US Quality Core Implementation Guide
1.0.0-ballot - STU 1 - ballot United States of America flag

US Quality Core Implementation Guide, published by HL7 International / Clinical Quality Information. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-quality-core/ and changes regularly. See the Directory of published versions

Resource Profile: US Quality Core QuestionnaireResponse

Official URL: http://hl7.org/fhir/us/quality-core/StructureDefinition/us-quality-core-questionnaireresponse Version: 1.0.0-ballot
Standards status: Trial-use Maturity Level: 4 Computable Name: USQualityCoreQuestionnaireResponse
Other Identifiers: OID:2.16.840.1.113883.4.642.40.78.42.45

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Quality Core QuestionnaireResponse Profile is based upon the US Core QuestionnaireResponse Profile and sets minimum expectations for the QuestionnaireResponse resource to record, search, and fetch retrieve captures the responses to form/survey and defines the core set of elements and extensions for quality rule and measure authors.

USCDI+ Quality Element Support Expectations

Systems are expected to support this profile as part of implementing USCDI+ Quality V2 in FHIR and meeting the conformance requirements of this guide.

The following elements are specifically relevant to USCDI+ Quality V2 data classes and elements. Systems are expected to support these elements as applicable to their role in US Quality Core data exchange. See the Must Support section of this guide for more information. These elements are flagged as (USCDI+ Quality) in the formal profile views.

USCDI+ Quality Elements:

Profile element Description USCDI+ Quality Data Element(s)
author Person who received and recorded the answers Provenance: Author
authored Date the answers were gathered Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
item.answer The response(s) to the question Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
item.answer.value[x] Single-valued answer to the question Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use
questionnaire Form being answered Health Status Assessments: Alcohol Use, Health Status Assessments: Disability Status, Health Status Assessments: Functional Status, Health Status Assessments: Mental/Cognitive Status, Health Status Assessments: Physical Activity, Health Status Assessments: SDOH Assessment, Health Status Assessments: Substance Use

Because this profile is derived directly or indirectly from US Core, systems are also expected to support the Must Support and Additional USCDI requirements specified by the US Core profile this profile inherits from. For more information about those requirements, refer to the US Core QuestionnaireResponse Profile. The Formal Views section also provides the formal summary, definitions, terminology requirements, and mandatory element requirements.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description Differentials, Snapshots, and other representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. QuestionnaireResponse C 0..* USCoreQuestionnaireResponseProfile(9.0.0) US Core Profile based on SDC QuestionnaireResponse
Constraints: sdcqr-1, sdcqr-2, sdcqr-3
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:adheresTo 0..* (Complex) Follows rules from
URL: http://hl7.org/fhir/StructureDefinition/workflow-adheresTo
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-adheresTo"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:triggeredBy 0..1 (Complex) Created because of following
URL: http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:signature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... extension:completionMode 0..1 CodeableConcept E.g. Verbal, written, electronic
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode
Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... questionnaire SΣ 1..1 canonical(SDC Base Questionnaire) (USCDI+ Quality) Form being answered
.... Slices for extension Content/Rules for all slices
..... extension:questionnaireDisplay S 0..1 string Display name for canonical reference
URL: http://hl7.org/fhir/StructureDefinition/display
..... extension:url S 0..1 uri The location where a non-FHIR questionnaire/survey form can be found.
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
... status ?!SΣ 1..1 code in-progress | completed | amended | entered-in-error | stopped
Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
... subject SΣ 1..1 Reference(US Quality Core Patient) The subject of the questions
... authored SΣ 1..1 dateTime (USCDI+ Quality) Date the answers were gathered
... author SΣ 0..1 Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Core Device Profile(9.0.0) | US Quality Core RelatedPerson) (USCDI+ Quality) Person who received and recorded the answers
... item SC 0..* BackboneElement Groups and questions
Constraints: qrs-1, qrs-2
.... Slices for extension Content/Rules for all slices
..... extension:itemMedia 0..1 Attachment Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
..... extension:ItemSignature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... linkId S 1..1 string Pointer to specific item from Questionnaire
.... text S 0..1 string Name for group or question text
.... answer S 0..* BackboneElement (USCDI+ Quality) The response(s) to the question
..... Slices for extension Content/Rules for all slices
...... extension:itemAnswerMedia 0..1 Attachment Answer Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
...... extension:itemWeight 0..1 decimal Assigned Ordinal Value
URL: http://hl7.org/fhir/StructureDefinition/itemWeight
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... value[x] S 0..1 (USCDI+ Quality) Single-valued answer to the question
Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
...... valueDate date
...... valueDateTime dateTime
...... valueDecimal decimal S
...... valueInteger integer
...... valueString string S
...... valueCoding Coding S
...... valueQuantity Quantity
..... item S 0..* See item (QuestionnaireResponse) Nested groups and questions
.... item S 0..* See item (QuestionnaireResponse) Nested questionnaire response items

