Release 4B Snapshot #1
FoundationThis page is part of the FHIR Specification v4.3.0-snapshot1: R4B Snapshot to support the Jan 2022 Connectathon. About the R4B version of FHIR. The current officially released version is 4.3.0. For a full list of available versions, see the Directory of published versions 
. Page versions: R5 R4B R4 R3 R2
| FHIR Infrastructure Work Group | Maturity Level: 3 | Trial Use | Security Category: Patient | Compartments: Device, Encounter, Patient, Practitioner, RelatedPerson |
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.
QuestionnaireResponse provides a complete or partial list of answers to a set of questions filled when responding to a questionnaire. The questions may be included directly or by reference to a Questionnaire resource that defines the questions as well as the constraints on the allowed answers. In some cases, both formal rules for editing the questionnaire (via link to Questionnaire) as well as sufficient local information to allow rendering of the questionnaire may be provided.
Each time a questionnaire is completed for a different subject or at a different time, a distinct QuestionnaireResponse is generated, though it may be possible for a previously entered set of answers to be edited or updated.
Questionnaire responses cover the need to communicate data originating from forms used in medical history examinations, research questionnaires and sometimes full clinical specialty records. In many systems this data is collected using user-defined screens and forms. Questionnaire responses record specifics about data capture - exactly what questions were asked, in what order, what answers were given, etc. Each of these questions is part of the Questionnaire, and as such the Questionnaire is a separately identifiable Resource, whereas the individual questions are not.
Examples of Questionnaires include:
QuestionnaireResponse resources can be validated against their corresponding Questionnaire to verify that required groups and questions are answered and that answers fit constraints in terms of cardinality, data type, etc.
The QuestionnaireResponse resource captures the responses to a questionnaire, while Questionnaire represents the definition of the questionnaire form, including what questions are asked, how they're organized and the constraints on the allowed answers.
While Observation, with its nested relatedObservation structure, can create complex hierarchies of
questions and answers, the focus is different. First, Observation is used primarily for capturing data elements that
are "true" observations - lab measurements, vital signs, social assessments, etc., while QuestionnaireResponse can be used to capture
any types of data, including data that would typically map to other resources (Procedure, Patient,
MedicationStatement, etc.). Second, the focus of QuestionnaireResponse includes the specific phrasing
and organization of the questions. All data must be explicitly captured as a question. With Observation, the focus is
only on the meaning of the answer, not what question was asked (assuming a question was even asked at all). Additional information such as normal
ranges, interpretation, date, etc., may also be captured.
This resource is referenced by ClinicalImpression, Consent, Contract, DeviceUseStatement, FamilyMemberHistory and Observation.
This resource implements the Event pattern.
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  QuestionnaireResponse | TU | DomainResource | A structured set of questions and their answers Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
  identifier | Σ | 0..1 | Identifier | Unique id for this set of answers |
 basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest) | Request fulfilled by this QuestionnaireResponse |
| partOf | Σ | 0..* | Reference(Observation | Procedure) | Part of this action |
| questionnaire | Σ | 0..1 | canonical(Questionnaire) | Form being answered |
 status | ?!Σ | 1..1 | code | in-progress | completed | amended | entered-in-error | stopped QuestionnaireResponseStatus (Required) |
| subject | Σ | 0..1 | Reference(Any) | The subject of the questions |
| encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of |
| authored | Σ | 0..1 | dateTime | Date the answers were gathered |
| author | Σ | 0..1 | Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) | Person who received and recorded the answers |
| source | Σ | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | The person who answered the questions |
  item | I | 0..* | BackboneElement | Groups and questions + Rule: Nested item can't be beneath both item and answer |
 linkId | 1..1 | string | Pointer to specific item from Questionnaire | |
| definition | 0..1 | uri | ElementDefinition - details for the item | |
