Da Vinci - Documentation Templates and Rules
2.2.0 - STU 2.2

Da Vinci - Documentation Templates and Rules, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-dtr/ and changes regularly. See the Directory of published versions

## Resource Profile: DTR Questionnaire Response - Detailed Descriptions

Page standards status: Trial-use | Maturity Level: 2

Definitions for the dtr-questionnaireresponse resource profile

- Key Elements Table
- Differential Table
- Snapshot Table

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.
Short | Standard Questionnaire ResponseA structured set of questions and their answers
Comments | The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.
Control | 0..*
Is Modifier | false
Summary | false
Alternate Names | Form, QuestionnaireAnswers, Form Data
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty()) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. QuestionnaireResponse.extension
Definition | An Extension May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and 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.
Short | ExtensionAdditional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 20..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `QuestionnaireResponse.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
6. QuestionnaireResponse.extension:adheresTo
Slice Name | adheresTo
Definition | The action represented by this resource has been determined to satisfy the expectations established by the referenced Definition resource.
Short | Follows 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.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(adheres to) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. 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.
Short | ExtensionAdditional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `QuestionnaireResponse.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
10. QuestionnaireResponse.extension:adheresTo.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/workflow-adheresTo`
12. 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).
Short | Value of extension
Control | 10..1
Type | Choice 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] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. QuestionnaireResponse.extension:triggeredBy
Slice Name | triggeredBy
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.
Short | Created because of following
Comments | See the notes in the workflow extensions area for more guidance on this element.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Triggered by) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
16. 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.
Short | ExtensionAdditional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..0*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `QuestionnaireResponse.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
18. QuestionnaireResponse.extension:triggeredBy.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy`
20. 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).
Short | Value of extension
Control | 10..1
Type | Choice 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] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. QuestionnaireResponse.extension:signature
Slice Name | signature
Definition | Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.
Short | A signature attesting to the content
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
24. QuestionnaireResponse.extension:completionMode
Slice Name | completionMode
Definition | Indicates how the individual completing the QuestionnaireResponse provided their responses.
Short | E.g. Verbal, written, electronic
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
26. QuestionnaireResponse.extension:coverage
Slice Name | coverage
Definition | Identifies the coverages associated with the specified QuestionnaireResponse.
Short | Identifies the coverages associated with the specified QuestionnaireResponse.
Control | 1..*
Type | Extension(Questionnaire Response Coverage) (Extension Type: Reference(CRD Coverage))
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
28. QuestionnaireResponse.extension:context
Slice Name | context
Definition | Identifies the orders and/or other resources associated with the specified QuestionnaireResponse. Allows finding the DTR responses associated with a particular Order/Encounter/Appointment for a particular insurance coverage.
Short | Identifies the orders and/or other resources associated with the specified QuestionnaireResponse.
Control | 0..*
Type | Extension(Questionnaire Response Context) (Extension Type: Reference(CRD Device Request, CRD Medication Request, CRD Nutrition Order, CRD Service Request, CRD Encounter, CRD Base Appointment))
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
30. QuestionnaireResponse.extension:coverage-information
Slice Name | coverage-information
Definition | Indicates coverage information.
Short | Coverage Info
Control | 0..*
Type | Extension(Coverage Information) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
32. QuestionnaireResponse.extension:intendedUse
Slice Name | intendedUse
Definition | Indicates how the EHR is to use the information with respect to the associated orders/records. If the Adaptive QuestionnaireResponse includes a prior authorization number the `intendedUse` element should be set to 'retain-doc' and/or 'withorder'.
Short | Indicates how the EHR is to use the information with respect to the associated orders/records.
Control | 1..*
Type | Extension(Intended Use) (Extension Type: CodeableConcept)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
34. 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).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
36. QuestionnaireResponse.identifier
Definition | A business identifier assigned to a particular completed (or partially completed) questionnaire.
