This page is part of the FHIR Specification (v1.0.0: DSTU 2 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2
General questionnaire example (id = "3141")
<Questionnaire 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> <ValueSet> <id value="yesno"/> <!-- In practice you could (should?) use boolean for this sort of circumstance. However, the reality is that many systems treat booleans as coded data --> <name value="Example YesNo"/> <status value="active"/> <description value="Captures simple yes-no"/> <codeSystem> <system value="http://example.org/system/code/yesno"/> <caseSensitive value="true"/> <concept> <code value="1"/> <display value="Yes"/> </concept> <concept> <code value="2"/> <display value="No"/> </concept> </codeSystem> </ValueSet> </contained> <status value="draft"/> <date value="2012-01"/> <subjectType value="Patient"/> <group> <linkId value="1"/> <title value="Cancer Quality Forum Questionnaire 2012"/> <required value="true"/> <group> <!-- COMORBIDITY --> <!-- First main section of the form, questions about comorbidity --> <linkId value="1.1"/> <concept> <system value="http://example.org/system/code/sections"/> <code value="COMORBIDITY"/> </concept> <!-- section contains one question: whether there is comorbidity --> <question> <linkId value="1.1.1"/> <concept> <system value="http://example.org/system/code/questions"/> <code value="COMORB"/> </concept> <type value="choice"/> <options> <reference value="#yesno"/> </options> <group> <!-- COMORBIDITY/CARDIAL --> <!-- Subsection about specific comorbidity: cardial --> <linkId value="1.1.1.1"/> <concept> <system value="http://example.org/system/code/sections"/> <code value="CARDIAL"/> </concept> <question> <linkId value="1.1.1.1.1"/> <concept> <system value="http://example.org/system/code/questions"/> <code value="COMORBCAR"/> </concept> <type value="choice"/> <options> <reference value="#yesno"/> </options> </question> <question> <!-- This answer carries both the questionnaire-specific name and an equivalent SNOMED CT code --> <linkId value="1.1.1.1.2"/> <concept> <system value="http://example.org/system/code/questions"/> <code value="COMCAR00"/> <display value="Angina Pectoris"/> </concept> <concept> <system value="http://snomed.info/sct"/> <code value="194828000"/> <display value="Angina (disorder)"/> </concept> <type value="choice"/> <options> <reference value="#yesno"/> </options> </question> <question> <linkId value="1.1.1.1.3"/> <concept> <system value="http://snomed.info/sct"/> <code value="22298006"/> <display value="Myocardial infarction (disorder)"/> </concept> <type value="choice"/> <options> <reference value="#yesno"/> </options> </question> </group> <group> <!-- COMORBIDITY/VASCULAR --> <linkId value="1.1.1.2"/> <concept> <system value="http://example.org/system/code/sections"/> <code value="VASCULAR"/> </concept> </group> </question> </group> <!-- Todo: What's supposed to go here? --> <group> <!-- HISTOPATHOLOGY --> <linkId value="1.2"/> <concept> <system value="http://example.org/system/code/sections"/> <code value="HISTOPATHOLOGY"/> </concept> <group> <linkId value="1.2.1"/> <concept> <system value="http://example.org/system/code/sections"/> <code value="ABDOMINAL"/> </concept> <question> <linkId value="1.2.1.2"/> <concept> <system value="http://example.org/system/code/questions"/> <code value="STADPT"/> <display value="pT category"/> </concept> </question> </group> </group> </group> </Questionnaire>
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.