survey,form, or questionnaire which is being anwered is not a FHIR Questionnaire, otherwise the canonical url for the FHIR Questionnaire is used.

              ShortThe location where a non-FHIR questionnaire/survey form can be found.
              Control0..1
              TypeExtension(US Core Extension Questionnaire URI) (Extension Type: uri)
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantsele-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())
              58. QuestionnaireResponse.questionnaire.value
              Definition

              Primitive value for canonical

              ShortPrimitive value for canonical
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              60. QuestionnaireResponse.status
              Definition

              The position of the questionnaire response within its overall lifecycle.

              Shortin-progress | completed | amended | entered-in-error | stopped
              Comments

              This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

              Control1..1
              BindingThe codes SHALL be taken from QuestionnaireResponseStatus
              (required to http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1)

              Lifecycle status of the questionnaire response.

              Typecode
              Is Modifiertrue 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 ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              Requirements

              The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              62. 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.

              ShortThe subject of the questions
              Control1..1
              TypeReference(US Core Patient Profile, Resource)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesReference(US Core Patient Profile)
              Summarytrue
              Requirements

              Allows linking the answers to the individual the answers describe. May also affect access control.

              Alternate NamesPatient, Focus
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              64. QuestionnaireResponse.encounter
              Definition

              The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.

              ShortEncounter created as part of
              Comments

              This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

              Control0..1
              TypeReference(Encounter)
              Is Modifierfalse
              Must Supporticon Removed:false
              Summarytrue
              Requirements

              Provides context for the information that was captured. May also affect access control.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              66. QuestionnaireResponse.authored
              Definition

              Identifies when this version of the answer set was created. Changes whenever the answers are updated.

              ShortDate 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.

              Control1..1
              TypedateTime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summarytrue
              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 NamesDate Created, Date published, Date Issued, Date updated
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              68. QuestionnaireResponse.author
              Definition

              Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.

              ShortPerson who 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.

              Control0..1
              TypeReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, PractitionerRole, US Core Device Profile, US Core RelatedPerson Profile)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesReference(US Core Practitioner Profile)
              Summarytrue
              Requirements

              Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

              Alternate NamesLaboratory, Service, Practitioner, Department, Company, Performer
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              70. QuestionnaireResponse.source
              Definition

              The person who answered the questions about the subject.

              ShortThe person who answered the questions
              Comments

              If not specified, no inference can be made about who provided the data.

              Control0..1
              TypeReference(Patient, Practitioner, PractitionerRole, RelatedPerson)
              Is Modifierfalse
              Must Supporticon Removed:false
              Summarytrue
              Requirements

              When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              72. QuestionnaireResponse.source.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              74. QuestionnaireResponse.source.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 manageable, 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.

              ShortAdditional 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.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-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())
              SlicingThis element introduces a set of slices on QuestionnaireResponse.source.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 76. QuestionnaireResponse.source.extension:r5Source
                Slice Namer5Source
                Definition

                Used when the target of the reference has a type that is not allowed by the definition of the element. In general, this should only arise when wrangling between versions using cross-version extensions.

                ShortAlternative reference (target type is wrong)
                Comments

                Given that a reference SHALL have a display or reference, using this extension implies that there's a display present.

                Control0..1
                TypeExtension(Alternate Reference) (Extension Type: Reference(Resource))
                Is Modifierfalse
                Summaryfalse
                Invariantsele-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())
                78. QuestionnaireResponse.source.extension:r5Source.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                80. QuestionnaireResponse.source.extension:r5Source.extension
                Definition

                An Extension

                ShortExtension
                Control0..0
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-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())
                SlicingThis element introduces a set of slices on QuestionnaireResponse.source.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 82. QuestionnaireResponse.source.extension:r5Source.url
                  Definition

                  Source of the definition for the extension code - a logical name or a URL.

                  Shortidentifies the meaning of the extension
                  Comments

                  The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                  Control1..1
                  Typeuri
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  Fixed Valuehttp://hl7.org/fhir/StructureDefinition/alternate-reference
                  84. QuestionnaireResponse.source.extension:r5Source.value[x]
                  Definition

                  Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                  ShortValue of extension
                  Control1..1
                  TypeReference(Device, Organization)
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. QuestionnaireResponse.source.reference
                  Definition

                  A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                  ShortLiteral reference, Relative, internal or absolute URL
                  Comments

                  Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                  Control0..1
                  This element is affected by the following invariants: ref-1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  88. QuestionnaireResponse.source.type
                  Definition

                  The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                  The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                  ShortType the reference refers to (e.g. "Patient")
                  Comments

                  This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                  Control0..1
                  BindingUnless not suitable, these codes SHALL be taken from ResourceType
                  (extensible to http://hl7.org/fhir/ValueSet/resource-types|4.0.1)

                  Aa resource (or, for logical models, the URI of the logical model).