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
QuestionnaireResponse.​status Base required QuestionnaireResponseStatus 📍4.0.1 FHIR Std.
QuestionnaireResponse.​item.answer.value[x] Base example Questionnaire Answer Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error QuestionnaireResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error QuestionnaireResponse 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 error QuestionnaireResponse 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 error QuestionnaireResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice QuestionnaireResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
qrs-1 error QuestionnaireResponse.item Nested item can't be beneath both item and answer (answer.exists() and item.exists()).not()
qrs-2 error QuestionnaireResponse.item Repeated answers are combined in the answers array of a single item repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()
sdcqr-1 best practice QuestionnaireResponse 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 best practice QuestionnaireResponse 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 error QuestionnaireResponse 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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. QuestionnaireResponse 0..* USCoreQuestionnaireResponseProfile(9.0.0) US Core Profile based on SDC QuestionnaireResponse
... questionnaire 1..1 canonical(SDC Base Questionnaire) (USCDI+ Quality) Form being answered
... subject 1..1 Reference(US Quality Core Patient) The subject of the questions
... authored 1..1 dateTime (USCDI+ Quality) Date the answers were gathered
... item
.... answer 0..* BackboneElement (USCDI+ Quality) The response(s) to the question
..... value[x] 0..1 (USCDI+ Quality) Single-valued answer to the question
...... valueDate date
...... valueDateTime dateTime
...... valueDecimal decimal
...... valueInteger integer
...... valueString string
...... valueCoding Coding
...... valueQuantity Quantity

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. QuestionnaireResponse C 0..* USCoreQuestionnaireResponseProfile(9.0.0) US Core Profile based on SDC QuestionnaireResponse
Constraints: sdcqr-1, sdcqr-2, sdcqr-3
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:adheresTo 0..* (Complex) Follows rules from
URL: http://hl7.org/fhir/StructureDefinition/workflow-adheresTo
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-adheresTo"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:triggeredBy 0..1 (Complex) Created because of following
URL: http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:signature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... extension:completionMode 0..1 CodeableConcept E.g. Verbal, written, electronic
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode
Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..1 Identifier Unique id for this set of answers
... basedOn Σ 0..* Reference(CarePlan | ServiceRequest) Request fulfilled by this QuestionnaireResponse
... partOf Σ 0..* Reference(Observation | Procedure) Part of this action
... questionnaire SΣ 1..1 canonical(SDC Base Questionnaire) (USCDI+ Quality) Form being answered
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:questionnaireDisplay S 0..1 string Display name for canonical reference
URL: http://hl7.org/fhir/StructureDefinition/display
..... extension:url S 0..1 uri The location where a non-FHIR questionnaire/survey form can be found.
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
.... value 0..1 string Primitive value for canonical
... status ?!SΣ 1..1 code in-progress | completed | amended | entered-in-error | stopped
Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
... subject SΣ 1..1 Reference(US Quality Core Patient) The subject of the questions
... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
... authored SΣ 1..1 dateTime (USCDI+ Quality) Date the answers were gathered
... author SΣ 0..1 Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Core Device Profile(9.0.0) | US Quality Core RelatedPerson) (USCDI+ Quality) Person who received and recorded the answers
... source Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) The person who answered the questions
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... extension:r5Source 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Device | Organization) Value of extension
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... item SC 0..* BackboneElement Groups and questions
Constraints: qrs-1, qrs-2
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:itemMedia 0..1 Attachment Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
..... extension:ItemSignature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... linkId S 1..1 string Pointer to specific item from Questionnaire
.... definition 0..1 uri ElementDefinition - details for the item
.... text S 0..1 string Name for group or question text
.... answer S 0..* BackboneElement (USCDI+ Quality) The response(s) to the question
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:itemAnswerMedia 0..1 Attachment Answer Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
...... extension:itemWeight 0..1 decimal Assigned Ordinal Value
URL: http://hl7.org/fhir/StructureDefinition/itemWeight
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... value[x] S 0..1 (USCDI+ Quality) Single-valued answer to the question
Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
...... valueDate date
...... valueDateTime dateTime
...... valueDecimal decimal S
...... valueInteger integer
...... valueString string S
...... valueCoding Coding S
...... valueQuantity Quantity
..... item S 0..* See item (QuestionnaireResponse) Nested groups and questions
.... item S 0..* See item (QuestionnaireResponse) Nested questionnaire response items