Short | Unique id for this set of answers
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1
Type | Identifier
Is Modifier | false
Must Support | true
Summary | true
Requirements | Used for tracking, registration and other business purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. 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.
Short | Request fulfilled by this QuestionnaireResponse
Control | 0..0*
Type | Reference(CarePlan, ServiceRequest)
Is Modifier | false
Summary | true
Requirements | Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.
Alternate Names | order
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. QuestionnaireResponse.partOf
Definition | A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.
Short | Part of 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.
Control | 0..0*
Type | Reference(Observation, Procedure)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. QuestionnaireResponse.questionnaire
Definition | The Questionnaire that defines and organizes the questions for which answers are being provided.
Short | Form 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.).
Control | 10..1
Type | canonical(SDC Base Questionnaire, Questionnaire)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.
Alternate Names | Form
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
44. QuestionnaireResponse.questionnaire.extension:questionnaireDisplay
Slice Name | questionnaireDisplay
Definition | The title or other name to display when referencing a resource by canonical URL.
Short | Display name for canonical reference
Comments | This SHALL be the title of the Questionnaire at the time the QuestionnaireResponse was originally authored.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Display Name) (Extension Type: string)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
46. QuestionnaireResponse.status
Definition | The position of the questionnaire response within its overall lifecycle.
Short | in-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.
Control | 1..1
Binding | The codes SHALL be taken from QuestionnaireResponseStatus http://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.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. QuestionnaireResponse.subject
Definition | The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.
Short | The subject of the questions
Comments | If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types. If subject is omitted - because the QuestionnaireResponse is not associated with a specific subject, ensure that QuestionnaireRsponse.identifier is present or the QuestionnaireResponse is referenced somewhere (e.g. Task.output, Composition.section.entry, etc.) to allow tracking and retrieval of the QuestionnaireResponse If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.
Control | 10..1
Type | Reference(CRD Patient, Resource)
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows linking the answers to the individual the answers describe. May also affect access control.
Alternate Names | Patient, Focus
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. 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.
Short | Date the answers were gathered
Comments | May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured. This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.
Control | 10..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.
Alternate Names | Date Created, Date published, Date Issued, Date updated
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
52. QuestionnaireResponse.author
Definition | Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.
Short | Person 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.
Control | 0..1
Type | Reference(Device, CRD Patient, US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization, RelatedPerson, Device, Practitioner, PractitionerRole, Patient, RelatedPerson, Organization)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Requirements | Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.
Alternate Names | Laboratory, Service, Practitioner, Department, Company, Performer
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. QuestionnaireResponse.item
Definition | A group or question item from the original questionnaire for which answers are provided.
Short | Groups and questions
Comments | Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-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())
56. QuestionnaireResponse.item.extension:itemMedia
Slice Name | itemMedia
Definition | Media to render/make available as an accompaniment to the question being asked
Short | Media to display
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Item Media) (Extension Type: Attachment)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
58. QuestionnaireResponse.item.extension:ItemSignature
Slice Name | ItemSignature
Definition | Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.
Short | A signature attesting to the content
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
60. QuestionnaireResponse.item.modifierExtension
Definition | May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
62. QuestionnaireResponse.item.linkId
Definition | The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
Short | Pointer to specific item from Questionnaire
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Requirements | Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. QuestionnaireResponse.item.text
Definition | Text that is displayed above the contents of the group or as the text of the question being answered.
Short | Name for group or question text
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Requirements | Allows the questionnaire response to be read without access to the questionnaire.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. QuestionnaireResponse.item.answer
Definition | The respondent's answer(s) to the question.
Short | The response(s) to the question
Comments | The value is nested because we cannot have a repeating structure that has variable type.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
68. QuestionnaireResponse.item.answer.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.
Short | ExtensionAdditional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 10..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
Slicing | This element introduces a set of slices on `QuestionnaireResponse.item.answer.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
70. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
Slice Name | itemAnswerMedia
Definition | Media to render/make available as an accompaniment to a specific answer option
Short | Answer Media to display
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Item Answer Media) (Extension Type: Attachment)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
72. QuestionnaireResponse.item.answer.extension:itemWeight
Slice Name | itemWeight
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.
