STU 3 Ballot

This page is part of the FHIR Specification (v1.6.0: STU 3 Ballot 4). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

Questionnaire-cqif-example.xml

Raw XML (canonical form)

Questionnaire used to define the questions involved in the PHQ-9 health questionnaire (id = "questionnaire-cqif-example")

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="questionnaire-cqif-example"/>
  <meta>
    <profile value="http://hl7.org/fhir/StructureDefinition/cqif-questionnaire"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">PHQ-9 Questionnaire with dynamic logic</div>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/cqif-basic-library">
    <valueReference>
      <reference value="Library/phq-9-logic"/>
    </valueReference>
  </extension>
  <identifier>
    <use value="official"/>
    <value value="phq-9"/>
  </identifier>
  <version value="1.0.0"/>
  <status value="draft"/>
  <title value="Patient Health Questionnaire (PHQ-9)"/>
  <concept>
    <system value="http://loinc.org"/>
    <code value="44249-1"/>
    <display value="PHQ-9 quick depression assessment panel:-:Pt:^Patient:-:Report.PHQ-9"/>
  </concept>
  <subjectType value="Patient"/>
  <item>
    <linkId value="LittleInterest"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44250-9"/>
    </concept>
    <text value="Little interest or pleasure in doing things"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="FeelingDown"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44255-8"/>
    </concept>
    <text value="Feeling down, depressed, or hopeless"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="TroubleSleeping"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44259-0"/>
    </concept>
    <text value="Trouble falling or staying asleep"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="FeelingTired"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44254-1"/>
    </concept>
    <text value="Feeling tired or having little energy"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="BadAppetite"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44251-7"/>
    </concept>
    <text value="Poor appetite or overeating"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="FeelingBadAboutSelf"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44258-2"/>
    </concept>
    <text value="Feeling bad about yourself - or that you are a failure or have let yourself or your family
     down"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="TroubleConcentrating"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44252-5"/>
    </concept>
    <text value="Trouble concentrating on things, such as reading the newspaper or watching television"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="MovingSpeaking"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44253-3"/>
    </concept>
    <text value="Moving or speaking so slowly that other people could have noticed. Or the opposite - being
     so fidgety or restless that you have been moving around a lot more than usual"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/cqif-basic-calculatedValue">
      <valueString value="CalculateTotalScore"/>
    </extension>
    <linkId value="TotalScore"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44261-6"/>
    </concept>
    <text value="Total score"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDepressionAnswersList"/>
    </options>
  </item>
  <item>
    <linkId value="Difficulty"/>
    <concept>
      <system value="http://loinc.org"/>
      <code value="44256-6"/>
    </concept>
    <text value="If you checked off any problems, how difficult have these problems made it for you to
     do your work, take care of things at home, or get along with other people"/>
    <type value="choice"/>
    <required value="true"/>
    <options>
      <reference value="ValueSet/LOINCDifficultyAnswersList"/>
    </options>
  </item>
</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.