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
QuestionnaireResponse.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
QuestionnaireResponse.​status Base required QuestionnaireResponseStatus 📍4.0.1 FHIR Std.
QuestionnaireResponse.​source.type Base extensible ResourceType 📍4.0.1 FHIR Std.
QuestionnaireResponse.​item.answer.value[x] Base example Questionnaire Answer Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error QuestionnaireResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error QuestionnaireResponse 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 error QuestionnaireResponse 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 error QuestionnaireResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice QuestionnaireResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
qrs-1 error QuestionnaireResponse.item Nested item can't be beneath both item and answer (answer.exists() and item.exists()).not()
qrs-2 error QuestionnaireResponse.item Repeated answers are combined in the answers array of a single item repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()
sdcqr-1 best practice QuestionnaireResponse 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 best practice QuestionnaireResponse 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 error QuestionnaireResponse 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

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. QuestionnaireResponse C 0..* USCoreQuestionnaireResponseProfile(9.0.0) US Core Profile based on SDC QuestionnaireResponse
Constraints: sdcqr-1, sdcqr-2, sdcqr-3
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... Slices for extension Content/Rules for all slices
.... extension:adheresTo 0..* (Complex) Follows rules from
URL: http://hl7.org/fhir/StructureDefinition/workflow-adheresTo
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-adheresTo"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:triggeredBy 0..1 (Complex) Created because of following
URL: http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:signature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... extension:completionMode 0..1 CodeableConcept E.g. Verbal, written, electronic
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode
Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... questionnaire SΣ 1..1 canonical(SDC Base Questionnaire) (USCDI+ Quality) Form being answered
.... Slices for extension Content/Rules for all slices
..... extension:questionnaireDisplay S 0..1 string Display name for canonical reference
URL: http://hl7.org/fhir/StructureDefinition/display
..... extension:url S 0..1 uri The location where a non-FHIR questionnaire/survey form can be found.
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
... status ?!SΣ 1..1 code in-progress | completed | amended | entered-in-error | stopped
Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
... subject SΣ 1..1 Reference(US Quality Core Patient) The subject of the questions
... authored SΣ 1..1 dateTime (USCDI+ Quality) Date the answers were gathered
... author SΣ 0..1 Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Core Device Profile(9.0.0) | US Quality Core RelatedPerson) (USCDI+ Quality) Person who received and recorded the answers
... item SC 0..* BackboneElement Groups and questions
Constraints: qrs-1, qrs-2
.... Slices for extension Content/Rules for all slices
..... extension:itemMedia 0..1 Attachment Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
..... extension:ItemSignature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... linkId S 1..1 string Pointer to specific item from Questionnaire
.... text S 0..1 string Name for group or question text
.... answer S 0..* BackboneElement (USCDI+ Quality) The response(s) to the question
..... Slices for extension Content/Rules for all slices
...... extension:itemAnswerMedia 0..1 Attachment Answer Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
...... extension:itemWeight 0..1 decimal Assigned Ordinal Value
URL: http://hl7.org/fhir/StructureDefinition/itemWeight
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... value[x] S 0..1 (USCDI+ Quality) Single-valued answer to the question
Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
...... valueDate date
...... valueDateTime dateTime
...... valueDecimal decimal S
...... valueInteger integer
...... valueString string S
...... valueCoding Coding S
...... valueQuantity Quantity
..... item S 0..* See item (QuestionnaireResponse) Nested groups and questions
.... item S 0..* See item (QuestionnaireResponse) Nested questionnaire response items

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
QuestionnaireResponse.​status Base required QuestionnaireResponseStatus 📍4.0.1 FHIR Std.
QuestionnaireResponse.​item.answer.value[x] Base example Questionnaire Answer Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error QuestionnaireResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error QuestionnaireResponse 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 error QuestionnaireResponse 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 error QuestionnaireResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice QuestionnaireResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
qrs-1 error QuestionnaireResponse.item Nested item can't be beneath both item and answer (answer.exists() and item.exists()).not()
qrs-2 error QuestionnaireResponse.item Repeated answers are combined in the answers array of a single item repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()
sdcqr-1 best practice QuestionnaireResponse 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 best practice QuestionnaireResponse 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 error QuestionnaireResponse 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

