SIL HIE Implementation Guide
0.1.0 - sil-hie-active

SIL HIE Implementation Guide, published by Kathurima Kimathi. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/savannahghi/hie-fhir-ig-profile/ and changes regularly. See the Directory of published versions

Resource Profile: HIEQuestionnaire - Detailed Descriptions

Active as of 2025-11-25

Definitions for the hie-questionnaire resource profile.

Guidance on how to interpret the contents of this table can be foundhere

0. Questionnaire
Definition

A structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.

ShortA structured set of questions
Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate NamesForm, CRF, Survey
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
que-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.exists() implies name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
que-2: The link ids for groups and questions must be unique within the questionnaire (descendants().linkId.isDistinct())
hie-q-has-items: Questionnaire must have at least one root item (item.exists())
2. Questionnaire.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Questionnaire.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supportfalse
Summaryfalse
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
6. Questionnaire.url
Definition

An absolute URI that is used to identify this questionnaire when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this questionnaire is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the questionnaire is stored on different servers.

ShortCanonical identifier for this questionnaire, represented as a URI (globally unique)
Comments

The name of the referenced questionnaire can be conveyed using the http://hl7.org/fhir/StructureDefinition/display extension.

Control10..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

… This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. Questionnaire.identifier
Definition

A formal identifier that is used to identify this questionnaire when it is represented in other formats, or referenced in a specification, model, design or an instance.

ShortAdditional identifier for the questionnaire
Comments

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this questionnaire outside of FHIR, where it is not possible to use the logical URI.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..*
TypeIdentifier
Is Modifierfalse
Must Supportfalse
Summarytrue
Requirements

Allows externally provided and/or usable business identifiers to be easily associated with the module.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
10. Questionnaire.identifier.use
Definition

The purpose of this identifier.

Shortusual | official | temp | secondary | old (If known)
Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Control10..1
BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|4.3.0
(required to http://hl7.org/fhir/ValueSet/identifier-use)
Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
12. Questionnaire.identifier.type
Definition

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

ShortDescription of identifier
Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Control10..1
BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codeshttp://hl7.org/fhir/ValueSet/identifier-type|4.3.0
(extensible to http://hl7.org/fhir/ValueSet/identifier-type)
TypeCodeableConcept(HIE CodeableConcept)
Is Modifierfalse
Summarytrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. Questionnaire.identifier.system
Definition

Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

ShortThe namespace for the identifier value
Comments

Identifier.system is always case sensitive.

Control10..1
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

ExampleGeneral: http://www.acme.com/identifiers/patient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. Questionnaire.identifier.value
Definition

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

ShortThe value that is unique
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
ExampleGeneral: 123456
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
18. Questionnaire.identifier.assigner
Definition

Organization that issued/manages the identifier.

ShortOrganization that issued id (may be just text)
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Control0..1
TypeReference(HIE Reference)(HIE Organization, Organization)
Is Modifierfalse
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. Questionnaire.name
Definition

A natural language name identifying the questionnaire. This name should be usable as an identifier for the module by machine processing applications such as code generation.

ShortName for this questionnaire (computer friendly)
Comments

The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Requirements

Support human navigation and code generation.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. Questionnaire.title
Definition

A short, descriptive, user-friendly title for the questionnaire.

ShortName for this questionnaire (human friendly)
Comments

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. Questionnaire.status
Definition

The status of this questionnaire. Enables tracking the life-cycle of the content.

Shortdraft | active | retired | unknown
Comments

Allows filtering of questionnaires that are appropriate for use versus not.

Control1..1
BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|4.3.0
(required to http://hl7.org/fhir/ValueSet/publication-status|4.3.0)

The lifecycle status of an artifact.

Typecode
Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Questionnaire.date
Definition

The date (and optionally time) when the questionnaire was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the questionnaire changes.

ShortDate last changed
Comments

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the questionnaire. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

Control10..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Alternate NamesRevision Date
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Questionnaire.description
Definition

A free text natural language description of the questionnaire from a consumer's perspective.

ShortNatural language description of the questionnaire
Comments

This description can be used to capture details such as why the questionnaire was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the questionnaire as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the questionnaire is presumed to be the predominant language in the place the questionnaire was created).

Control10..1
Typemarkdown
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Questionnaire.item
Definition

A particular question, question grouping or display text that is part of the questionnaire.

ShortQuestions and sections within the Questionnaire
Comments

The content of the questionnaire is constructed from an ordered, hierarchical collection of items.

Control10..*
This element is affected by the following invariants: que-3
TypeBackboneElement
Is Modifierfalse
Must Supporttrue
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
que-1a: Group items must have nested items when Questionanire is complete ((type='group' and %resource.status='complete') implies item.empty().not())
que-1b: Groups should have items (type='group' implies item.empty().not())
que-1c: Display items cannot have child items (type='display' implies item.empty())
que-3: Display items cannot have a "code" asserted (type!='display' or code.empty())
que-4: A question cannot have both answerOption and answerValueSet (answerOption.empty() or answerValueSet.empty())
que-5: Only 'choice' and 'open-choice' items can have answerValueSet ((type ='choice' or type = 'open-choice' or type = 'decimal' or type = 'integer' or type = 'date' or type = 'dateTime' or type = 'time' or type = 'string' or type = 'quantity') or (answerValueSet.empty() and answerOption.empty()))
que-6: Required and repeat aren't permitted for display items (type!='display' or (required.empty() and repeats.empty()))
que-8: Initial values can't be specified for groups or display items ((type!='group' and type!='display') or initial.empty())
que-9: Read-only can't be specified for "display" items (type!='display' or readOnly.empty())
que-10: Maximum length can only be declared for simple question types ((type in ('boolean' | 'decimal' | 'integer' | 'string' | 'text' | 'url' | 'open-choice')) or maxLength.empty())
que-11: If one or more answerOption is present, initial[x] must be missing (answerOption.empty() or initial.empty())
que-12: If there are more than one enableWhen, enableBehavior must be specified (enableWhen.count() > 1 implies enableBehavior.exists())
que-13: Can only have multiple initial values for repeating items (repeats=true or initial.count() <= 1)
hie-q-unique-linkid: linkId values must be unique within the questionnaire (item.select(linkId).isDistinct())
hie-q-group-no-answers: Group items do not have answers, initial, or answer value sets ((type != 'group') or (answerOption.empty() and answerValueSet.empty() and initial.empty()))
hie-q-leaf-answerable: Non-group, non-display items must be answerable or descriptive ((type in {'group','display'}) or (answerOption.exists() or answerValueSet.exists() or type.exists()))
32. Questionnaire.item.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortUI hints and custom constraintsAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
34. Questionnaire.item.extension.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..0*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on Questionnaire.item.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 36. Questionnaire.item.extension.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    38. Questionnaire.item.extension.value[x]
    Definition

