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-render Version: 4.0.0
Standards status: Informative Active as of 2025-10-22 Computable Name: SDCAdvancedRenderingExample
Other Identifiers: OID:2.16.840.1.113883.4.642.40.17.35.16

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. SDCAdvancedRenderingExample Questionnaire http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render#4.0.0
... 1 Text Appearance 0..1 group
.... 1.1 Enter your First Name 0..1 string
.... 1.2 Please answer Yes or No to each of the following questions: 0..1 display
.... 1.2b Please answer Yes or No to each of the following questions: 0..1 display
.... 1.3 ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL. 0..1 display iconicon
.... 1.4 null 0..1 group
..... 1.4.1 Form ID 0..1 string iconicon
..... 1.4.2 Event ID 0..1 string
... 2 Control Appearance 0..1 group
.... 2.1 If you have any other medical problems or serious injuries, please describe them here: 0..1 text
.... 2.2 Gender: 0..1 choice iconicon Options: 4 options
.... 2.3 Rate your doctor: 0..1 integer Initial Value: integer = 50
..... 2.3.1 Completely dissatisfied 0..1 display
..... 2.3.2 Completely satisfied 0..1 display
.... 2.4 Medical History 0..1 group
..... 2.4.1 Diabetes 0..1 choice Options: 2 options
..... 2.4.2 Other Information 0..1 choice Options: 4 options
.... 2.5 null 0..1 group
..... 2.5.1 Relationship to patient 0..1 choice Options: 3 options
..... 2.5.2 Name 0..1 string
..... 2.5.3 Gender 0..1 choice Options: 4 options
.... 2.6 Lifestyle Factors 0..1 group
..... 2.6.1 Exercise Habits 0..1 choice Options: 4 options
..... 2.6.2 Smoking Frequency 0..1 choice Options: 4 options
..... 2.6.3 Alcohol Consumption 0..1 choice Options: 4 options
... 3 Additional Display Content 0..1 group
.... 3.1 Have you traveled outside the country within the last 14 days? 0..1 choice Options: 2 options
.... 3.2 Select Platelet: 0..1 choice Value Set: LOINC Answer Codes for LL715-4
.... 3.3 Gender: 0..1 choice Options: 4 options
.... 3.4 Enter timing of harm assessment: 0..1 choice iconicon Value Set: Timing of harm assessment [AHRQ]
.... 3.5 Birth Date 0..1 date
.... 3.6 IMPORTANT: Please complete questionnaire. 0..1 display
.... 3.7 Enter your Middle Name 0..1 string iconicon
.... 3.8 During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits. 0..1 decimal
.... 3.9 Which of the following time-slots are you available for? 0..1 string Options: 6 options
.... 3.10 Select a condition (terminology server: tx.fhir.org) 0..1 choice Value Set: All Codes SCT ValueSet

doco Documentation for this format

Options Sets

Answer options for 2.2

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 2.4.1

  • http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")
  • http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")

Answer options for 2.4.2

  • http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")
  • http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")
  • http://example.org/CodeSystem/conditions#otherinformation-hypertension ("Hypertension")
  • http://example.org/CodeSystem/conditions#otherinformation-smoker ("Smoker")

Answer options for 2.5.1

  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Father")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Mother")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIB ("Sibling")

Answer options for 2.5.3

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 2.6.1

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 2.6.2

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 2.6.3

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 3.1

  • http://terminology.hl7.org/CodeSystem/v2-0532#Y ("Yes")
  • http://terminology.hl7.org/CodeSystem/v2-0532#N ("No")

Answer options for 3.3

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 3.9

  • 9-10am
  • 10-11am
  • 11am-12pm
  • 1-2pm
  • 2-3pm
  • 3-4pm

Contained Resources

Text Appearance

  • linkId: 1

Enter your First Name

  • linkId: 1.1

Please answer Yes or No to each of the following questions:

  • linkId: 1.2

Please answer Yes or No to each of the following questions:

  • linkId: 1.2b

ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.

  • Flags: icon
  • linkId: 1.3

  • linkId: 1.4

Form ID

  • Flags: icon
  • linkId: 1.4.1

Event ID

  • linkId: 1.4.2

Control Appearance

  • linkId: 2

If you have any other medical problems or serious injuries, please describe them here:

  • linkId: 2.1

Gender:

Rate your doctor:

  • linkId: 2.3
  • Initial Values: 50

Completely dissatisfied

  • linkId: 2.3.1

Completely satisfied

  • linkId: 2.3.2

Medical History

  • linkId: 2.4

Diabetes

Other Information

  • linkId: 2.5

Relationship to patient

Name

  • linkId: 2.5.2

Gender

Lifestyle Factors

  • linkId: 2.6

Exercise Habits

Smoking Frequency

Alcohol Consumption

Additional Display Content

  • linkId: 3

Have you traveled outside the country within the last 14 days?

Select Platelet:

Gender:

Enter timing of harm assessment:

Birth Date

  • linkId: 3.5

IMPORTANT: Please complete questionnaire.

  • linkId: 3.6

Enter your Middle Name

  • Flags: icon
  • linkId: 3.7

During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.

  • linkId: 3.8

Which of the following time-slots are you available for?

Select a condition (terminology server: tx.fhir.org)

Contained Resources

LinkIDDescription & Constraintsdoco
.. 1
... 1.1
... 1.2
... 1.2b
... 1.4
.... 1.4.1
.... 1.4.2
.. 2
... 2.1
... 2.2 Options: 4 options
... 2.3 Initial Value: integer = 50
.... 2.3.1
.... 2.3.2
... 2.4
.... 2.4.1 Options: 2 options
.... 2.4.2 Options: 4 options
... 2.5
.... 2.5.1 Options: 3 options
.... 2.5.2
.... 2.5.3 Options: 4 options
... 2.6
.... 2.6.1 Options: 4 options
.... 2.6.2 Options: 4 options
.... 2.6.3 Options: 4 options
.. 3
... 3.1 Options: 2 options
... 3.2 Value Set: LOINC Answer Codes for LL715-4
... 3.3 Options: 4 options
... 3.4 Value Set: Timing of harm assessment [AHRQ]
... 3.5
... 3.6
... 3.7
... 3.8
... 3.9 Options: 6 options
... 3.10 Value Set: All Codes SCT ValueSet

doco Documentation for this format

Contained Resources

Test this Questionnaire

Try this questionnaire out:

    Contained Resources

    Responses for this Questionnaire

    Contained resources