eHealth Infrastructure
3.2.0 - release

This page is part of the FUT Infrastructure (v3.2.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Resource Profile: ehealth-questionnaireresponse - Detailed Descriptions

Active as of 2024-09-02

Definitions for the ehealth-questionnaireresponse resource profile.

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

0. QuestionnaireResponse
2. QuestionnaireResponse.extension
Control2..?
SlicingThis element introduces a set of slices on QuestionnaireResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. QuestionnaireResponse.extension:episodeOfCare
    Slice NameepisodeOfCare
    Control1..1
    TypeExtension(Episode of care) (Extension Type: Reference(EpisodeOfCare))
    6. QuestionnaireResponse.extension:quality
    Slice Namequality
    Control0..*
    TypeExtension(Quality) (Complex Extension)
    8. QuestionnaireResponse.extension:resolvedTiming
    Slice NameresolvedTiming
    Control1..1
    TypeExtension(Resolved timing) (Complex Extension)
    10. QuestionnaireResponse.basedOn
    Control1..1
    TypeReference(ehealth-servicerequest)referenced
    12. QuestionnaireResponse.partOf
    Control0..1
    TypeReference(ehealth-observation, Procedure)referenced
    14. QuestionnaireResponse.questionnaire
    Control1..?
    Typecanonical(ehealth-questionnaire)referenced
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    16. QuestionnaireResponse.subject
    Control1..?
    18. QuestionnaireResponse.authored
    Control1..?
    20. QuestionnaireResponse.author
    TypeReference(ehealth-device, ehealth-practitioner, ehealth-patient, ehealth-relatedperson)referenced
    22. QuestionnaireResponse.source
    Control1..?
    TypeReference(ehealth-patient, ehealth-practitioner, ehealth-relatedperson)referenced

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

    0. QuestionnaireResponse
    Definition

    A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to.

    ShortA structured set of questions and their answers
    Comments

    The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.

    Control0..*
    Is Modifierfalse
    Summaryfalse
    Alternate NamesForm, QuestionnaireAnswers
    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 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(canonical) = '#').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())
    2. QuestionnaireResponse.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
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. QuestionnaireResponse.extension
    Definition

    An Extension


    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.

    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.

    Control20..*
    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 QuestionnaireResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. QuestionnaireResponse.extension:episodeOfCare
      Slice NameepisodeOfCare
      Definition

      Identifies the episode(s) of care that this resource is relevant to. Establishes the EpisodeOfCare as a 'grouper' of resources that are relevant to that episode.

      ShortAssociated Encounter episode of care
      Control1..1
      TypeExtension(Episode of care) (Extension Type: Reference(EpisodeOfCare))
      Is Modifierfalse
      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())
      ele-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())
      8. QuestionnaireResponse.extension:quality
      Slice Namequality
      Definition

      Minimum required or actually assessed quality values. The qualityType element states the type of quality. For different values of qualityType the required or assessed quality value (qualityCode) must be from different value sets. The relation between qualityType and allowed value sets are defined in the definition of value set http://ehealth.sundhed.dk/vs/quality-types.

      ShortMinimum requirements for qualities
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(Quality) (Complex Extension)
      Is Modifierfalse
      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())
      10. QuestionnaireResponse.extension:resolvedTiming
      Slice NameresolvedTiming
      Definition

      Resolved timing reflects whether a measurement (Observation, QuestionnaireResponse or Media) has been performed ad-hoc or as fulfillment of a measurement regime time slot in which case the extent of the time slot is given by start and end. If the measurement regime has a form for which a time slot cannot be resolved or determining is/was not supported, the type unresolved is used.

      ShortResolved Timing
      Control1..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Resolved timing) (Complex Extension)
      Is Modifierfalse
      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())
      12. QuestionnaireResponse.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
      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())
      14. QuestionnaireResponse.basedOn
      Definition

      The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.

      ShortRequest fulfilled by this QuestionnaireResponse
      Control10..1*
      TypeReference(ehealth-servicerequest, CarePlan, ServiceRequest)referenced
      Is Modifierfalse
      Summarytrue
      Requirements

      Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.

      Alternate Namesorder
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. QuestionnaireResponse.partOf
      Definition

      A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.

      ShortPart of this action
      Comments

      Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.

      Control0..1*
      TypeReference(ehealth-observation, Procedure, Observation)referenced
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. QuestionnaireResponse.questionnaire
      Definition

      The Questionnaire that defines and organizes the questions for which answers are being provided.