    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortValue of extension
    Control0..1
    TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Questionnaire.item.extension.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 40. Questionnaire.item.extension.value[x]:valueCodeableConcept
      Slice NamevalueCodeableConcept
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control0..1
      BindingUnless not suitable, these codes SHALL be taken from For codes, see QuestionnaireItemUIControlCodes
      (extensible to http://hl7.org/fhir/ValueSet/questionnaire-item-control)
      TypeCodeableConcept, date, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, RatioRange, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, Reference, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, CodeableReference, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Questionnaire.item.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      44. Questionnaire.item.linkId
      Definition

      An identifier that is unique within the Questionnaire allowing linkage to the equivalent item in a QuestionnaireResponse resource.

      ShortUnique id for item in questionnaire
      Comments

      This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

      Control1..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      QuestionnaireResponse does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.


      QuestionnaireResponse does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. Questionnaire.item.text
      Definition

      The name of a section, the text of a question or text content for a display item.

      ShortPrimary text for the item
      Comments

      When using this element to represent the name of a section, use group type item and also make sure to limit the text element to a short string suitable for display as a section heading. Group item instructions should be included as a display type item within the group.

      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. Questionnaire.item.type
      Definition

      The type of questionnaire item this is - whether text for display, a grouping of other items or a particular type of data to be captured (string, integer, coded choice, etc.).

      Shortgroup | display | boolean | decimal | integer | date | dateTime +
      Comments

      Additional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.

      Control1..1
      BindingThe codes SHALL be taken from QuestionnaireItemTypehttp://hl7.org/fhir/ValueSet/item-type|4.3.0
      (required to http://hl7.org/fhir/ValueSet/item-type|4.3.0)

      Distinguishes groups from questions and display text and indicates data type for questions.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Requirements

      Defines the format in which the user is to be prompted for the answer.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. Questionnaire.item.enableWhen
      Definition

      A constraint indicating that this item should only be enabled (displayed/allow answers to be captured) when the specified condition is true.

      ShortOnly allow data when
      Comments

      If multiple repetitions of this extension are present, the item should be enabled when the condition for any of the repetitions is true. I.e. treat "enableWhen"s as being joined by an "or" clause. This element is a modifier because if enableWhen is present for an item, "required" is ignored unless one of the enableWhen conditions is met. When an item is disabled, all of its descendants are disabled, regardless of what their own enableWhen logic might evaluate to.

      Control0..*
      TypeBackboneElement
      Is Modifiertrue because If enableWhen is present and the condition evaluates to false, then the Questionnaire behaves as though the elements weren't actually present
      Must Supportfalse
      Summaryfalse
      Requirements

      Allows questionnaires to adapt based on answers to other questions. E.g. If physical gender is specified as a male, no need to capture pregnancy history. Also allows conditional display of instructions or groups of questions.

      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      que-7: If the operator is 'exists', the value must be a boolean (operator = 'exists' implies (answer is boolean))
      52. Questionnaire.item.enableWhen.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      54. Questionnaire.item.enableWhen.question
      Definition

      The linkId for the question whose answer (or lack of answer) governs whether this item is enabled.

      ShortQuestion that determines whether item is enabled
      Comments

      If multiple question occurrences are present for the same question (same linkId), then this refers to the nearest question occurrence reachable by tracing first the "ancestor" axis and then the "preceding" axis and then the "following" axis.

      Control1..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. Questionnaire.item.enableWhen.operator
      Definition

      Specifies the criteria by which the question is enabled.

      Shortexists | = | != | > | < | >= | <=
      Control1..1
      BindingThe codes SHALL be taken from QuestionnaireItemOperatorhttp://hl7.org/fhir/ValueSet/questionnaire-enable-operator|4.3.0
      (required to http://hl7.org/fhir/ValueSet/questionnaire-enable-operator)
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. Questionnaire.item.enableWhen.answer[x]
      Definition

      A value that the referenced question is tested using the specified operator in order for the item to be enabled.

      ShortValue for question comparison based on operator
      Control1..1
      This element is affected by the following invariants: que-7
      BindingFor example codes, see QuestionnaireAnswerCodeshttp://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0
      (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0)

      Allowed values to answer questions.

      TypeChoice of: boolean, decimal, integer, date, dateTime, time, string, Coding, Quantity, Reference(Resource)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. Questionnaire.item.enableBehavior
      Definition

      Controls how multiple enableWhen values are interpreted - whether all or any must be true.

      Shortany or allall | any
      Comments

      This element must be specified if more than one enableWhen value is provided.

