Release 5 Draft Ballot

This is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions

Questionnaireresponse-example.xml

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

Jump past Narrative

General questionnaire response example (id = "3141")

<?xml version="1.0" encoding="UTF-8"?>

<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="3141"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <pre> 
            Comorbidity? YES
              Cardial Comorbidity? YES
                Angina? YES
                MI? NO
              Vascular Comorbidity?
                (no answers)
              ...
            Histopathology
              Abdominal
                pT category: 1a
              ...
          </pre> 
    </div> 
  </text> 
  <contained> 
    <Patient> 
      <id value="patsub"/> 
      <identifier> 
        <system value="http://cancer.questionnaire.org/systems/id/patientnr"/> 
        <value value="A34442332"/> 
      </identifier> 
      <identifier> 
        <type> 
          <text value="Dutch BSN"/> 
        </type> 
        <system value="urn:oid:2.16.840.1.113883.2.4.6.3"/> 
        <value value="188912345"/> 
      </identifier> 
      <gender value="male"/> 
      <birthDate value="1972-11-30"/> 
    </Patient> 
  </contained> 
  <contained> 
    <ServiceRequest> 
      <id value="order"/> 
      <status value="unknown"/> 
      <intent value="order"/> 
      <subject> 
        <reference value="#patsub"/> 
      </subject> 
      <requester> 
          <reference value="Practitioner/example"/> 
      </requester> 
    </ServiceRequest> 
  </contained> 
  <contained> 
    <Practitioner> 
      <id value="questauth"/> 
      <identifier> 
        <type> 
          <text value="AUMC, Den Helder"/> 
        </type> 
        <system value="http://cancer.questionnaire.org/systems/id/org"/> 
        <value value="AUMC"/> 
      </identifier> 
    </Practitioner> 
  </contained> 
  <!--     TODO: decide how to do this
  <contained>

    <Observation>
      <id value="obs.pt-category"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="53786006"/>
          <display value="pT1 category"/>
        </coding>
      </code>
      <subject>
        <reference value="#patsub"/>
      </subject>
      <performer>
        <reference value="#questauth"/>
      </performer>
      <valueCodeableConcept>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="443357004"/>
          <display value="pT1a category"/>
        </coding>
      </valueCodeableConcept>
    </Observation>
  </contained>   -->
  <identifier> 
    <system value="http://example.org/fhir/NamingSystem/questionnaire-ids"/> 
    <value value="Q12349876"/> 
  </identifier> 
  <basedOn> 
    <reference value="#order"/> 
  </basedOn> 
  <partOf> 
    <reference value="Procedure/f201"/> 
  </partOf> 
  <status value="completed"/> 
  <subject> 
    <reference value="#patsub"/> 
  </subject> 
  <encounter> 
    <reference value="Encounter/example"/> 
  </encounter> 
  <authored value="2013-02-19T14:15:00-05:00"/> 
  <author> 
    <reference value="#questauth"/> 
  </author> 
  <item> 
    <!--     COMORBIDITY     -->
    <!--     First main section of the form, questions about comorbidity     -->
    <!--     section contains one question: whether there is comorbidity     -->
    <linkId value="1"/> 
    <item> 
      <linkId value="1.1"/> 
      <answer> 
        <valueCoding> 
          <system value="http://cancer.questionnaire.org/system/code/yesno"/> 
          <code value="1"/> 
          <display value="Yes"/> 
        </valueCoding> 
        <item> 
          <!--     COMORBIDITY/CARDIAL     -->
          <!--     Subsection about specific comorbidity: cardial     -->
          <linkId value="1.1.1"/> 
          <item> 
            <linkId value="1.1.1.1"/> 
            <answer> 
              <valueCoding> 
                <system value="http://cancer.questionnaire.org/system/code/yesno"/> 
                <code value="1"/> 
              </valueCoding> 
            </answer> 
          </item> 
          <item> 
            <!--     This answer carries both the questionnaire-specific name and an equivalent SNOMED
             CT code     -->
            <linkId value="1.1.1.2"/> 
            <answer> 
              <valueCoding> 
                <system value="http://cancer.questionnaire.org/system/code/yesno"/> 
                <code value="1"/> 
              </valueCoding> 
            </answer> 
          </item> 
          <item> 
            <linkId value="1.1.1.3"/> 
            <answer> 
              <valueCoding> 
                <system value="http://cancer.questionnaire.org/system/code/yesno"/> 
                <code value="0"/> 
              </valueCoding> 
            </answer> 
          </item> 
        </item> 
      </answer> 
    </item> 
  </item> 
  <!--     HISTOPATHOLOGY     -->
  <!--     TODO: decide how to do this
  <item>

    <item>
      <item>
       <dataResource>
          <reference value="#obs.pt-category"/>
        </dataResource>
      </item>
    </item>
  </item>     -->
</QuestionnaireResponse> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.