Structured Data Capture
4.0.0 - STU 4 International flag

Structured Data Capture, published by HL7 International / FHIR Infrastructure. This guide is not an authorized publication; it is the continuous build for version 4.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/sdc/ and changes regularly. See the Directory of published versions

Questionnaire:

Official URL: http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior Version: 4.0.0
Standards status: Informative Active as of 2026-03-24 Computable Name: SDCAdvancedRenderingExample
Other Identifiers: OID:2.16.840.1.113883.4.642.40.17.35.9

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. SDCAdvancedRenderingExample Questionnaire http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior#4.0.0
... 1 Value constraints 0..1 group Value Set:
.... 1.1 First Name 0..1 string Max Length: 50
Value Set:
.... 1.2 Last Name 0..1 string Value Set:
.... 1.3 Postal Code (A1A 1A1) 0..1 string Value Set:
.... 1.4 Enter your weight in kg 0..1 decimal Value Set:
.... 1.5 Body Weight 0..1 quantity Value Set:
.... 1.6 Attach Proof of Citizenship 0..1 attachment Value Set:
... 2 Value constraints 0..1 group Value Set:
.... 2.1 (I/We) worried whether (my/our) food would run out before (I/we) got money to buy more. 0..1 choice Value Set:
Options: 4 options
.... 2.3 Activity Level 0..1 choice Value Set: LOINC Answer Codes for LL4882-8
.... 2.5 Applicable health conditions 0..* choice Value Set: Questionnaire Form Behavior Conditions
.... 2.6 Email* 1..1 string Value Set:
.... 2.7 Current Date: 0..1 date iconicon Value Set:
.... 2.7.1 null 0..1 display Value Set:
.... 2.8 Heart History (check all that applies) 0..* open-choice Value Set:
Options: 5 options
.... 2.9 Heart History (check at least 2): 1..* choice Value Set:
Options: 5 options
.... 2.10 Heart History (check no more than 3): 1..* choice Value Set:
Options: 5 options
.... 2.11 What treatments do you now have for heart disease? (select all that applies) 0..* choice Value Set:
Options: 6 options
.... 2.12 Dosage 0..1 quantity Value Set:
.... 2.13 Specify age: 0..1 quantity Value Set:
.... 2.14 Select your preferred practitioner: 0..1 reference Value Set:
... 3 Calculation 0..1 group Value Set:
.... 3.1 Deadline for submission (7 days from now) 0..1 date iconicon Value Set:
.... 3.2 null 0..1 group Value Set:
..... 3.2.1 Last Name: 0..1 string iconicon Value Set:
..... 3.2.2 First Name: 0..1 string iconicon Value Set:
..... 3.2.3 Gender: 0..1 string iconicon Value Set:
.... 3.3 Calculated Expression 0..1 group Value Set:
..... 3.3.1 Weight (kg) 0..1 decimal Value Set:
..... 3.3.2 Body Height (inches) 0..1 decimal Value Set:
..... 3.3.3 Your Body Mass Index (BMI) 0..1 decimal iconicon Value Set:
.... 3.4 CQF-related Example 0..1 group Value Set:
..... 3.4.1 Enter weight in kg 0..1 decimal Value Set:
..... 3.4.2 Enter email address 0..1 string Value Set:
.... 3.5 null 0..1 display Value Set:
.... 4.1 Marital Status 0..1 choice Value Set: MaritalStatus
Initial Value: Coding = MaritalStatus#D "Divorced"
.... 4.2 null 0..1 group Value Set:
..... 4.2.1 Choose Gender 0..1 choice Value Set: AdministrativeGender
..... 4.2.2 Are you pregnant? (enableWhen = gender is Female, disableDisplay=protected) 0..1 choice Enable When: 4.2.1 = Female (AdministrativeGender#female)
Value Set: Yes/No/Don't Know
..... 4.2.3 Are you diabetic? (enableWhen = gender is Female, disableDisplay=hidden) 0..1 choice Enable When: 4.2.1 = Female (AdministrativeGender#female)
Value Set: Yes/No/Don't Know
..... 4.2.4 Have you been diagnosed with Gestational Diabetes? (enableBehavior = only when pregnant and diabetic, disableDisplay=protected) 0..1 choice Enable When:
  • 4.2.2 = Yes (v2 Y/N Indicator#Y)
  • 4.2.3 = Yes (v2 Y/N Indicator#Y)