      Control0..1
      This element is affected by the following invariants: que-12
      BindingThe codes SHALL be taken from EnableWhenBehaviorhttp://hl7.org/fhir/ValueSet/questionnaire-enable-behavior|4.3.0
      (required to http://hl7.org/fhir/ValueSet/questionnaire-enable-behavior|4.3.0)

      Controls how multiple enableWhen values are interpreted - whether all or any must be true.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      62. Questionnaire.item.required
      Definition

      An indication, if true, that the item must be present in a "completed" QuestionnaireResponse. If false, the item may be skipped when answering the questionnaire.

      ShortIf true, at least one answer is expected at runtimeWhether the item must be included in data results
      Comments

      Questionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. If an item that contains other items is marked as required, that does not automatically make the contained elements required (though required groups must contain at least one child element). The value may come from the ElementDefinition referred to by .definition.

      Control0..1
      This element is affected by the following invariants: que-6
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Meaning if MissingItems are generally assumed not to be required unless explicitly specified. Systems SHOULD always populate this value
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. Questionnaire.item.answerValueSet
      Definition

      A reference to a value set containing a list of codes representing permitted answers for a "choice" or "open-choice" question.

      ShortValueset containing permitted answers
      Comments

      LOINC defines many useful value sets for questionnaire responses. See LOINC Answer Lists. The value may come from the ElementDefinition referred to by .definition.

      Control0..1
      This element is affected by the following invariants: que-4, que-5
      Typecanonical(ValueSet)
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. Questionnaire.item.answerOption
      Definition

      One of the permitted answers for a "choice" or "open-choice" question.

      ShortPermitted answer
      Comments

      This element can be used when the value set machinery of answerValueSet is deemed too cumbersome or when there's a need to capture possible answers that are not codes.

      Control0..*
      This element is affected by the following invariants: que-4, que-5
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      68. Questionnaire.item.answerOption.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      70. Questionnaire.item.answerOption.value[x]
      Definition

      A potential answer that's allowed as the answer to this question.

      ShortAnswer value
      Comments

      The data type of the value must agree with the item.type.

      Control1..1
      BindingFor example codes, see QuestionnaireAnswerCodeshttp://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0
      (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0)

      Allowed values to answer questions.

      TypeChoice of: integer, date, time, string, Coding, Reference(Resource)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      72. Questionnaire.item.initial
      Definition

      One or more values that should be pre-populated in the answer when initially rendering the questionnaire for user input.

      ShortInitial value(s) when item is first rendered
      Comments

      The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created. Note that initial values can influence results. The data type of initial[x] must agree with the item.type, and only repeating items can have more then one initial value.

      Control0..*
      This element is affected by the following invariants: que-8, que-13
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      In some workflows, having defaults saves time.

      Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
      74. Questionnaire.item.initial.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

      Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      76. Questionnaire.item.initial.value[x]
      Definition

      The actual value to for an initial answer.

      ShortActual value for initializing the question
      Comments

      The type of the initial value must be consistent with the type of the item.

      Control1..1
      BindingFor example codes, see QuestionnaireAnswerCodeshttp://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0
      (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0)

      Allowed values to answer questions.

      TypeChoice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference(Resource)
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      78. Questionnaire.item.item
      Definition

      Text, questions and other groups to be nested beneath a question or group.

      ShortNested questionnaire items
      Comments

      There is no specified limit to the depth of nesting. However, Questionnaire authors are encouraged to consider the impact on the user and user interface of overly deep nesting.

      Control0..*
      This element is affected by the following invariants: que-1a, que-1b, que-1c
      TypeSeettp://hl7.org/fhir/StructureDefinition/Questionnaire#Questionnaire.item
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Reports can consist of complex nested groups.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be foundhere

      0. Questionnaire
      Invariantshie-q-has-items: Questionnaire must have at least one root item (item.exists())
      2. Questionnaire.url
      Control1..?
      Must Supporttrue
      4. Questionnaire.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..?
      6. Questionnaire.identifier.use
      Control1..?
      BindingThe codes SHALL be taken from IdentifierUse
      (required to http://hl7.org/fhir/ValueSet/identifier-use)
      8. Questionnaire.identifier.type
      Control1..?
      BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
      (extensible to http://hl7.org/fhir/ValueSet/identifier-type)
      TypeCodeableConcept(HIE CodeableConcept)
      10. Questionnaire.identifier.system
      Control1..?
      12. Questionnaire.identifier.value
      Control1..?
      Must Supporttrue
      14. Questionnaire.identifier.assigner
      TypeReference(HIE Reference)(HIE Organization)
      Must Supporttrue
      16. Questionnaire.name
      Must Supporttrue
      18. Questionnaire.title
      Control1..?
      Must Supporttrue
      20. Questionnaire.status
      Must Supporttrue
      22. Questionnaire.date
      Control1..?
      Must Supporttrue
      24. Questionnaire.description
      Control1..?
      Must Supporttrue
      26. Questionnaire.item
      Control1..?
      Must Supporttrue
      Invariantshie-q-unique-linkid: linkId values must be unique within the questionnaire (item.select(linkId).isDistinct())
      hie-q-group-no-answers: Group items do not have answers, initial, or answer value sets ((type != 'group') or (answerOption.empty() and answerValueSet.empty() and initial.empty()))
      hie-q-leaf-answerable: Non-group, non-display items must be answerable or descriptive ((type in {'group','display'}) or (answerOption.exists() or answerValueSet.exists() or type.exists()))
      28. Questionnaire.item.extension
      ShortUI hints and custom constraints
      30. Questionnaire.item.extension.extension
      Control0..0
      32. Questionnaire.item.extension.url
      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      34. Questionnaire.item.extension.value[x]
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      SlicingThis element introduces a set of slices on Questionnaire.item.extension.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 36. Questionnaire.item.extension.value[x]:valueCodeableConcept
        Slice NamevalueCodeableConcept
        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from QuestionnaireItemUIControlCodes
        (extensible to http://hl7.org/fhir/ValueSet/questionnaire-item-control)
        TypeCodeableConcept
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        38. Questionnaire.item.linkId
        Must Supporttrue
        40. Questionnaire.item.text
        Must Supporttrue
        42. Questionnaire.item.type
        Must Supporttrue
        44. Questionnaire.item.enableWhen
        46. Questionnaire.item.enableWhen.operator
        BindingThe codes SHALL be taken from QuestionnaireItemOperator
        (required to http://hl7.org/fhir/ValueSet/questionnaire-enable-operator)
        48. Questionnaire.item.enableBehavior
        Shortany or all
        50. Questionnaire.item.required
        ShortIf true, at least one answer is expected at runtime
        52. Questionnaire.item.item
        TypeBackboneElement

