US Core Implementation Guide
7.0.0-ballot - Ballot United States of America flag

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 7.0.0-ballot 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 found here

0. QuestionnaireResponse
Definition

-

ShortUS Core Profile based on SDC QuestionnaireResponse
Comments

-

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, Device, 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] NoteSee Choice of Data Types for 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 found here

0. QuestionnaireResponse
Definition

-


A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to.

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
Must Supportfalse
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())
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: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..*
TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifierfalse
Must Supportfalse
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())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. QuestionnaireResponse.extension:completionMode
Slice NamecompletionMode
Definition

Indicates how the individual completing the QuestionnaireResponse provided their responses.

ShortE.g. Verbal, written, electronic
Control0..1
TypeExtension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supportfalse
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())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. QuestionnaireResponse.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())
10. 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()))
12. 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(SDCBaseQuestionnaire, 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()))
14. 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
TypeExtension(Display Name) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
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())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
16. QuestionnaireResponse.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())
18. 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

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()))
20. 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)
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()))
22. 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()))
24. 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, Device, US Core RelatedPerson Profile, Practitioner, 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()))
26. 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-1: Nested item can't be beneath both item and answer ((answer.exists() and item.exists()).not())
28. 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
Must Supportfalse
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())
30. 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..*
TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifierfalse
Must Supportfalse
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())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
32. 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())
34. 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()))
36. 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()))
38. 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()))
40. 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
Must Supportfalse
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())
42. QuestionnaireResponse.item.answer.extension:ordinalValue
Slice NameordinalValue
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.

ShortAssigned Ordinal Value
Comments

Scores are commonly encountered in various clinical assessment scales. Assigning a value to a concept should generally be done in a formal code system that defines the value, or in an applicable value set for the concept, but some concepts do not have a formal definition (or are not even represented as a concept formally, especially in Questionnaires, so this extension is allowed to appear ouside those preferred contexts. Scores may even be assigned arbitrarily during use (hence, on Coding). The value may be constrained to an integer in some contexts of use. Todo: Scoring algorithms may also be defined directly, but how this is done is not yet defined.

Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Ordinal Value) (Extension Type: decimal)
Is Modifierfalse
Must Supportfalse
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())
44. 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())
46. 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

Code indicating the response provided for a question.

TypeChoice of: boolean, date, dateTime, time, decimal, integer, string, Coding, uri, Quantity, Attachment, Reference(Resource)
[x] NoteSee Choice of Data Types for 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()))
48. QuestionnaireResponse.item.answer.item
Definition

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

ShortNested groups and questions
Control0..*
TypeSee ttp://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()))
50. QuestionnaireResponse.item.item
Definition

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

ShortNested questionnaire response items
Control0..*
TypeSee ttp://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 found here

0. QuestionnaireResponse
Definition

-

ShortUS Core Profile based on SDC QuestionnaireResponse
Comments

-

Control0..*
Is Modifierfalse
Must Supportfalse
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())
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

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 are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
16. 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..*
TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifierfalse
Must Supportfalse
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:completionMode
Slice NamecompletionMode
Definition

Indicates how the individual completing the QuestionnaireResponse provided their responses.

ShortE.g. Verbal, written, electronic
Control0..1
TypeExtension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
Is Modifierfalse
Must Supportfalse
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())
20. 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())
22. 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()))
24. 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 Supportfalse
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()))
26. 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 Supportfalse
Summarytrue
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.

Control1..1
Typecanonical(SDCBaseQuestionnaire)
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.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
32. 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 are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
34. 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
TypeExtension(Display Name) (Extension Type: string)
Is Modifierfalse
Must Supporttrue
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())
36. 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())
38. 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
40. 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

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()))
42. 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()))
44. 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 Supportfalse
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()))
46. 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()))
48. 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, Device, 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()))
50. 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 Supportfalse
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()))
52. 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())
54. 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
56. 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 are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
58. 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
Must Supportfalse
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())
60. 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..*
TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifierfalse
Must Supportfalse
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.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())
64. 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()))
66. 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()))
68. 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()))
70. 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()))
72. 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
74. 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 are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
76. 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
Must Supportfalse
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.item.answer.extension:ordinalValue
Slice NameordinalValue
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.

ShortAssigned Ordinal Value
Comments

Scores are commonly encountered in various clinical assessment scales. Assigning a value to a concept should generally be done in a formal code system that defines the value, or in an applicable value set for the concept, but some concepts do not have a formal definition (or are not even represented as a concept formally, especially in Questionnaires, so this extension is allowed to appear ouside those preferred contexts. Scores may even be assigned arbitrarily during use (hence, on Coding). The value may be constrained to an integer in some contexts of use. Todo: Scoring algorithms may also be defined directly, but how this is done is not yet defined.

Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Ordinal Value) (Extension Type: decimal)
Is Modifierfalse
Must Supportfalse
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())
80. 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())
82. 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

Code indicating the response provided for a question.

TypeChoice of: boolean, date, dateTime, time, decimal, integer, string, Coding, uri, Quantity, Attachment, Reference
[x] NoteSee Choice of Data Types for 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()))
84. QuestionnaireResponse.item.answer.item
Definition

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

ShortNested groups and questions
Control0..*
TypeSee ttp://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()))
86. QuestionnaireResponse.item.item
Definition

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

ShortNested questionnaire response items
Control0..*
TypeSee ttp://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()))