| text | 0..1 | string | Name for group or question text | |
 answer | 0..* | BackboneElement | The response(s) to the question | |
  value[x] | 0..1 | Single-valued answer to the question Questionnaire Answer Codes (Example) | ||
| valueBoolean | boolean | |||
| valueDecimal | decimal | |||
| valueInteger | integer | |||
| valueDate | date | |||
| valueDateTime | dateTime | |||
| valueTime | time | |||
| valueString | string | |||
| valueUri | uri | |||
| valueAttachment | Attachment | |||
| valueCoding | Coding | |||
| valueQuantity | Quantity | |||
 valueReference | Reference(Any) | |||
 item | 0..* | see item | Nested groups and questions | |
| item | 0..* | see item | Nested questionnaire response items | |
| Documentation for this format | ||||
UML Diagram (Legend)
XML Template
<QuestionnaireResponse xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..1 Identifier Unique id for this set of answers --></identifier> <basedOn><!-- 0..* Reference(CarePlan|ServiceRequest) Request fulfilled by this QuestionnaireResponse --></basedOn> <partOf><!-- 0..* Reference(Observation|Procedure) Part of this action --></partOf> <questionnaire><!-- 0..1 canonical(Questionnaire) Form being answered --></questionnaire> <status value="[code]"/><!-- 1..1 in-progress | completed | amended | entered-in-error | stopped --> <subject><!-- 0..1 Reference(Any) The subject of the questions --></subject> <encounter><!-- 0..1 Reference(Encounter) Encounter created as part of --></encounter> <authored value="[dateTime]"/><!-- 0..1 Date the answers were gathered --> <author><!-- 0..1 Reference(Device|Organization|Patient|Practitioner| PractitionerRole|RelatedPerson) Person who received and recorded the answers --></author> <source><!-- 0..1 Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) The person who answered the questions --></source> <item> <!-- 0..* Groups and questions --> <linkId value="[string]"/><!-- 1..1 Pointer to specific item from Questionnaire --> <definition value="[uri]"/><!-- 0..1 ElementDefinition - details for the item --> <text value="[string]"/><!-- 0..1 Name for group or question text --> <answer> <!-- 0..* The response(s) to the question --> <value[x]><!-- 0..1 boolean|decimal|integer|date|dateTime|time|string|uri| Attachment|Coding|Quantity|Reference(Any) Single-valued answer to the question --></value[x]> <item><!-- 0..* Content as for QuestionnaireResponse.item Nested groups and questions --></item> </answer> <item><!-- 0..* Content as for QuestionnaireResponse.item Nested questionnaire response items --></item> </item> </QuestionnaireResponse>
JSON Template
{
"resourceType" : "QuestionnaireResponse",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : { Identifier }, // Unique id for this set of answers
"basedOn" : [{ Reference(CarePlan|ServiceRequest) }], // Request fulfilled by this QuestionnaireResponse
"partOf" : [{ Reference(Observation|Procedure) }], // Part of this action
"questionnaire" : { canonical(Questionnaire) }, // Form being answered
"status" : "<code>", // R! in-progress | completed | amended | entered-in-error | stopped
"subject" : { Reference(Any) }, // The subject of the questions
"encounter" : { Reference(Encounter) }, // Encounter created as part of
"authored" : "<dateTime>", // Date the answers were gathered
"author" : { Reference(Device|Organization|Patient|Practitioner|
PractitionerRole|RelatedPerson) }, // Person who received and recorded the answers
"source" : { Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) }, // The person who answered the questions
"item" : [{ // Groups and questions
"linkId" : "<string>", // R! Pointer to specific item from Questionnaire
"definition" : "<uri>", // ElementDefinition - details for the item
"text" : "<string>", // Name for group or question text
"answer" : [{ // The response(s) to the question
// value[x]: Single-valued answer to the question. One of these 12:
"valueBoolean" : <boolean>,
"valueDecimal" : <decimal>,
"valueInteger" : <integer>,
"valueDate" : "<date>",
"valueDateTime" : "<dateTime>",
"valueTime" : "<time>",
"valueString" : "<string>",
"valueUri" : "<uri>",
"valueAttachment" : { Attachment },
"valueCoding" : { Coding },
"valueQuantity" : { Quantity },
"valueReference" : { Reference(Any) },
"item" : [{ Content as for QuestionnaireResponse.item }] // Nested groups and questions
}],
"item" : [{ Content as for QuestionnaireResponse.item }] // Nested questionnaire response items
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since R3
| QuestionnaireResponse | |
| QuestionnaireResponse.status |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 5 tests that all execute ok. 1 fail round-trip testing and 5 r3 resources are invalid (0 errors).)