        Guidance on how to interpret the contents of this table can be foundhere

        0. Questionnaire
        Definition

        A structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.

        ShortA structured set of questions
        Control0..*
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate NamesForm, CRF, Survey
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: 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.exists() and ('#'+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(uri) = '#').exists()).not()).trace('unmatched', id).empty())
        dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        que-0: Name should be usable as an identifier for the module by machine processing applications such as code generation (name.exists() implies name.matches('[A-Z]([A-Za-z0-9_]){0,254}'))
        que-2: The link ids for groups and questions must be unique within the questionnaire (descendants().linkId.isDistinct())
        hie-q-has-items: Questionnaire must have at least one root item (item.exists())
        2. Questionnaire.id
        Definition

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        ShortLogical id of this artifact
        Comments

        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

        Control0..1
        Typeid
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        4. Questionnaire.meta
        Definition

        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

        ShortMetadata about the resource
        Control0..1
        TypeMeta
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. Questionnaire.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        8. Questionnaire.language
        Definition

        The base language in which the resource is written.

        ShortLanguage of the resource content
        Comments

        Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

        Control0..1
        BindingThe codes SHOULD be taken from CommonLanguages
        (preferred to http://hl7.org/fhir/ValueSet/languages|4.3.0)

        IETF language tag

        Additional BindingsPurpose
        AllLanguagesMax Binding
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. Questionnaire.text
        Definition

        A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

        ShortText summary of the resource, for human interpretation
        Comments

        Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

        Control0..1
        TypeNarrative
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate Namesnarrative, html, xhtml, display
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. Questionnaire.contained
        Definition

        These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

        ShortContained, inline Resources
        Comments

        This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

        Control0..*
        TypeResource
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate Namesinline resources, anonymous resources, contained resources
        Invariantsdom-r4b: Containing new R4B resources within R4 resources may cause interoperability issues if instances are shared with R4 systems (($this is Citation or $this is Evidence or $this is EvidenceReport or $this is EvidenceVariable or $this is MedicinalProductDefinition or $this is PackagedProductDefinition or $this is AdministrableProductDefinition or $this is Ingredient or $this is ClinicalUseDefinition or $this is RegulatedAuthorization or $this is SubstanceDefinition or $this is SubscriptionStatus or $this is SubscriptionTopic) implies (%resource is Citation or %resource is Evidence or %resource is EvidenceReport or %resource is EvidenceVariable or %resource is MedicinalProductDefinition or %resource is PackagedProductDefinition or %resource is AdministrableProductDefinition or %resource is Ingredient or %resource is ClinicalUseDefinition or %resource is RegulatedAuthorization or %resource is SubstanceDefinition or %resource is SubscriptionStatus or %resource is SubscriptionTopic))
        14. Questionnaire.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        16. Questionnaire.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Must Supportfalse
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. Questionnaire.url
        Definition

        An absolute URI that is used to identify this questionnaire when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this questionnaire is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the questionnaire is stored on different servers.

        ShortCanonical identifier for this questionnaire, represented as a URI (globally unique)
        Comments

        The name of the referenced questionnaire can be conveyed using the http://hl7.org/fhir/StructureDefinition/display extension.

        Control1..1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        … This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        20. Questionnaire.identifier
        Definition

        A formal identifier that is used to identify this questionnaire when it is represented in other formats, or referenced in a specification, model, design or an instance.

        ShortAdditional identifier for the questionnaire
        Comments

        Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this questionnaire outside of FHIR, where it is not possible to use the logical URI.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control1..*
        TypeIdentifier
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Allows externally provided and/or usable business identifiers to be easily associated with the module.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Questionnaire.identifier.id
        Definition

        Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

        ShortUnique id for inter-element referencing
        Control0..1
        Typeid
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        24. Questionnaire.identifier.extension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        ShortAdditional content defined by implementations
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on Questionnaire.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 26. Questionnaire.identifier.use
          Definition

          The purpose of this identifier.

          Shortusual | official | temp | secondary | old (If known)
          Comments

          Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

          Control1..1
          BindingThe codes SHALL be taken from IdentifierUse
          (required to http://hl7.org/fhir/ValueSet/identifier-use)
          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          28. Questionnaire.identifier.type
          Definition

          A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

          ShortDescription of identifier
          Comments

          This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

          Control1..1
          BindingUnless not suitable, these codes SHALL be taken from Identifier Type Codes
          (extensible to http://hl7.org/fhir/ValueSet/identifier-type)
          TypeCodeableConcept(HIE CodeableConcept)
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows users to make use of identifiers when the identifier system is not known.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          30. Questionnaire.identifier.system
          Definition

          Establishes the namespace for the value - that is, a URL that describes a set values that are unique.

          ShortThe namespace for the identifier value
          Comments

          Identifier.system is always case sensitive.

          Control1..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

          ExampleGeneral: http://www.acme.com/identifiers/patient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. Questionnaire.identifier.value
          Definition

          The portion of the identifier typically relevant to the user and which is unique within the context of the system.