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. QuestionnaireResponse 0..* USCoreQuestionnaireResponseProfile(9.0.0) US Core Profile based on SDC QuestionnaireResponse
... questionnaire 1..1 canonical(SDC Base Questionnaire) (USCDI+ Quality) Form being answered
... subject 1..1 Reference(US Quality Core Patient) The subject of the questions
... authored 1..1 dateTime (USCDI+ Quality) Date the answers were gathered
... item
.... answer 0..* BackboneElement (USCDI+ Quality) The response(s) to the question
..... value[x] 0..1 (USCDI+ Quality) Single-valued answer to the question
...... valueDate date
...... valueDateTime dateTime
...... valueDecimal decimal
...... valueInteger integer
...... valueString string
...... valueCoding Coding
...... valueQuantity Quantity

doco Documentation for this format

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. QuestionnaireResponse C 0..* USCoreQuestionnaireResponseProfile(9.0.0) US Core Profile based on SDC QuestionnaireResponse
Constraints: sdcqr-1, sdcqr-2, sdcqr-3
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:adheresTo 0..* (Complex) Follows rules from
URL: http://hl7.org/fhir/StructureDefinition/workflow-adheresTo
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-adheresTo"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:triggeredBy 0..1 (Complex) Created because of following
URL: http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..0 Extension
Slice: Unordered, Open by value:url
..... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/workflow-triggeredBy"
..... value[x] 1..1 Value of extension
...... valueCanonical canonical(ActivityDefinition | PlanDefinition)
...... valueReference Reference(ActivityDefinition | PlanDefinition)
...... valueUri uri
.... extension:signature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... extension:completionMode 0..1 CodeableConcept E.g. Verbal, written, electronic
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode
Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..1 Identifier Unique id for this set of answers
... basedOn Σ 0..* Reference(CarePlan | ServiceRequest) Request fulfilled by this QuestionnaireResponse
... partOf Σ 0..* Reference(Observation | Procedure) Part of this action
... questionnaire SΣ 1..1 canonical(SDC Base Questionnaire) (USCDI+ Quality) Form being answered
.... id 0..1 string xml:id (or equivalent in JSON)
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:questionnaireDisplay S 0..1 string Display name for canonical reference
URL: http://hl7.org/fhir/StructureDefinition/display
..... extension:url S 0..1 uri The location where a non-FHIR questionnaire/survey form can be found.
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
.... value 0..1 string Primitive value for canonical
... status ?!SΣ 1..1 code in-progress | completed | amended | entered-in-error | stopped
Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
... subject SΣ 1..1 Reference(US Quality Core Patient) The subject of the questions
... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
... authored SΣ 1..1 dateTime (USCDI+ Quality) Date the answers were gathered
... author SΣ 0..1 Reference(US Quality Core Practitioner | US Quality Core Organization | US Quality Core Patient | US Quality Core PractitionerRole | US Core Device Profile(9.0.0) | US Quality Core RelatedPerson) (USCDI+ Quality) Person who received and recorded the answers
... source Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) The person who answered the questions
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... extension:r5Source 0..1 (Complex) Alternative reference (target type is wrong)
URL: http://hl7.org/fhir/StructureDefinition/alternate-reference
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..0 Extension
Slice: Unordered, Open by value:url
...... url 1..1 uri "http://hl7.org/fhir/StructureDefinition/alternate-reference"
...... value[x] 1..1 Reference(Device | Organization) Value of extension
.... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
.... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
.... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
.... display Σ 0..1 string Text alternative for the resource
... item SC 0..* BackboneElement Groups and questions
Constraints: qrs-1, qrs-2
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:itemMedia 0..1 Attachment Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
..... extension:ItemSignature 0..* Signature A signature attesting to the content
URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... linkId S 1..1 string Pointer to specific item from Questionnaire
.... definition 0..1 uri ElementDefinition - details for the item
.... text S 0..1 string Name for group or question text
.... answer S 0..* BackboneElement (USCDI+ Quality) The response(s) to the question
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:itemAnswerMedia 0..1 Attachment Answer Media to display
URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
...... extension:itemWeight 0..1 decimal Assigned Ordinal Value
URL: http://hl7.org/fhir/StructureDefinition/itemWeight
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... value[x] S 0..1 (USCDI+ Quality) Single-valued answer to the question
Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
...... valueDate date
...... valueDateTime dateTime
...... valueDecimal decimal S
...... valueInteger integer
...... valueString string S
...... valueCoding Coding S
...... valueQuantity Quantity
..... item S 0..* See item (QuestionnaireResponse) Nested groups and questions
.... item S 0..* See item (QuestionnaireResponse) Nested questionnaire response items

