Structured Data Capture
4.0.0-ci-build - STU 4 CI-build
Structured Data Capture
4.0.0-ci-build - STU 4 CI-build
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-ci-build 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
| Page standards status: Informative |
@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <http://loinc.org/rdf#> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/QuestionnaireResponse/Cardiology-MariaSantos> a fhir:QuestionnaireResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "Cardiology-MariaSantos"] ;
fhir:Resource.language [ fhir:value "en"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient Information<br/> Surname: Santos<br/>First Name: Maria<br/>DOB: 1948-05-19<br/>Gender: Female<br/>HN PC: ON<br/>Address (Line 1): 85 King St S<br/>Mobile #: 519-555-0362<br/>Home #: 519-555-0198<br/>Email: maria.santos@example.com<br/>[Optional] Additional Patient Information<br/><br/> Sex assigned at birth: Female<br/>Pronouns: She/HerThey/Them<br/>Preferred language: English<br/>Best method of contact: Home<br/><span style=\"display:none;\"><br/></span> Accessibility concerns or disability<br/><br/>Wheelchair; Hearing impaired<br/><br/>Referral Details<br/> Triage Considerations Requested Priority: <br/><span style=\"font-weight:bold;color:#EE6B00;\">Routine<br/></span><br/>Service(s) Requested <span style=\"display:none;\"><br/></span> Cardiology Consultation<br/><b>Concern(s) / Indication(s) Triggering Referral</b><br/><i>Select all that apply:</i><br/><br/> <span style=\"display:none;\"><br/></span> Congestive Heart Failure<br/><span style=\"font-weight:bold;\">Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations<br/></span> 77F, progressive exertional dyspnea and bilateral ankle edema x 2 months. BNP elevated at 480. CXR shows mild cardiomegaly. On furosemide 20mg with partial response. Please assess and advise on HF management.<br/>Cumulative Patient Profile<br/><br/><i>Please delete any sensitive information you do not intend to share from the CPP</i><br/> Current Problem List: Suspected CHF (onset Jan 2026)\nHypertension\nType 2 diabetes<br/>Past Medical History: Left hip replacement (2020)\nType 2 diabetes (2012)<br/>Current Medications : Furosemide 20 mg PO daily\nPerindopril 4 mg PO daily\nMetformin 500 mg PO BID\nEmpagliflozin 10 mg PO daily<br/>Family History: Mother: CHF, deceased age 80<br/>Allergies: NKDA<br/>Referrer's Information<br/> Site Name: Amplify Primary Care<br/>Address (Line 1): 10248 Yonge St<br/>Phone #: 416-555-5555<br/>Fax #: 416-555-5555<br/>Billing Number: 55554<br/>Professional ID: 55555<br/>Signed: Dr. Sean Sender<br/>Role: Family Physician</div>"
] ;
fhir:QuestionnaireResponse.questionnaire [
fhir:value "http://hl7.org/fhir/uv/sdc/Questionnaire/CardiologyForm" ;
fhir:link <http://hl7.org/fhir/uv/sdc/Questionnaire/CardiologyForm>
] ;
fhir:QuestionnaireResponse.status [ fhir:value "completed"] ;
fhir:QuestionnaireResponse.subject [
fhir:link <http://hl7.org/fhir/Patient/pat-53234> ;
fhir:Reference.reference [ fhir:value "Patient/pat-53234" ] ;
fhir:Reference.display [ fhir:value "MOMO ABBAS" ]
] ;
fhir:QuestionnaireResponse.authored [ fhir:value "2026-03-12T22:51:31.735Z"^^xsd:dateTime] ;
fhir:QuestionnaireResponse.author [
fhir:link <http://hl7.org/fhir/Practitioner/smart-Practitioner-71482713> ;
fhir:Reference.reference [ fhir:value "Practitioner/smart-Practitioner-71482713" ] ;
fhir:Reference.type [ fhir:value "Practitioner" ] ;
fhir:Reference.display [ fhir:value "Susan Clark" ]
] ;
fhir:QuestionnaireResponse.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_header" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Patient Information" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_surname" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Surname:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Santos" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_firstname" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "First Name:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Maria" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_date_of_birth" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "DOB:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueDate [ fhir:value "1948-05-19"^^xsd:date ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_gender" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Gender:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/administrative-gender" ] ;
fhir:Coding.code [ fhir:value "female" ] ;
fhir:Coding.display [ fhir:value "Female" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_hc_pc" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "HN PC:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "ON" ] ;
fhir:QuestionnaireResponse.item.answer.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_hc_number" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "HN:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "7413582609" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_hc_vc" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "HN VC:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "TC" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_address_line1" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Address (Line 1):" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "85 King St S" ] ;
fhir:QuestionnaireResponse.item.answer.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_address_line2" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Address (Line 2):" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Unit 302" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_address_city" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "City:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Waterloo" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_address_province" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Province:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "ON" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_address_postalcode" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Postal Code:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "N2J 1P2" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_phone_mobile" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Mobile #:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "519-555-0362" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_phone_home" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Home #:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "519-555-0198" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "patient_email" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Email:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "maria.santos@example.com" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_header" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "[Optional] Additional Patient Information" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_sexassignedatbirth" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Sex assigned at birth:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
a loinc:LA3-6 ;
fhir:Coding.system [ fhir:value "http://loinc.org" ] ;
fhir:Coding.code [ fhir:value "LA3-6" ] ;
fhir:Coding.display [ fhir:value "Female" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_pronouns" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Pronouns:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
a loinc:LA29519-8 ;
fhir:Coding.system [ fhir:value "http://loinc.org" ] ;
fhir:Coding.code [ fhir:value "LA29519-8" ] ;
fhir:Coding.display [ fhir:value "She/Her" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_preferredlanguage" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Preferred language:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.system [ fhir:value "urn:ietf:bcp:47" ] ;
fhir:Coding.code [ fhir:value "en" ] ;