          ShortThe value that is unique
          Comments

          If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

          Control1..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          ExampleGeneral: 123456
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          34. Questionnaire.identifier.period
          Definition

          Time period during which identifier is/was valid for use.

          ShortTime period when id is/was valid for use
          Control0..1
          TypePeriod
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          36. Questionnaire.identifier.assigner
          Definition

          Organization that issued/manages the identifier.

          ShortOrganization that issued id (may be just text)
          Comments

          The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

          Control0..1
          TypeReference(HIE Reference)(HIE Organization)
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. Questionnaire.version
          Definition

          The identifier that is used to identify this version of the questionnaire when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the questionnaire author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.

          ShortBusiness version of the questionnaire
          Comments

          There may be different questionnaire instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the questionnaire with the format [url]|[version].

          NoteThis is a business version Id, not a resource version Id (see discussion)
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. Questionnaire.name
          Definition

          A natural language name identifying the questionnaire. This name should be usable as an identifier for the module by machine processing applications such as code generation.

          ShortName for this questionnaire (computer friendly)
          Comments

          The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Requirements

          Support human navigation and code generation.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          42. Questionnaire.title
          Definition

          A short, descriptive, user-friendly title for the questionnaire.

          ShortName for this questionnaire (human friendly)
          Comments

          This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

          Control1..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. Questionnaire.derivedFrom
          Definition

          The URL of a Questionnaire that this Questionnaire is based on.

          ShortInstantiates protocol or definition
          Control0..*
          Typecanonical(Questionnaire)
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Requirements

          Allows a Questionnaire to be created based on another Questionnaire.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. Questionnaire.status
          Definition

          The status of this questionnaire. Enables tracking the life-cycle of the content.

          Shortdraft | active | retired | unknown
          Comments

          Allows filtering of questionnaires that are appropriate for use versus not.

          Control1..1
          BindingThe codes SHALL be taken from PublicationStatus
          (required to http://hl7.org/fhir/ValueSet/publication-status|4.3.0)

          The lifecycle status of an artifact.

          Typecode
          Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. Questionnaire.experimental
          Definition

          A Boolean value to indicate that this questionnaire is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.

          ShortFor testing purposes, not real usage
          Comments

          Allows filtering of questionnaires that are appropriate for use versus not.

          Control0..1
          Typeboolean
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Requirements

          Enables experimental content to be developed following the same lifecycle that would be used for a production-level questionnaire.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. Questionnaire.subjectType
          Definition

          The types of subjects that can be the subject of responses created for the questionnaire.

          ShortResource that can be subject of QuestionnaireResponse
          Comments

          If none are specified, then the subject is unlimited.

          Control0..*
          BindingThe codes SHALL be taken from ResourceType
          (required to http://hl7.org/fhir/ValueSet/resource-types|4.3.0)

          One of the resource types defined as part of this version of FHIR.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Questionnaire.date
          Definition

          The date (and optionally time) when the questionnaire was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the questionnaire changes.

          ShortDate last changed
          Comments

          Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the questionnaire. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

          Control1..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Alternate NamesRevision Date
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Questionnaire.publisher
          Definition

          The name of the organization or individual that published the questionnaire.

          ShortName of the publisher (organization or individual)
          Comments

          Usually an organization but may be an individual. The publisher (or steward) of the questionnaire is the organization or individual primarily responsible for the maintenance and upkeep of the questionnaire. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the questionnaire. This item SHOULD be populated unless the information is available from context.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Requirements

          Helps establish the "authority/credibility" of the questionnaire. May also allow for contact.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Questionnaire.contact
          Definition

          Contact details to assist a user in finding and communicating with the publisher.

          ShortContact details for the publisher
          Comments

          May be a web site, an email address, a telephone number, etc.

          Control0..*
          TypeContactDetail
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. Questionnaire.description
          Definition

          A free text natural language description of the questionnaire from a consumer's perspective.

          ShortNatural language description of the questionnaire
          Comments

          This description can be used to capture details such as why the questionnaire was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the questionnaire as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the questionnaire is presumed to be the predominant language in the place the questionnaire was created).

          Control1..1
          Typemarkdown
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. Questionnaire.useContext
          Definition

          The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate questionnaire instances.

          ShortThe context that the content is intended to support
          Comments

          When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

          Control0..*
          TypeUsageContext
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Assist in searching for appropriate content.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          62. Questionnaire.jurisdiction
          Definition

          A legal or geographic region in which the questionnaire is intended to be used.

          ShortIntended jurisdiction for questionnaire (if applicable)
          Comments

          It may be possible for the questionnaire to be used in jurisdictions other than those for which it was originally designed or intended.

          Control0..*
          BindingUnless not suitable, these codes SHALL be taken from Jurisdiction ValueSet
          (extensible to http://hl7.org/fhir/ValueSet/jurisdiction|4.3.0)

          Countries and regions within which this artifact is targeted for use.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          64. Questionnaire.purpose
          Definition

          Explanation of why this questionnaire is needed and why it has been designed as it has.

          ShortWhy this questionnaire is defined
          Comments

          This element does not describe the usage of the questionnaire. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this questionnaire.

          Control0..1
          Typemarkdown
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. Questionnaire.copyright
          Definition

          A copyright statement relating to the questionnaire and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the questionnaire.

          ShortUse and/or publishing restrictions
          Control0..1
          Typemarkdown
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Requirements

          Consumers must be able to determine any legal restrictions on the use of the questionnaire and/or its content.

          Alternate NamesLicense, Restrictions
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. Questionnaire.approvalDate
          Definition

          The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

          ShortWhen the questionnaire was approved by publisher
          Comments

          The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

          Control0..1
          Typedate
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. Questionnaire.lastReviewDate
          Definition

          The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

          ShortWhen the questionnaire was last reviewed
          Comments

          If specified, this date follows the original approval date.