Value Set: Yes/No/Don't Know
..... 4.2.5 Enter your birthdate (MM/DD/YYYY) 0..1 date Value Set: AdministrativeGender
..... 4.2.6 Have you had mammogram before?(enableWhenExpression = only when gender is female and age > 40, disableDisplay=protected) 0..1 choice Value Set: Yes/No/Don't Know
.... 4.4 Signature of Patient 1..1 attachment Value Set:
.... 4.5 All the practitioners below can speak the patient's language. Choose all preferred practioners: 0..* reference Value Set:
.... 4.6 null 0..1 group Value Set:
..... 4.6.1 Home Address 0..1 display Value Set:
..... 4.6.2 Address 0..1 string Definition: Patient.address.line
Value Set:
..... 4.6.3 City 0..1 string Definition: Patient.address.city
Value Set:
..... 4.6.4 Province 0..1 choice Definition: Patient.address.state
Value Set:
Options: 10 options
..... 4.6.5 Postal Code 0..1 string Definition: Patient.address.postalCode
Value Set:

doco Documentation for this format

Options Sets

Answer options for 2.1

  • http://loinc.org#LA28397-0 ("Often true")
  • http://loinc.org#LA6729-3 ("Sometimes true")
  • http://loinc.org#LA28398-8 ("Never true")
  • http://loinc.org#LA15775-2 ("Don't know/refused")

Answer options for 2.8

  • http://example.org/CodeSystem/procedures#U1 ("Heart attack")
  • http://example.org/CodeSystem/procedures#U2 ("Heart surgery")
  • http://example.org/CodeSystem/procedures#U3 ("Cardiac catheterization")
  • http://example.org/CodeSystem/procedures#U4 ("Coronary angioplasty (PTCA)")
  • http://example.org/CodeSystem/procedures#U5 ("Cardiac pacemaker")

Answer options for 2.9

  • http://example.org/CodeSystem/procedures#U1 ("Heart attack")
  • http://example.org/CodeSystem/procedures#U2 ("Heart surgery")
  • http://example.org/CodeSystem/procedures#U3 ("Cardiac catheterization")
  • http://example.org/CodeSystem/procedures#U4 ("Coronary angioplasty (PTCA)")
  • http://example.org/CodeSystem/procedures#U5 ("Cardiac pacemaker")

Answer options for 2.10

  • http://example.org/CodeSystem/procedures#U1 ("Heart attack")
  • http://example.org/CodeSystem/procedures#U2 ("Heart surgery")
  • http://example.org/CodeSystem/procedures#U3 ("Cardiac catheterization")
  • http://example.org/CodeSystem/procedures#U4 ("Coronary angioplasty (PTCA)")
  • http://example.org/CodeSystem/procedures#U5 ("Cardiac pacemaker")

Answer options for 2.11

  • http://example.org/CodeSystem/treatments#noTreatment ("NoTreatment")
  • http://example.org/CodeSystem/treatments#aspirin ("Aspirin")
  • http://example.org/CodeSystem/treatments#otherMeds ("Other medicines, tablets, or pills")
  • http://example.org/CodeSystem/treatments#diet ("Diet")
  • http://example.org/CodeSystem/treatments#exercise ("Exercise")
  • http://example.org/CodeSystem/treatments#none ("None of the above")

Answer options for 4.6.4

  • http://example.org/CodeSystem/provinces#Alberta ("Alberta")
  • http://example.org/CodeSystem/provinces#BritishColumbia ("British Columbia")
  • http://example.org/CodeSystem/provinces#Manitoba ("Manitoba")
  • http://example.org/CodeSystem/provinces#NewBrunswick ("New Brunswick")
  • http://example.org/CodeSystem/provinces#NewfoundlandAndLabrador ("Newfoundland and Labrador")
  • http://example.org/CodeSystem/provinces#NovaScotia ("Nova Scotia")
  • http://example.org/CodeSystem/provinces#Ontario ("Ontario")
  • http://example.org/CodeSystem/provinces#PrinceEdwardIsland ("Prince Edward Island")
  • http://example.org/CodeSystem/provinces#Quebec ("Quebec")
  • http://example.org/CodeSystem/provinces#Saskatchewan ("Saskatchewan")

Value constraints

  • linkId: 1
  • Answers:

First Name

  • linkId: 1.1
  • Max Length:: 50
  • Answers:

Last Name

  • linkId: 1.2
  • Answers:

Postal Code (A1A 1A1)

  • linkId: 1.3
  • Answers:

Enter your weight in kg

  • linkId: 1.4
  • Answers:

Body Weight

  • linkId: 1.5
  • Answers:

Attach Proof of Citizenship

  • linkId: 1.6
  • Answers:

Value constraints

  • linkId: 2
  • Answers:

(I/We) worried whether (my/our) food would run out before (I/we) got money to buy more.