Short | Assigned 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 ​For questionnaires, see additional guidance and examples in the SDC implementation guide.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Item Weight) (Extension Type: decimal)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
74. QuestionnaireResponse.item.answer.extension:origin
Slice Name | origin
Definition | Identifies the origin of the information in the answer and how it came to exist.
Short | Extension
Control | 1..1
Type | Extension(Information Origin) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
76. QuestionnaireResponse.item.answer.extension:containedReference
Slice Name | containedReference
Definition | Indicates that when filling a QuestionnaireResponse and selecting a reference, that the referenced resource should be included as a 'contained' resource within the QuestionnaireResponse
Short | Contain the reference?
Control | 0..1
Type | Extension(Contained Reference) (Extension Type: boolean)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
78. 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count())) ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
80. QuestionnaireResponse.item.answer.value[x]
Definition | The answer (or one of the answers) provided by the respondent to the question.
Short | Single-valued answer to the question
Comments | More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.
Control | 0..1
Binding | For example codes, see QuestionnaireAnswerCodes http://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.
Type | Choice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference(Resource)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | false
Requirements | Ability to retain a single-valued answer to a question.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
82. QuestionnaireResponse.item.answer.item
Definition | Nested groups and/or questions found within this particular answer.
Short | Nested groups and questions
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
Is Modifier | false
Must Support | true
Summary | false
Requirements | It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
84. QuestionnaireResponse.item.item
Definition | Questions or sub-groups nested beneath a question or group.
Short | Nested questionnaire response items
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
Is Modifier | false
Must Support | true
Summary | false
Requirements | Reports can consist of complex nested groups.
Invariants | ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

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

0. QuestionnaireResponse
2. QuestionnaireResponse.extension
Control | 2..?
4. QuestionnaireResponse.extension:signature
Slice Name | signature
Must Support | true
6. QuestionnaireResponse.extension:coverage
Slice Name | coverage
Short | Identifies the coverages associated with the specified QuestionnaireResponse.
Control | 1..*
Type | Extension(Questionnaire Response Coverage) (Extension Type: Reference(CRD Coverage))
Must Support | true
8. QuestionnaireResponse.extension:context
Slice Name | context
Short | Identifies the orders and/or other resources associated with the specified QuestionnaireResponse.
Control | 0..*
Type | Extension(Questionnaire Response Context) (Extension Type: Reference(CRD Device Request, CRD Medication Request, CRD Nutrition Order, CRD Service Request, CRD Encounter, CRD Base Appointment))
Must Support | true
10. QuestionnaireResponse.extension:coverage-information
Slice Name | coverage-information
Short | Coverage Info
Control | 0..*
Type | Extension(Coverage Information) (Complex Extension)
Must Support | true
12. QuestionnaireResponse.extension:intendedUse
Slice Name | intendedUse
Short | Indicates how the EHR is to use the information with respect to the associated orders/records.
Control | 1..*
Type | Extension(Intended Use) (Extension Type: CodeableConcept)
Must Support | true
14. QuestionnaireResponse.basedOn
Control | 0..0
16. QuestionnaireResponse.partOf
Control | 0..0
18. QuestionnaireResponse.subject
Control | 1..?
Type | Reference(CRD Patient)
20. QuestionnaireResponse.author
Type | Reference(Device, CRD Patient, US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization, RelatedPerson)
22. QuestionnaireResponse.item
24. QuestionnaireResponse.item.extension:ItemSignature
Slice Name | ItemSignature
Must Support | true
26. QuestionnaireResponse.item.answer
28. QuestionnaireResponse.item.answer.extension
Control | 1..?
30. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
Slice Name | itemAnswerMedia
Must Support | true
32. QuestionnaireResponse.item.answer.extension:itemWeight
Slice Name | itemWeight
Must Support | true
34. QuestionnaireResponse.item.answer.extension:origin
Slice Name | origin
Control | 1..1
Type | Extension(Information Origin) (Complex Extension)
Must Support | true
36. QuestionnaireResponse.item.answer.extension:containedReference
Slice Name | containedReference
Short | Contain the reference?
Control | 0..1
Type | Extension(Contained Reference) (Extension Type: boolean)
Must Support | true

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.
Short | Standard Questionnaire Response
Comments | The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.
Control | 0..*
Is Modifier | false
Summary | false
Alternate Names | Form, QuestionnaireAnswers, Form Data
Invariants | dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (`contained.contained.empty()`) dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (`contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().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.
Short | Logical 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.
Control | 0..1
Type | id
Is Modifier | false
Summary | true
4. QuestionnaireResponse.meta
Definition | The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Short | Metadata about the resource
Control | 0..1
Type | Meta
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
6. QuestionnaireResponse.implicitRules
Definition | A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Short | A set of rules under which this content was created
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Control | 0..1
Type | uri
Is Modifier | true because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
8. QuestionnaireResponse.language
Definition | The base language in which the resource is written.
Short | Language of the resource content
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
Control | 0..1
Binding | The codes SHOULD be taken from CommonLanguages (preferred to `http://hl7.org/fhir/ValueSet/languages|4.0.1` ) A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Type | code
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
10. QuestionnaireResponse.text
Definition | A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Short | Text summary of the resource, for human interpretation
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
Control | 0..1
Type | Narrative
Is Modifier | false
Summary | false
Alternate Names | narrative, html, xhtml, display
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
12. QuestionnaireResponse.contained
Definition | These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Short | Contained, inline Resources
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Control | 0..*
Type | Resource
Is Modifier | false
Summary | false
Alternate Names | inline resources, anonymous resources, contained resources
14. QuestionnaireResponse.extension
Definition | An Extension
Short | Extension
Control | 2..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
16. QuestionnaireResponse.extension:adheresTo
Slice Name | adheresTo
Definition | The action represented by this resource has been determined to satisfy the expectations established by the referenced Definition resource.
Short | Follows 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.
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(adheres to) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
18. QuestionnaireResponse.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.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
20. QuestionnaireResponse.extension:adheresTo.extension
Definition | An Extension
Short | Extension
Control | 0..0
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.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.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://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).
Short | Value of extension
Control | 1..1
Type | Choice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
26. QuestionnaireResponse.extension:triggeredBy
Slice Name | triggeredBy
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.
Short | Created because of following
Comments | See the notes in the workflow extensions area for more guidance on this element.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Triggered by) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, ObservationDefinition, PlanDefinition, Questionnaire), uri)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
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.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
30. QuestionnaireResponse.extension:triggeredBy.extension
Definition | An Extension
Short | Extension
Control | 0..0
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.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.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://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).
Short | Value of extension
Control | 1..1
Type | Choice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
36. QuestionnaireResponse.extension:signature
Slice Name | signature
Definition | Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.
Short | A signature attesting to the content
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
38. QuestionnaireResponse.extension:completionMode
Slice Name | completionMode
Definition | Indicates how the individual completing the QuestionnaireResponse provided their responses.
Short | E.g. Verbal, written, electronic
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
40. QuestionnaireResponse.extension:coverage
Slice Name | coverage
Definition | Identifies the coverages associated with the specified QuestionnaireResponse.
Short | Identifies the coverages associated with the specified QuestionnaireResponse.
Control | 1..*
Type | Extension(Questionnaire Response Coverage) (Extension Type: Reference(CRD Coverage))
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
42. QuestionnaireResponse.extension:context
Slice Name | context
Definition | Identifies the orders and/or other resources associated with the specified QuestionnaireResponse. Allows finding the DTR responses associated with a particular Order/Encounter/Appointment for a particular insurance coverage.