          Control0..1
          Typedate
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Requirements

          Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. Questionnaire.effectivePeriod
          Definition

          The period during which the questionnaire content was or is planned to be in active use.

          ShortWhen the questionnaire is expected to be used
          Comments

          The effective period for a questionnaire determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

          Control0..1
          TypePeriod
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the questionnaire are or are expected to be used instead.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. Questionnaire.code
          Definition

          An identifier for this question or group of questions in a particular terminology such as LOINC.

          ShortConcept that represents the overall questionnaire
          Control0..*
          BindingFor example codes, see QuestionnaireQuestionCodes
          (example to http://hl7.org/fhir/ValueSet/questionnaire-questions|4.3.0)

          Codes for questionnaires, groups and individual questions.

          TypeCoding
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Allows linking of the complete Questionnaire resources to formal terminologies. It's common for "panels" of questions to be identified by a code.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. Questionnaire.item
          Definition

          A particular question, question grouping or display text that is part of the questionnaire.

          ShortQuestions and sections within the Questionnaire
          Comments

          The content of the questionnaire is constructed from an ordered, hierarchical collection of items.

          Control1..*
          This element is affected by the following invariants: que-3
          TypeBackboneElement
          Is Modifierfalse
          Must Supporttrue
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
          que-1a: Group items must have nested items when Questionanire is complete ((type='group' and %resource.status='complete') implies item.empty().not())
          que-1b: Groups should have items (type='group' implies item.empty().not())
          que-1c: Display items cannot have child items (type='display' implies item.empty())
          que-3: Display items cannot have a "code" asserted (type!='display' or code.empty())
          que-4: A question cannot have both answerOption and answerValueSet (answerOption.empty() or answerValueSet.empty())
          que-5: Only 'choice' and 'open-choice' items can have answerValueSet ((type ='choice' or type = 'open-choice' or type = 'decimal' or type = 'integer' or type = 'date' or type = 'dateTime' or type = 'time' or type = 'string' or type = 'quantity') or (answerValueSet.empty() and answerOption.empty()))
          que-6: Required and repeat aren't permitted for display items (type!='display' or (required.empty() and repeats.empty()))
          que-8: Initial values can't be specified for groups or display items ((type!='group' and type!='display') or initial.empty())
          que-9: Read-only can't be specified for "display" items (type!='display' or readOnly.empty())
          que-10: Maximum length can only be declared for simple question types ((type in ('boolean' | 'decimal' | 'integer' | 'string' | 'text' | 'url' | 'open-choice')) or maxLength.empty())
          que-11: If one or more answerOption is present, initial[x] must be missing (answerOption.empty() or initial.empty())
          que-12: If there are more than one enableWhen, enableBehavior must be specified (enableWhen.count() > 1 implies enableBehavior.exists())
          que-13: Can only have multiple initial values for repeating items (repeats=true or initial.count() <= 1)
          hie-q-unique-linkid: linkId values must be unique within the questionnaire (item.select(linkId).isDistinct())
          hie-q-group-no-answers: Group items do not have answers, initial, or answer value sets ((type != 'group') or (answerOption.empty() and answerValueSet.empty() and initial.empty()))
          hie-q-leaf-answerable: Non-group, non-display items must be answerable or descriptive ((type in {'group','display'}) or (answerOption.exists() or answerValueSet.exists() or type.exists()))
          78. Questionnaire.item.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          80. Questionnaire.item.extension
          Definition

          An Extension

          ShortUI hints and custom constraints
          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          82. Questionnaire.item.extension.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          Typeid
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          84. Questionnaire.item.extension.extension
          Definition

          An Extension

          ShortExtension
          Control0..0
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on Questionnaire.item.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 86. Questionnaire.item.extension.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
            88. Questionnaire.item.extension.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control0..1
            TypeChoice of: base64Binary, boolean, canonical, code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, CodeableReference, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, RatioRange, Reference, SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Questionnaire.item.extension.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 90. Questionnaire.item.extension.value[x]:valueCodeableConcept
              Slice NamevalueCodeableConcept
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortValue of extension
              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from QuestionnaireItemUIControlCodes
              (extensible to http://hl7.org/fhir/ValueSet/questionnaire-item-control)
              TypeCodeableConcept
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              92. Questionnaire.item.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              94. Questionnaire.item.linkId
              Definition

              An identifier that is unique within the Questionnaire allowing linkage to the equivalent item in a QuestionnaireResponse resource.

              ShortUnique id for item in questionnaire
              Comments

              This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

              Control1..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              QuestionnaireResponse does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              96. Questionnaire.item.definition
              Definition

              This element is a URI that refers to an ElementDefinition that provides information about this item, including information that might otherwise be included in the instance of the Questionnaire resource. A detailed description of the construction of the URI is shown in Comments, below. If this element is present then the following element values MAY be derived from the Element Definition if the corresponding elements of this Questionnaire resource instance have no value:

              • code (ElementDefinition.code)
              • type (ElementDefinition.type)
              • required (ElementDefinition.min)
              • repeats (ElementDefinition.max)
              • maxLength (ElementDefinition.maxLength)
              • answerValueSet (ElementDefinition.binding)
              • options (ElementDefinition.binding).
              ShortElementDefinition - details for the item
              Comments

              The uri refers to an ElementDefinition in a StructureDefinition and always starts with the canonical URL for the target resource. When referring to a StructureDefinition, a fragment identifier is used to specify the element definition by its id Element.id. E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. In the absence of a fragment identifier, the first/root element definition in the target is the matching element definition.

              Control0..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              A common pattern is to define a set of data elements and then build multiple questionnaires for different circumstances to gather the data. This element provides traceability to the common definition and allows the content for the question to come from the underlying definition.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              98. Questionnaire.item.code
              Definition

              A terminology code that corresponds to this group or question (e.g. a code from LOINC, which defines many questions and answers).