                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  90. QuestionnaireResponse.source.identifier
                  Definition

                  An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                  ShortLogical reference, when literal reference is not known
                  Comments

                  When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                  When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                  Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                  Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                  NoteThis is a business identifier, not a resource identifier (see discussion)
                  Control0..1
                  TypeIdentifier
                  Is Modifierfalse
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. QuestionnaireResponse.source.display
                  Definition

                  Plain text narrative that identifies the resource in addition to the resource reference.

                  ShortText alternative for the resource
                  Comments

                  This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  94. QuestionnaireResponse.item
                  Definition

                  A group or question item from the original questionnaire for which answers are provided.

                  ShortGroups 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).

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  qrs-1: Nested item can't be beneath 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())
                  96. 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.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  98. QuestionnaireResponse.item.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-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())
                  SlicingThis element introduces a set of slices on QuestionnaireResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 100. QuestionnaireResponse.item.extension:itemMedia
                    Slice NameitemMedia
                    Definition

                    Media to render/make available as an accompaniment to the question being asked

                    ShortMedia to display
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Item Media) (Extension Type: Attachment)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-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())
                    102. QuestionnaireResponse.item.extension:ItemSignature
                    Slice NameItemSignature
                    Definition

                    Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

                    ShortA signature attesting to the content
                    Control0..*
                    This element is affected by the following invariants: ele-1
                    TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-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())
                    104. 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 manageable, 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).

                    ShortExtensions 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.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    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 Namesextensions, user content, modifiers
                    Invariantsele-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())
                    106. QuestionnaireResponse.item.linkId
                    Definition

                    The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.

                    ShortPointer to specific item from Questionnaire
                    Control1..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    108. QuestionnaireResponse.item.definition
                    Definition

                    A reference to an ElementDefinition that provides the details for the item.

                    ShortElementDefinition - 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.

                    Control0..1
                    Typeuri
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    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.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    110. QuestionnaireResponse.item.text
                    Definition

                    Text that is displayed above the contents of the group or as the text of the question being answered.

                    ShortName for group or question text
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Allows the questionnaire response to be read without access to the questionnaire.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    112. QuestionnaireResponse.item.answer
                    Definition

                    The respondent's answer(s) to the question.

                    ShortThe response(s) to the question
                    Comments

                    The value is nested because we cannot have a repeating structure that has variable type.

                    Control0..*
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    114. 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.

                    ShortUnique id for inter-element referencing
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    116. QuestionnaireResponse.item.answer.extension
                    Definition

                    An Extension

                    ShortExtension
                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-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())
                    SlicingThis element introduces a set of slices on QuestionnaireResponse.item.answer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 118. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
                      Slice NameitemAnswerMedia
                      Definition

                      Media to render/make available as an accompaniment to a specific answer option

                      ShortAnswer Media to display
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Item Answer Media) (Extension Type: Attachment)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-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())
                      120. QuestionnaireResponse.item.answer.extension:itemWeight
                      Slice NameitemWeight
                      Definition

                      A numeric value that allows the comparison (less than, greater than) or other numerical manipulation of a concept (e.g. Adding up components of a score). Scores are usually a whole number, but occasionally decimals are encountered in scores. In the CodeSystem and ValueSet resources, the item weight is represented using the itemWeight property. In questionnaires, this extension goes on answerOption where possible.

                      ShortAssigned Ordinal Value
                      Comments

                      Inclusion of weights in QRs can increase performance when calculating based on weights.

                      Control0..1
                      This element is affected by the following invariants: ele-1
                      TypeExtension(Item Weight) (Extension Type: decimal)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-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())
                      122. 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 manageable, 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).

                      ShortExtensions 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.

                      Control0..*
                      TypeExtension
                      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                      Summarytrue
                      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 Namesextensions, user content, modifiers
                      Invariantsele-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())
                      124. QuestionnaireResponse.item.answer.value[x]
                      Definition

                      The answer (or one of the answers) provided by the respondent to the question.

                      ShortSingle-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.

                      Control0..1
                      BindingFor example codes, see QuestionnaireAnswerCodes
                      (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.0.1)

                      Code indicating the response provided for a question.

                      TypeChoice of: boolean, date, dateTime, time, decimal, integer, string, Coding, uri, Quantity, Attachment, Reference
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Must Support TypesChoice of: decimal, string, Coding
                      Summaryfalse
                      Requirements

                      Ability to retain a single-valued answer to a question.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      126. QuestionnaireResponse.item.answer.item
                      Definition

                      Nested groups and/or questions found within this particular answer.

                      ShortNested groups and questions
                      Control0..*
                      TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      128. QuestionnaireResponse.item.item
                      Definition

                      Questions or sub-groups nested beneath a question or group.

                      ShortNested questionnaire response items
                      Control0..*
                      TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      Reports can consist of complex nested groups.

                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))