Short | Identifies the orders and/or other resources associated with the specified QuestionnaireResponse.
Control | 0..*
Type | Extension(Questionnaire Response Context) (Extension Type: Reference(CRD Device Request, CRD Medication Request, CRD Nutrition Order, CRD Service Request, CRD Encounter, CRD Base Appointment))
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
44. QuestionnaireResponse.extension:coverage-information
Slice Name | coverage-information
Definition | Indicates coverage information.
Short | Coverage Info
Control | 0..*
Type | Extension(Coverage Information) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
46. QuestionnaireResponse.extension:intendedUse
Slice Name | intendedUse
Definition | Indicates how the EHR is to use the information with respect to the associated orders/records. If the Adaptive QuestionnaireResponse includes a prior authorization number the `intendedUse` element should be set to 'retain-doc' and/or 'withorder'.
Short | Indicates how the EHR is to use the information with respect to the associated orders/records.
Control | 1..*
Type | Extension(Intended Use) (Extension Type: CodeableConcept)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
48. 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).
Short | Extensions that cannot be ignored
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summary | false
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
50. QuestionnaireResponse.identifier
Definition | A business identifier assigned to a particular completed (or partially completed) questionnaire.
Short | Unique id for this set of answers
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1
Type | Identifier
Is Modifier | false
Must Support | true
Summary | true
Requirements | Used for tracking, registration and other business purposes.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
52. 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.
Short | Request fulfilled by this QuestionnaireResponse
Control | 0..0
Type | Reference(CarePlan, ServiceRequest)
Is Modifier | false
Summary | true
Requirements | Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.
Alternate Names | order
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
54. QuestionnaireResponse.partOf
Definition | A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.
Short | Part of 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.
Control | 0..0
Type | Reference(Observation, Procedure)
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
56. QuestionnaireResponse.questionnaire
Definition | The Questionnaire that defines and organizes the questions for which answers are being provided.
Short | Form being answered
Comments | For SDC, this SHALL be the version-specific URL of the form as hosted on the Form Manager.
Control | 1..1
Type | canonical(SDC Base Questionnaire)
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.
Alternate Names | Form
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
58. QuestionnaireResponse.questionnaire.id
Definition | unique id for the element within a resource (for internal references)
Short | xml:id (or equivalent in JSON)
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
60. QuestionnaireResponse.questionnaire.extension
Definition | An Extension
Short | Extension
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.questionnaire.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
62. QuestionnaireResponse.questionnaire.extension:questionnaireDisplay
Slice Name | questionnaireDisplay
Definition | The title or other name to display when referencing a resource by canonical URL.
Short | Display name for canonical reference
Comments | This SHALL be the title of the Questionnaire at the time the QuestionnaireResponse was originally authored.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Display Name) (Extension Type: string)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
64. QuestionnaireResponse.questionnaire.value
Definition | Primitive value for canonical
Short | Primitive value for canonical
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
66. QuestionnaireResponse.status
Definition | The position of the questionnaire response within its overall lifecycle.
Short | in-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.
Control | 1..1
Binding | The 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.
Type | code
Is Modifier | true because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
68. QuestionnaireResponse.subject
Definition | The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.
Short | The subject of the questions
Comments | If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types. If subject is omitted - because the QuestionnaireResponse is not associated with a specific subject, ensure that QuestionnaireRsponse.identifier is present or the QuestionnaireResponse is referenced somewhere (e.g. Task.output, Composition.section.entry, etc.) to allow tracking and retrieval of the QuestionnaireResponse
Control | 1..1
Type | Reference(CRD Patient)
Is Modifier | false
Must Support | true
Summary | true
Requirements | Allows linking the answers to the individual the answers describe. May also affect access control.
Alternate Names | Patient, Focus
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
70. QuestionnaireResponse.encounter
Definition | The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.
Short | Encounter 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.