fhir:Coding.display [ fhir:value "English" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_bestmethodofcontact" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Best method of contact:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/contact-point-use" ] ;
fhir:Coding.code [ fhir:value "home" ] ;
fhir:Coding.display [ fhir:value "Home" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_accessibilityconcernsordisability_selectt" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Accessibility concerns or disability" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Accessibility concerns or disability" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "additionalinfo_accessibilityconcernsordisability" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Accessibility concerns Options" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
a sct:105503008 ;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
fhir:Coding.code [ fhir:value "105503008" ] ;
fhir:Coding.display [ fhir:value "Wheelchair" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
a sct:15188001 ;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
fhir:Coding.code [ fhir:value "15188001" ] ;
fhir:Coding.display [ fhir:value "Hearing impaired" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "102173268919" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Referral Details" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cardio_triagecons" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Triage Considerations" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referral_requestedpriority" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Requested Priority:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/request-priority" ] ;
fhir:Coding.code [ fhir:value "routine" ] ;
fhir:Coding.display [ fhir:value "Routine" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "695991571585" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Service(s) Requested Select all that apply:" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "785727177547" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Cardiology Consultation" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.system [ fhir:value "http://example.com/CodeSystem/standardized-referral-form-codes" ] ;
fhir:Coding.code [ fhir:value "20002" ] ;
fhir:Coding.display [ fhir:value "Cardiology Consultation" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "186952778859" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Concern(s) / Indication(s) Triggering Referral Select all that apply:" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "832263816528" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Congestive Heart Failure" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
fhir:Coding.system [ fhir:value "http://example.com/CodeSystem/standardized-referral-form-codes" ] ;
fhir:Coding.code [ fhir:value "20036" ] ;
fhir:Coding.display [ fhir:value "Congestive Heart Failure" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "Descriptionofclinicalquestion" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "77F, progressive exertional dyspnea and bilateral ankle edema x 2 months. BNP elevated at 480. CXR shows mild cardiomegaly. On furosemide 20mg with partial response. Please assess and advise on HF management." ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cpp_header" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cpp_currentprob" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Current Problem List:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Suspected CHF (onset Jan 2026)\nHypertension\nType 2 diabetes" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cpp_pastmedicalhistory" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Past Medical History:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Left hip replacement (2020)\nType 2 diabetes (2012)" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cpp_currentmedications" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Current Medications :" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Furosemide 20 mg PO daily\nPerindopril 4 mg PO daily\nMetformin 500 mg PO BID\nEmpagliflozin 10 mg PO daily" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cpp_familyhistory" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Family History:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Mother: CHF, deceased age 80" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "cpp_allergies" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Allergies:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "NKDA" ]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_header" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Referrer's Information" ] ;
fhir:QuestionnaireResponse.item.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_sitename" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Site Name:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Amplify Primary Care" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_address_line1" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Address (Line 1):" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "10248 Yonge St" ] ;
fhir:QuestionnaireResponse.item.answer.item [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_address_line2" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Address (Line 2):" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Suite 515" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_address_city" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "City:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Richmond Hill" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_address_province" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Province:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "ON" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_address_postalcode" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Postal Code:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "L4C 5K9" ]
]
]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_phone" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Phone #:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value " 416-555-5555" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_fax" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Fax #:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value " 416-555-5555" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_billing" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Billing Number:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueInteger [ fhir:value "55554"^^xsd:integer ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_professionalid" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Professional ID:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueInteger [ fhir:value "55555"^^xsd:integer ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_signature" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Signed:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueString [ fhir:value "Dr. Sean Sender" ]
]
], [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.linkId [ fhir:value "referrer_role" ] ;
fhir:QuestionnaireResponse.item.text [ fhir:value "Role:" ] ;
fhir:QuestionnaireResponse.item.answer [
fhir:index -1 ;
fhir:QuestionnaireResponse.item.answer.valueCoding [
a sct:62247001 ;
fhir:Coding.system [ fhir:value "http://snomed.info/sct" ] ;
fhir:Coding.code [ fhir:value "62247001" ] ;
fhir:Coding.display [ fhir:value "Family Physician" ]
]
]
]
] .
<http://hl7.org/fhir/Patient/pat-53234> a fhir:Patient .
<http://hl7.org/fhir/Practitioner/smart-Practitioner-71482713> a fhir:Practitioner .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/QuestionnaireResponse/Cardiology-MariaSantos.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/QuestionnaireResponse/Cardiology-MariaSantos.ttl> .
IG © 2022+ HL7 International / FHIR Infrastructure.
Package hl7.fhir.uv.sdc#4.0.0-ci-build based on FHIR 4.0.1.
Generated
2026-07-15
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