              ShortCorresponding concept for this item in a terminology
              Comments

              The value may come from the ElementDefinition referred to by .definition.

              Control0..*
              This element is affected by the following invariants: que-3
              BindingFor example codes, see QuestionnaireQuestionCodes
              (example to http://hl7.org/fhir/ValueSet/questionnaire-questions|4.3.0)

              Codes for questionnaires, groups and individual questions.

              TypeCoding
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Allows linking of groups of questions to formal terminologies.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              100. Questionnaire.item.prefix
              Definition

              A short label for a particular group, question or set of display text within the questionnaire used for reference by the individual completing the questionnaire.

              ShortE.g. "1(a)", "2.5.3"
              Comments

              These are generally unique within a questionnaire, though this is not guaranteed. Some questionnaires may have multiple questions with the same label with logic to control which gets exposed. Typically, these won't be used for "display" items, though such use is not prohibited. Systems SHOULD NOT generate their own prefixes if prefixes are defined for any items within a Questionnaire.

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              Separating the label from the question text allows improved rendering. Also, instructions will often refer to specific prefixes, so there's a need for the questionnaire design to have control over what labels are used.

              Alternate Nameslabel
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              102. Questionnaire.item.text
              Definition

              The name of a section, the text of a question or text content for a display item.

              ShortPrimary text for the item
              Comments

              When using this element to represent the name of a section, use group type item and also make sure to limit the text element to a short string suitable for display as a section heading. Group item instructions should be included as a display type item within the group.

              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              104. Questionnaire.item.type
              Definition

              The type of questionnaire item this is - whether text for display, a grouping of other items or a particular type of data to be captured (string, integer, coded choice, etc.).

              Shortgroup | display | boolean | decimal | integer | date | dateTime +
              Comments

              Additional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.

              Control1..1
              BindingThe codes SHALL be taken from QuestionnaireItemType
              (required to http://hl7.org/fhir/ValueSet/item-type|4.3.0)

              Distinguishes groups from questions and display text and indicates data type for questions.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Summaryfalse
              Requirements

              Defines the format in which the user is to be prompted for the answer.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              106. Questionnaire.item.enableWhen
              Definition

              A constraint indicating that this item should only be enabled (displayed/allow answers to be captured) when the specified condition is true.

              ShortOnly allow data when
              Comments

              If multiple repetitions of this extension are present, the item should be enabled when the condition for any of the repetitions is true. I.e. treat "enableWhen"s as being joined by an "or" clause. This element is a modifier because if enableWhen is present for an item, "required" is ignored unless one of the enableWhen conditions is met. When an item is disabled, all of its descendants are disabled, regardless of what their own enableWhen logic might evaluate to.

              Control0..*
              TypeBackboneElement
              Is Modifiertrue because If enableWhen is present and the condition evaluates to false, then the Questionnaire behaves as though the elements weren't actually present
              Must Supportfalse
              Summaryfalse
              Requirements

              Allows questionnaires to adapt based on answers to other questions. E.g. If physical gender is specified as a male, no need to capture pregnancy history. Also allows conditional display of instructions or groups of questions.

              Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
              que-7: If the operator is 'exists', the value must be a boolean (operator = 'exists' implies (answer is boolean))
              108. Questionnaire.item.enableWhen.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              110. Questionnaire.item.enableWhen.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              112. Questionnaire.item.enableWhen.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              114. Questionnaire.item.enableWhen.question
              Definition

              The linkId for the question whose answer (or lack of answer) governs whether this item is enabled.

              ShortQuestion that determines whether item is enabled
              Comments

              If multiple question occurrences are present for the same question (same linkId), then this refers to the nearest question occurrence reachable by tracing first the "ancestor" axis and then the "preceding" axis and then the "following" axis.

              Control1..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. Questionnaire.item.enableWhen.operator
              Definition

              Specifies the criteria by which the question is enabled.

              Shortexists | = | != | > | < | >= | <=
              Control1..1
              BindingThe codes SHALL be taken from QuestionnaireItemOperator
              (required to http://hl7.org/fhir/ValueSet/questionnaire-enable-operator)
              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. Questionnaire.item.enableWhen.answer[x]
              Definition

              A value that the referenced question is tested using the specified operator in order for the item to be enabled.

              ShortValue for question comparison based on operator
              Control1..1
              This element is affected by the following invariants: que-7
              BindingFor example codes, see QuestionnaireAnswerCodes
              (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0)

              Allowed values to answer questions.

              TypeChoice of: boolean, decimal, integer, date, dateTime, time, string, Coding, Quantity, Reference(Resource)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              120. Questionnaire.item.enableBehavior
              Definition

              Controls how multiple enableWhen values are interpreted - whether all or any must be true.

              Shortany or all
              Comments

              This element must be specified if more than one enableWhen value is provided.

              Control0..1
              This element is affected by the following invariants: que-12
              BindingThe codes SHALL be taken from EnableWhenBehavior
              (required to http://hl7.org/fhir/ValueSet/questionnaire-enable-behavior|4.3.0)

              Controls how multiple enableWhen values are interpreted - whether all or any must be true.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              122. Questionnaire.item.required
              Definition

              An indication, if true, that the item must be present in a "completed" QuestionnaireResponse. If false, the item may be skipped when answering the questionnaire.

              ShortIf true, at least one answer is expected at runtime
              Comments

              Questionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. If an item that contains other items is marked as required, that does not automatically make the contained elements required (though required groups must contain at least one child element). The value may come from the ElementDefinition referred to by .definition.