Control | 0..1
Type | Reference(Encounter)
Is Modifier | false
Summary | true
Requirements | Provides context for the information that was captured. May also affect access control.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
72. QuestionnaireResponse.authored
Definition | Identifies when this version of the answer set was created. Changes whenever the answers are updated.
Short | Date the answers were gathered
Comments | May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured. This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.
Control | 1..1
Type | dateTime
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | true
Requirements | Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.
Alternate Names | Date Created, Date published, Date Issued, Date updated
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
74. QuestionnaireResponse.author
Definition | Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.
Short | Person 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.
Control | 0..1
Type | Reference(Device, CRD Patient, US Core Practitioner Profile, HRex PractitionerRole Profile, CRD Organization, RelatedPerson)
Is Modifier | false
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | true
Requirements | Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.
Alternate Names | Laboratory, Service, Practitioner, Department, Company, Performer
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
76. QuestionnaireResponse.source
Definition | The person who answered the questions about the subject.
Short | The person who answered the questions
Comments | If not specified, no inference can be made about who provided the data.
Control | 0..1
Type | Reference(Patient, Practitioner, PractitionerRole, RelatedPerson)
Is Modifier | false
Summary | true
Requirements | When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
78. 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.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
80. 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.
Short | Additional content defined by implementations
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Alternate Names | extensions, user content
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.source.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
82. QuestionnaireResponse.source.extension:r5Source
Slice Name | r5Source
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.
Short | Alternative 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.
Control | 0..1
Type | Extension(Alternate Reference) (Extension Type: Reference(Resource))
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
84. 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.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
86. QuestionnaireResponse.source.extension:r5Source.extension
Definition | An Extension
Short | Extension
Control | 0..0
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.source.extension.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
88. QuestionnaireResponse.source.extension:r5Source.url
Definition | Source of the definition for the extension code - a logical name or a URL.
Short | identifies 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.
Control | 1..1
Type | uri
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
Fixed Value | `http://hl7.org/fhir/StructureDefinition/alternate-reference`
90. 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).
Short | Value of extension
Control | 1..1
Type | Reference(Device, Organization)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
92. 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.
Short | Literal 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.
Control | 0..1 This element is affected by the following invariants: ref-1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
94. 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).
Short | Type 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.
Control | 0..1
Binding | Unless 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).
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
96. 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.
Short | Logical 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).
Note | This is a business identifier, not a resource identifier (see discussion)
Control | 0..1
Type | Identifier
Is Modifier | false
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
98. QuestionnaireResponse.source.display
Definition | Plain text narrative that identifies the resource in addition to the resource reference.
Short | Text 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.
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
100. QuestionnaireResponse.item
Definition | A group or question item from the original questionnaire for which answers are provided.
Short | Groups and questions
Comments | Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-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()`)
102. QuestionnaireResponse.item.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
104. QuestionnaireResponse.item.extension
Definition | An Extension
Short | Extension
Control | 0..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.item.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
106. QuestionnaireResponse.item.extension:itemMedia
Slice Name | itemMedia
Definition | Media to render/make available as an accompaniment to the question being asked
Short | Media to display
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Item Media) (Extension Type: Attachment)
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
108. QuestionnaireResponse.item.extension:ItemSignature
Slice Name | ItemSignature
Definition | Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.
Short | A signature attesting to the content
Control | 0..* This element is affected by the following invariants: ele-1
Type | Extension(QuestionnaireResponse Signature) (Extension Type: Signature)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
110. 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
112. QuestionnaireResponse.item.linkId
Definition | The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
Short | Pointer to specific item from Questionnaire
Control | 1..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Requirements | Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
114. QuestionnaireResponse.item.definition
Definition | A reference to an ElementDefinition that provides the details for the item.
Short | ElementDefinition - details for the item
Comments | The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. There is no need for this element if the item pointed to by the linkId has a definition listed.
Control | 0..1
Type | uri
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Summary | false
Requirements | A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
116. QuestionnaireResponse.item.text
Definition | Text that is displayed above the contents of the group or as the text of the question being answered.