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
QuestionnaireResponse.​language Base preferred Common Languages 📍4.0.1 FHIR Std.
QuestionnaireResponse.​status Base required QuestionnaireResponseStatus 📍4.0.1 FHIR Std.
QuestionnaireResponse.​source.type Base extensible ResourceType 📍4.0.1 FHIR Std.
QuestionnaireResponse.​item.answer.value[x] Base example Questionnaire Answer Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error QuestionnaireResponse If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error QuestionnaireResponse 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 error QuestionnaireResponse 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 error QuestionnaireResponse If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice QuestionnaireResponse A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
qrs-1 error QuestionnaireResponse.item Nested item can't be beneath both item and answer (answer.exists() and item.exists()).not()
qrs-2 error QuestionnaireResponse.item Repeated answers are combined in the answers array of a single item repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()
sdcqr-1 best practice QuestionnaireResponse 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 best practice QuestionnaireResponse 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 error QuestionnaireResponse 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

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Element Conformance Indicators by Profile Layer

Badges identify the profile layer where each conformance indicator is first introduced. Indicators introduced in an earlier layer remain applicable in later derived profiles.

Element conformance indicators organized by the profile layer where they are first introduced
Profile element FHIR US Core US Quality Core
extension:adheresTo.url Mandatory
extension:adheresTo.value[x] Mandatory
extension:triggeredBy.url Mandatory
extension:triggeredBy.value[x] Mandatory
identifier Must Support
questionnaire Mandatory Must Support USCDI+ Quality
questionnaire.extension:questionnaireDisplay Must Support
questionnaire.extension:url Must Support
status Mandatory Must Support
subject Mandatory Must Support
authored Mandatory Must Support USCDI+ Quality
author Must Support USCDI+ Quality
source.extension:r5Source.url Mandatory
source.extension:r5Source.value[x] Mandatory
item Must Support
item.linkId Mandatory Must Support
item.text Must Support
item.answer Must Support USCDI+ Quality
item.answer.value[x] Must Support USCDI+ Quality
item.answer.item Must Support
item.item Must Support

Cardinality note: “Mandatory” means the element has a minimum cardinality greater than zero. For nested elements, the cardinality indicator applies when the containing element is present.

Mandatory US Quality Core Server Search Parameters

The searches below are the focused set identified by US Quality Core as needed to retrieve USCDI+ Quality data for quality measurement and reporting. See the US Core FHIR RESTful Search API Requirements for detailed information on requirements by search parameter type.

Because this profile derives directly or indirectly from US Core, servers SHALL also support all mandatory searches described in the US Core Server CapabilityStatement requirements for QuestionnaireResponse. When possible, this guide reuses mandatory searches from US Core and notes them with the EXISTING US CORE REQUIREMENT flag. While US Quality Core may restate US Core requirements to highlight searches directly relevant to USCDI+ Quality data access, US Core requirements not restated here remain applicable.

See the US Quality Core Server CapabilityStatement for complete requirements for the underlying QuestionnaireResponse resource and Search Requirement Selection for how this focused set was selected.

Servers supporting this profile SHALL support the following search parameters and search parameter combinations:

  1. SHALL support searching for all QuestionnaireResponse resources for a patient using the patient search parameter. EXISTING US CORE REQUIREMENT

    GET [base]/QuestionnaireResponse?patient={Patient/}[id]

    Example:

    GET [base]/QuestionnaireResponse?patient=Patient/example

    Implementation Notes: Fetches a bundle of US Quality Core QuestionnaireResponse resources matching the specified search criteria. See how to search by reference.

    Rationale for inclusion: Supports patient-scoped retrieval of QuestionnaireResponse resources for USCDI+ Quality workflows.

  2. SHALL support searching for all QuestionnaireResponse resources for a patient using the combination of the patient and questionnaire search parameters.

    GET [base]/QuestionnaireResponse?patient={Patient/}[id]&questionnaire={Questionnaire/}[id]

    Example:

    GET [base]/QuestionnaireResponse?patient=Patient/example&questionnaire=http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-PHQ9

    Implementation Notes: Fetches a bundle of US Quality Core QuestionnaireResponse resources matching the specified search criteria. See how to search by reference.

    Rationale for inclusion: Supports patient-scoped retrieval of QuestionnaireResponse resources filtered by questionnaire for USCDI+ Quality workflows.