Structured Data Capture
4.0.0 - 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 2025-10-22 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
.... 1.1 First Name 0..1 string Max Length: 50
.... 1.2 Last Name 0..1 string
.... 1.3 Postal Code (A1A 1A1) 0..1 string
.... 1.4 Enter your weight in kg 0..1 decimal
.... 1.5 Body Weight 0..1 quantity
.... 1.6 Attach Proof of Citizenship 0..1 attachment
... 2 Value constraints 0..1 group
.... 2.1 (I/We) worried whether (my/our) food would run out before (I/we) got money to buy more. 0..1 choice 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
.... 2.7 Current Date: 0..1 date iconicon
.... 2.7.1 null 0..1 display
.... 2.8 Heart History (check all that applies) 0..* open-choice Options: 5 options
.... 2.9 Heart History (check at least 2): 1..* choice Options: 5 options
.... 2.10 Heart History (check no more than 3): 1..* choice Options: 5 options
.... 2.11 What treatments do you now have for heart disease? (select all that applies) 0..* choice Options: 6 options
.... 2.12 Dosage 0..1 quantity
.... 2.13 Specify age: 0..1 quantity
.... 2.14 Select your preferred practitioner: 0..1 reference
... 3 Calculation 0..1 group
.... 3.1 Deadline for submission (7 days from now) 0..1 date iconicon
.... 3.2 null 0..1 group
..... 3.2.1 Last Name: 0..1 string iconicon
..... 3.2.2 First Name: 0..1 string iconicon
..... 3.2.3 Gender: 0..1 string iconicon
.... 3.3 Calculated Expression 0..1 group
..... 3.3.1 Weight (kg) 0..1 decimal
..... 3.3.2 Body Height (inches) 0..1 decimal
..... 3.3.3 Your Body Mass Index (BMI) 0..1 decimal iconicon
.... 3.4 CQF-related Example 0..1 group
..... 3.4.1 Enter weight in kg 0..1 decimal
..... 3.4.2 Enter email address 0..1 string
.... 3.5 null 0..1 display
.... 4.1 Marital Status 0..1 choice Value Set: MaritalStatus
Initial Value: Coding = MaritalStatus#D "Divorced"
.... 4.2 null 0..1 group
..... 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 =
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 =
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:
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
.... 4.5 All the practitioners below can speak the patient's language. Choose all preferred practioners: 0..* reference
.... 4.6 null 0..1 group
..... 4.6.1 Home Address 0..1 display
..... 4.6.2 Address 0..1 string Definition: Patient.address.line
..... 4.6.3 City 0..1 string Definition: Patient.address.city
..... 4.6.4 Province 0..1 choice Definition: Patient.address.state
Options: 10 options
..... 4.6.5 Postal Code 0..1 string Definition: Patient.address.postalCode

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")

Contained Resources

Profile: SDC Value Set

This value set includes codes based on the following rules:

Value constraints

  • linkId: 1

First Name

  • linkId: 1.1
  • Max Length:: 50

Last Name

  • linkId: 1.2

Postal Code (A1A 1A1)

  • linkId: 1.3

Enter your weight in kg

  • linkId: 1.4

Body Weight

  • linkId: 1.5

Attach Proof of Citizenship

  • linkId: 1.6

Value constraints

  • linkId: 2

(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

Current Date:

  • linkId: 2.7

  • linkId: 2.7.1

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

Specify age:

  • linkId: 2.13

Select your preferred practitioner:

  • linkId: 2.14

Calculation

  • linkId: 3

Deadline for submission (7 days from now)

  • linkId: 3.1

  • linkId: 3.2

Last Name:

  • linkId: 3.2.1

First Name:

  • linkId: 3.2.2

Gender:

  • linkId: 3.2.3

Calculated Expression

  • linkId: 3.3

Weight (kg)

  • linkId: 3.3.1

Body Height (inches)

  • linkId: 3.3.2

Your Body Mass Index (BMI)

  • linkId: 3.3.3

CQF-related Example

  • linkId: 3.4

Enter weight in kg

  • linkId: 3.4.1

Enter email address

  • linkId: 3.4.2

  • linkId: 3.5

Other Controls

  • linkId: 4

Marital Status

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

  • linkId: 4.2

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

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

  • linkId: 4.5

  • linkId: 4.6

Home Address

  • linkId: 4.6.1

Address

City

Province

Postal Code

Contained Resources

Profile: SDC Value Set

This value set includes codes based on the following rules:

LinkIDDescription & Constraintsdoco
.. 1
... 1.1 Max Length: 50
... 1.2
... 1.3
... 1.5
... 1.6
.. 2
... 2.1 Options: 4 options
... 2.3 Value Set: LOINC Answer Codes for LL4882-8
... 2.5 Value Set: Questionnaire Form Behavior Conditions
... 2.6
... 2.7
... 2.7.1
... 2.8 Options: 5 options
... 2.9 Options: 5 options
... 2.10 Options: 5 options
... 2.11 Options: 6 options
... 2.12
... 2.13
... 2.14
.. 3
... 3.1
... 3.2
.... 3.2.1
.... 3.2.2
.... 3.2.3
... 3.3
.... 3.3.1
.... 3.3.2
.... 3.3.3
... 3.4
.... 3.4.1
.... 3.4.2
... 3.5
.. 4
... 4.1 Value Set: MaritalStatus
Initial Value: Coding = MaritalStatus#D "Divorced"
... 4.2
.... 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
... 4.5
... 4.6
.... 4.6.1
.... 4.6.2 Definition: Patient.address.line
.... 4.6.3 Definition: Patient.address.city
.... 4.6.4 Definition: Patient.address.state
Options: 10 options
.... 4.6.5 Definition: Patient.address.postalCode

doco Documentation for this format

Contained Resources

Profile: SDC Value Set

This value set includes codes based on the following rules:

Test this Questionnaire

Try this questionnaire out:

    Contained Resources

    Profile: SDC Value Set

    This value set includes codes based on the following rules:

    Responses for this Questionnaire

    Contained resources