      ShortForm being answered
      Comments

      If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).

      Control10..1
      Typecanonical(ehealth-questionnaire, Questionnaire)referenced
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

      Alternate NamesForm
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. QuestionnaireResponse.status
      Definition

      The position of the questionnaire response within its overall lifecycle.

      Shortin-progress | completed | amended | entered-in-error | stopped
      Comments

      This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from QuestionnaireResponseStatushttp://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1
      (required to http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1)

      Lifecycle status of the questionnaire response.

      Typecode
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Requirements

      The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

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

      The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.

      ShortThe subject of the questions
      Comments

      If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.

      Control10..1
      TypeReference(Resource)
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows linking the answers to the individual the answers describe. May also affect access control.

      Alternate NamesPatient, Focus
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. QuestionnaireResponse.authored
      Definition

      The date and/or time that this set of answers were last changed.

      ShortDate the answers were gathered
      Comments

      May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured.

      This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.

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

      Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.

      Alternate NamesDate Created, Date published, Date Issued, Date updated
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. QuestionnaireResponse.author
      Definition

      Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.

      ShortPerson who received and recorded the answers
      Comments

      Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.

      Control0..1
      TypeReference(ehealth-device, ehealth-practitioner, ehealth-patient, ehealth-relatedperson, Device, Practitioner, PractitionerRole, Patient, RelatedPerson, Organization)referenced
      Is Modifierfalse
      Summarytrue
      Requirements

      Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

      Alternate NamesLaboratory, Service, Practitioner, Department, Company, Performer
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. QuestionnaireResponse.source
      Definition

      The person who answered the questions about the subject.

      ShortThe person who answered the questions
      Comments

      If not specified, no inference can be made about who provided the data.

      Control10..1
      TypeReference(ehealth-patient, ehealth-practitioner, ehealth-relatedperson, Patient, Practitioner, PractitionerRole, RelatedPerson)referenced
      Is Modifierfalse
      Summarytrue
      Requirements

      When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.

      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 found here

      0. QuestionnaireResponse
      Definition

      A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to.

      ShortA structured set of questions and their answers
      Comments

      The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.

      Control0..*
      Is Modifierfalse
      Summaryfalse
      Alternate NamesForm, QuestionnaireAnswers
      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 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(canonical) = '#').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())
      2. QuestionnaireResponse.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
      Summarytrue
      4. QuestionnaireResponse.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
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. QuestionnaireResponse.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
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. QuestionnaireResponse.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)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      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()))
      10. QuestionnaireResponse.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
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. QuestionnaireResponse.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
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. QuestionnaireResponse.extension
      Definition

      An Extension

      ShortExtension
      Control2..*
      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 QuestionnaireResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. QuestionnaireResponse.extension:episodeOfCare
        Slice NameepisodeOfCare
        Definition

        Identifies the episode(s) of care that this resource is relevant to. Establishes the EpisodeOfCare as a 'grouper' of resources that are relevant to that episode.

        ShortAssociated Encounter episode of care
        Control1..1
        TypeExtension(Episode of care) (Extension Type: Reference(EpisodeOfCare))
        Is Modifierfalse
        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. QuestionnaireResponse.extension:quality
        Slice Namequality
        Definition

        Minimum required or actually assessed quality values. The qualityType element states the type of quality. For different values of qualityType the required or assessed quality value (qualityCode) must be from different value sets. The relation between qualityType and allowed value sets are defined in the definition of value set http://ehealth.sundhed.dk/vs/quality-types.

        ShortMinimum requirements for qualities
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(Quality) (Complex Extension)
        Is Modifierfalse
        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())
        20. QuestionnaireResponse.extension:resolvedTiming
        Slice NameresolvedTiming
        Definition

        Resolved timing reflects whether a measurement (Observation, QuestionnaireResponse or Media) has been performed ad-hoc or as fulfillment of a measurement regime time slot in which case the extent of the time slot is given by start and end. If the measurement regime has a form for which a time slot cannot be resolved or determining is/was not supported, the type unresolved is used.

        ShortResolved Timing
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Resolved timing) (Complex Extension)
        Is Modifierfalse
        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())
        22. QuestionnaireResponse.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
        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())
        24. QuestionnaireResponse.identifier
        Definition

        A business identifier assigned to a particular completed (or partially completed) questionnaire.

        ShortUnique id for this set of answers
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..1
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Requirements

        Used for tracking, registration and other business purposes.

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

        The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.