              Control0..1
              This element is affected by the following invariants: que-6
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Meaning if MissingItems are generally assumed not to be required unless explicitly specified. Systems SHOULD always populate this value
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              124. Questionnaire.item.repeats
              Definition

              An indication, if true, that the item may occur multiple times in the response, collecting multiple answers for questions or multiple sets of answers for groups.

              ShortWhether the item may repeat
              Comments

              If a question is marked as repeats=true, then multiple answers can be provided for the question in the corresponding QuestionnaireResponse. When rendering the questionnaire, it is up to the rendering software whether to render the question text for each answer repetition (i.e. "repeat the question") or to simply allow entry/selection of multiple answers for the question (repeat the answers). Which is most appropriate visually may depend on the type of answer as well as whether there are nested items.

              The resulting QuestionnaireResponse will be populated the same way regardless of rendering - one 'question' item with multiple answer values.

              The value may come from the ElementDefinition referred to by .definition.

              Control0..1
              This element is affected by the following invariants: que-6
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              Items may be used to create set of (related) questions that can be repeated to give multiple answers to such a set.

              Meaning if MissingItems are generally assumed not to repeat unless explicitly specified. Systems SHOULD always populate this value
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              126. Questionnaire.item.readOnly
              Definition

              An indication, when true, that the value cannot be changed by a human respondent to the Questionnaire.

              ShortDon't allow human editing
              Comments

              The value of readOnly elements can be established by asserting extensions for defaultValues, linkages that support pre-population and/or extensions that support calculation based on other answers.

              Control0..1
              This element is affected by the following invariants: que-9
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              Allows certain information to be phrased (and rendered) as a question and an answer, while keeping users from changing it. May also be useful for preventing changes to pre-populated portions of a questionnaire, for calculated values, etc.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              128. Questionnaire.item.maxLength
              Definition

              The maximum number of characters that are permitted in the answer to be considered a "valid" QuestionnaireResponse.

              ShortNo more than this many characters
              Comments

              For base64binary, reflects the number of characters representing the encoded data, not the number of bytes of the binary data. The value may come from the ElementDefinition referred to by .definition.

              Control0..1
              This element is affected by the following invariants: que-10
              Typeinteger
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              130. Questionnaire.item.answerValueSet
              Definition

              A reference to a value set containing a list of codes representing permitted answers for a "choice" or "open-choice" question.

              ShortValueset containing permitted answers
              Comments

              LOINC defines many useful value sets for questionnaire responses. See LOINC Answer Lists. The value may come from the ElementDefinition referred to by .definition.

              Control0..1
              This element is affected by the following invariants: que-4, que-5
              Typecanonical(ValueSet)
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              132. Questionnaire.item.answerOption
              Definition

              One of the permitted answers for a "choice" or "open-choice" question.

              ShortPermitted answer
              Comments

              This element can be used when the value set machinery of answerValueSet is deemed too cumbersome or when there's a need to capture possible answers that are not codes.

              Control0..*
              This element is affected by the following invariants: que-4, que-5
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
              134. Questionnaire.item.answerOption.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              136. Questionnaire.item.answerOption.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              138. Questionnaire.item.answerOption.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              140. Questionnaire.item.answerOption.value[x]
              Definition

              A potential answer that's allowed as the answer to this question.

              ShortAnswer value
              Comments

              The data type of the value must agree with the item.type.

              Control1..1
              BindingFor example codes, see QuestionnaireAnswerCodes
              (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0)

              Allowed values to answer questions.

              TypeChoice of: integer, date, time, string, Coding, Reference(Resource)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              142. Questionnaire.item.answerOption.initialSelected
              Definition

              Indicates whether the answer value is selected when the list of possible answers is initially shown.

              ShortWhether option is selected by default
              Comments

              Use this instead of initial[v] if answerValueSet is present.

              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Meaning if MissingOnly selected items explicitly marked to be selected
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              144. Questionnaire.item.initial
              Definition

              One or more values that should be pre-populated in the answer when initially rendering the questionnaire for user input.

              ShortInitial value(s) when item is first rendered
              Comments

              The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created. Note that initial values can influence results. The data type of initial[x] must agree with the item.type, and only repeating items can have more then one initial value.

              Control0..*
              This element is affected by the following invariants: que-8, que-13
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              In some workflows, having defaults saves time.

              Invariantsele-1: All FHIR elements must have a @value or children unless an empty Parameters resource (hasValue() or (children().count() > id.count()) or $this is Parameters)
              146. Questionnaire.item.initial.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              148. Questionnaire.item.initial.extension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              ShortAdditional content defined by implementations
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              150. Questionnaire.item.initial.modifierExtension
              Definition

              May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

              Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

              ShortExtensions that cannot be ignored even if unrecognized
              Comments

              There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

              Control0..*
              TypeExtension
              Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
              Summarytrue
              Requirements

              Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

              Alternate Namesextensions, user content, modifiers
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              152. Questionnaire.item.initial.value[x]
              Definition

              The actual value to for an initial answer.

              ShortActual value for initializing the question
              Comments

              The type of the initial value must be consistent with the type of the item.

              Control1..1
              BindingFor example codes, see QuestionnaireAnswerCodes
              (example to http://hl7.org/fhir/ValueSet/questionnaire-answers|4.3.0)

              Allowed values to answer questions.

              TypeChoice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference(Resource)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              154. Questionnaire.item.item
              Definition

              Text, questions and other groups to be nested beneath a question or group.

              ShortNested questionnaire items
              Comments

              There is no specified limit to the depth of nesting. However, Questionnaire authors are encouraged to consider the impact on the user and user interface of overly deep nesting.

              Control0..*
              This element is affected by the following invariants: que-1a, que-1b, que-1c
              TypeSeettp://hl7.org/fhir/StructureDefinition/Questionnaire#Questionnaire.item
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Reports can consist of complex nested groups.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))