Short | Name for group or question text
Control | 0..1
Type | string
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Summary | false
Requirements | Allows the questionnaire response to be read without access to the questionnaire.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
118. QuestionnaireResponse.item.answer
Definition | The respondent's answer(s) to the question.
Short | The response(s) to the question
Comments | The value is nested because we cannot have a repeating structure that has variable type.
Control | 0..*
Type | BackboneElement
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
120. QuestionnaireResponse.item.answer.id
Definition | Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Short | Unique id for inter-element referencing
Control | 0..1
Type | string
Is Modifier | false
XML Format | In the XML format, this property is represented as an attribute.
Summary | false
122. QuestionnaireResponse.item.answer.extension
Definition | An Extension
Short | Extension
Control | 1..*
Type | Extension
Is Modifier | false
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
Slicing | This element introduces a set of slices on `QuestionnaireResponse.item.answer.extension`. The slices areUnordered and Open, and can be differentiated using the following discriminators: value @ url
124. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
Slice Name | itemAnswerMedia
Definition | Media to render/make available as an accompaniment to a specific answer option
Short | Answer Media to display
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Item Answer Media) (Extension Type: Attachment)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
126. QuestionnaireResponse.item.answer.extension:itemWeight
Slice Name | itemWeight
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.
Short | Assigned 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 ​For questionnaires, see additional guidance and examples in the SDC implementation guide.
Control | 0..1 This element is affected by the following invariants: ele-1
Type | Extension(Item Weight) (Extension Type: decimal)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
128. QuestionnaireResponse.item.answer.extension:origin
Slice Name | origin
Definition | Identifies the origin of the information in the answer and how it came to exist.
Short | Extension
Control | 1..1
Type | Extension(Information Origin) (Complex Extension)
Is Modifier | false
Must Support | true
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
130. QuestionnaireResponse.item.answer.extension:containedReference
Slice Name | containedReference
Definition | Indicates that when filling a QuestionnaireResponse and selecting a reference, that the referenced resource should be included as a 'contained' resource within the QuestionnaireResponse
Short | Contain the reference?
Control | 0..1
Type | Extension(Contained Reference) (Extension Type: boolean)
Is Modifier | false
Must Support | true
Summary | false
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
132. 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).
Short | Extensions that cannot be ignored even if unrecognized
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Control | 0..*
Type | Extension
Is Modifier | true because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
Summary | true
Requirements | Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Alternate Names | extensions, user content, modifiers
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`) ext-1: Must have either extensions or value[x], not both (`extension.exists() != value.exists()`)
134. QuestionnaireResponse.item.answer.value[x]
Definition | The answer (or one of the answers) provided by the respondent to the question.
Short | Single-valued answer to the question
Comments | More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.
Control | 0..1
Binding | For example codes, see QuestionnaireAnswerCodes (example to `http://hl7.org/fhir/ValueSet/questionnaire-answers|4.0.1` ) Code indicating the response provided for a question.
Type | Choice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference(Resource)
[x] Note | SeeChoice of Data Typesfor further information about how to use [x]
Is Modifier | false
Primitive Value | This primitive element may be present, or absent, or replaced by an extension
Must Support | true
Must Support Types | No must-support rules about the choice of types/profiles
Summary | false
Requirements | Ability to retain a single-valued answer to a question.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
136. QuestionnaireResponse.item.answer.item
Definition | Nested groups and/or questions found within this particular answer.
Short | Nested groups and questions
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
Is Modifier | false
Must Support | true
Summary | false
Requirements | It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)
138. QuestionnaireResponse.item.item
Definition | Questions or sub-groups nested beneath a question or group.
Short | Nested questionnaire response items
Control | 0..*
Type | Seettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
Is Modifier | false
Must Support | true
Summary | false
Requirements | Reports can consist of complex nested groups.
Invariants | ele-1: All FHIR elements must have a @value or children (`hasValue() or (children().count() > id.count())`)