        ShortRequest fulfilled by this QuestionnaireResponse
        Control1..1
        TypeReference(ehealth-servicerequest)referenced
        Is Modifierfalse
        Summarytrue
        Requirements

        Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.

        Alternate Namesorder
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. QuestionnaireResponse.partOf
        Definition

        A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.

        ShortPart of this action
        Comments

        Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.

        Control0..1
        TypeReference(ehealth-observation, Procedure)referenced
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. QuestionnaireResponse.questionnaire
        Definition

        The Questionnaire that defines and organizes the questions for which answers are being provided.

        ShortForm being answered
        Comments

        If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).

        Control1..1
        Typecanonical(ehealth-questionnaire)referenced
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

        Alternate NamesForm
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. QuestionnaireResponse.status
        Definition

        The position of the questionnaire response within its overall lifecycle.

        Shortin-progress | completed | amended | entered-in-error | stopped
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from QuestionnaireResponseStatus
        (required to http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1)

        Lifecycle status of the questionnaire response.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Requirements

        The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

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

        The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.

        ShortThe subject of the questions
        Comments

        If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.

        Control1..1
        TypeReference(Resource)
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows linking the answers to the individual the answers describe. May also affect access control.

        Alternate NamesPatient, Focus
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. QuestionnaireResponse.encounter
        Definition

        The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.

        ShortEncounter created as part of
        Comments

        This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

        Control0..1
        TypeReference(Encounter)
        Is Modifierfalse
        Summarytrue
        Requirements

        Provides context for the information that was captured. May also affect access control.

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

        The date and/or time that this set of answers were last changed.

        ShortDate the answers were gathered
        Comments

        May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured.

        This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.

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

        Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.

        Alternate NamesDate Created, Date published, Date Issued, Date updated
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. QuestionnaireResponse.author
        Definition

        Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.

        ShortPerson who received and recorded the answers
        Comments

        Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.

        Control0..1
        TypeReference(ehealth-device, ehealth-practitioner, ehealth-patient, ehealth-relatedperson)referenced
        Is Modifierfalse
        Summarytrue
        Requirements

        Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

        Alternate NamesLaboratory, Service, Practitioner, Department, Company, Performer
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. QuestionnaireResponse.source
        Definition

        The person who answered the questions about the subject.

        ShortThe person who answered the questions
        Comments

        If not specified, no inference can be made about who provided the data.

        Control1..1
        TypeReference(ehealth-patient, ehealth-practitioner, ehealth-relatedperson)referenced
        Is Modifierfalse
        Summarytrue
        Requirements

        When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.

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

        A group or question item from the original questionnaire for which answers are provided.

        ShortGroups and questions
        Comments

        Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        qrs-1: Nested item can't be beneath both item and answer ((answer.exists() and item.exists()).not())
        46. QuestionnaireResponse.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
        48. QuestionnaireResponse.item.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())
        50. QuestionnaireResponse.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())
        52. QuestionnaireResponse.item.linkId
        Definition

        The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.

        ShortPointer to specific item from Questionnaire
        Control1..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.

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

        A reference to an ElementDefinition that provides the details for the item.

        ShortElementDefinition - details for the item
        Comments

        The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].

        There is no need for this element if the item pointed to by the linkId has a definition listed.

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

        A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.

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

        Text that is displayed above the contents of the group or as the text of the question being answered.

        ShortName for group or question text
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Requirements

        Allows the questionnaire response to be read without access to the questionnaire.

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

        The respondent's answer(s) to the question.

        ShortThe response(s) to the question
        Comments

        The value is nested because we cannot have a repeating structure that has variable type.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. QuestionnaireResponse.item.answer.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
        62. QuestionnaireResponse.item.answer.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())
        64. QuestionnaireResponse.item.answer.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())
        66. QuestionnaireResponse.item.answer.value[x]
        Definition

        The answer (or one of the answers) provided by the respondent to the question.

        ShortSingle-valued answer to the question
        Comments

        More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.

        Control0..1
        BindingFor example codes, see QuestionnaireAnswerCodes
        (example to http://hl7.org/fhir/ValueSet/questionnaire-answers)

        Code indicating the response provided for a question.

        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
        Summaryfalse
        Requirements

        Ability to retain a single-valued answer to a question.

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

        Nested groups and/or questions found within this particular answer.

        ShortNested groups and questions
        Control0..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
        Is Modifierfalse
        Summaryfalse
        Requirements

        It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.

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

        Questions or sub-groups nested beneath a question or group.

        ShortNested questionnaire response items
        Control0..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
        Is Modifierfalse
        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()))