Activity Level

Applicable health conditions

Email**

  • linkId: 2.6
  • Answers:

Current Date:

  • linkId: 2.7
  • Answers:

  • linkId: 2.7.1
  • Answers:

Heart History (check all that applies)

Heart History (check at least 2):*

Heart History (check no more than 3):*

What treatments do you now have for heart disease? (select all that applies)

Dosage

  • linkId: 2.12
  • Answers:

Specify age:

  • linkId: 2.13
  • Answers:

Select your preferred practitioner:

  • linkId: 2.14
  • Answers:

Calculation

  • linkId: 3
  • Answers:

Deadline for submission (7 days from now)

  • linkId: 3.1
  • Answers:

  • linkId: 3.2
  • Answers:

Last Name:

  • linkId: 3.2.1
  • Answers:

First Name:

  • linkId: 3.2.2
  • Answers:

Gender:

  • linkId: 3.2.3
  • Answers:

Calculated Expression

  • linkId: 3.3
  • Answers:

Weight (kg)

  • linkId: 3.3.1
  • Answers:

Body Height (inches)

  • linkId: 3.3.2
  • Answers:

Your Body Mass Index (BMI)

  • linkId: 3.3.3
  • Answers:

CQF-related Example

  • linkId: 3.4
  • Answers:

Enter weight in kg

  • linkId: 3.4.1
  • Answers:

Enter email address

  • linkId: 3.4.2
  • Answers:

  • linkId: 3.5
  • Answers:

Other Controls

  • linkId: 4
  • Answers:

Marital Status

  • linkId: 4.1
  • Answers: MaritalStatus
  • Initial Values: Divorced (Details: MaritalStatus code D = 'Divorced')

  • linkId: 4.2
  • Answers:

Choose Gender

Are you pregnant? (enableWhen = gender is Female, disableDisplay=protected)

Are you diabetic? (enableWhen = gender is Female, disableDisplay=hidden)

Have you been diagnosed with Gestational Diabetes? (enableBehavior = only when pregnant and diabetic, disableDisplay=protected)

Enter your birthdate (MM/DD/YYYY)

Have you had mammogram before?(enableWhenExpression = only when gender is female and age > 40, disableDisplay=protected)

Signature of Patient*

  • linkId: 4.4
  • Answers:

All the practitioners below can speak the patient's language. Choose all preferred practioners:

  • linkId: 4.5
  • Answers:

  • linkId: 4.6
  • Answers:

Home Address

  • linkId: 4.6.1
  • Answers:

Address

City

Province

Postal Code

LinkIDDescription & Constraintsdoco
.. 1 Value Set:
... 1.1 Max Length: 50
Value Set:
... 1.2 Value Set:
... 1.3 Value Set:
... 1.5 Value Set:
... 1.6 Value Set:
.. 2 Value Set:
... 2.1 Value Set:
Options: 4 options
... 2.3 Value Set: LOINC Answer Codes for LL4882-8
... 2.5 Value Set: Questionnaire Form Behavior Conditions
... 2.6 Value Set:
... 2.7 Value Set:
... 2.7.1 Value Set:
... 2.8 Value Set:
Options: 5 options
... 2.9 Value Set:
Options: 5 options
... 2.10 Value Set:
Options: 5 options
... 2.11 Value Set:
Options: 6 options
... 2.12 Value Set:
... 2.13 Value Set:
... 2.14 Value Set:
.. 3 Value Set:
... 3.1 Value Set:
... 3.2 Value Set:
.... 3.2.1 Value Set:
.... 3.2.2 Value Set:
.... 3.2.3 Value Set:
... 3.3 Value Set:
.... 3.3.1 Value Set:
.... 3.3.2 Value Set:
.... 3.3.3 Value Set:
... 3.4 Value Set:
.... 3.4.1 Value Set:
.... 3.4.2 Value Set:
... 3.5 Value Set:
.. 4 Value Set:
... 4.1 Value Set: MaritalStatus
Initial Value: Coding = MaritalStatus#D "Divorced"
... 4.2 Value Set:
.... 4.2.1 Value Set: AdministrativeGender
.... 4.2.2 Enable When: Not done yet
Value Set: Yes/No/Don't Know
.... 4.2.3 Enable When: Not done yet
Value Set: Yes/No/Don't Know
.... 4.2.4 Enable When: Not done yet
Value Set: Yes/No/Don't Know
.... 4.2.5 Value Set: AdministrativeGender
.... 4.2.6 Value Set: Yes/No/Don't Know
... 4.4 Value Set:
... 4.5 Value Set:
... 4.6 Value Set:
.... 4.6.1 Value Set:
.... 4.6.2 Definition: Patient.address.line
Value Set:
.... 4.6.3 Definition: Patient.address.city
Value Set:
.... 4.6.4 Definition: Patient.address.state
Value Set:
Options: 10 options
.... 4.6.5 Definition: Patient.address.postalCode
Value Set:

doco Documentation for this format

Contained resources

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.