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| QuestionnaireResponse | TU | DomainResource | A structured set of questions and their answers Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
| identifier | Σ | 0..1 | Identifier | Unique id for this set of answers |
| basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest) | Request fulfilled by this QuestionnaireResponse |
| partOf | Σ | 0..* | Reference(Observation | Procedure) | Part of this action |
| questionnaire | Σ | 0..1 | canonical(Questionnaire) | Form being answered |
| status | ?!Σ | 1..1 | code | in-progress | completed | amended | entered-in-error | stopped QuestionnaireResponseStatus (Required) |
| subject | Σ | 0..1 | Reference(Any) | The subject of the questions |
| encounter | Σ | 0..1 | Reference(Encounter) | Encounter created as part of |
| authored | Σ | 0..1 | dateTime | Date the answers were gathered |
| author | Σ | 0..1 | Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization) | Person who received and recorded the answers |
| source | Σ | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | The person who answered the questions |
| item | I | 0..* | BackboneElement | Groups and questions + Rule: Nested item can't be beneath both item and answer |
| linkId | 1..1 | string | Pointer to specific item from Questionnaire | |
| definition | 0..1 | uri | ElementDefinition - details for the item | |
| text | 0..1 | string | Name for group or question text | |
| answer | 0..* | BackboneElement | The response(s) to the question | |
| value[x] | 0..1 | Single-valued answer to the question Questionnaire Answer Codes (Example) | ||
| valueBoolean | boolean | |||
| valueDecimal | decimal | |||
| valueInteger | integer | |||
| valueDate | date | |||
| valueDateTime | dateTime | |||
| valueTime | time | |||
| valueString | string | |||
| valueUri | uri | |||
| valueAttachment | Attachment | |||
| valueCoding | Coding | |||
| valueQuantity | Quantity | |||
| valueReference | Reference(Any) | |||
| item | 0..* | see item | Nested groups and questions | |
| item | 0..* | see item | Nested questionnaire response items | |
| Documentation for this format | ||||
XML Template
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "QuestionnaireResponse",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : { Identifier }, // Unique id for this set of answers
"basedOn" : [{ Reference(CarePlan|ServiceRequest) }], // Request fulfilled by this QuestionnaireResponse
"partOf" : [{ Reference(Observation|Procedure) }], // Part of this action
"questionnaire" : { canonical(Questionnaire) }, // Form being answered
"status" : "<code>", // R! in-progress | completed | amended | entered-in-error | stopped
"subject" : { Reference(Any) }, // The subject of the questions
"encounter" : { Reference(Encounter) }, // Encounter created as part of
"authored" : "<dateTime>", // Date the answers were gathered
"author" : { Reference(Device|Organization|Patient|Practitioner|
PractitionerRole|RelatedPerson) }, // Person who received and recorded the answers
"source" : { Reference(Patient|Practitioner|PractitionerRole|RelatedPerson) }, // The person who answered the questions
"item" : [{ // Groups and questions
"linkId" : "<string>", // R! Pointer to specific item from Questionnaire
"definition" : "<uri>", // ElementDefinition - details for the item
"text" : "<string>", // Name for group or question text
"answer" : [{ // The response(s) to the question
// value[x]: Single-valued answer to the question. One of these 12:
"valueBoolean" : <boolean>,
"valueDecimal" : <decimal>,
"valueInteger" : <integer>,
"valueDate" : "<date>",
"valueDateTime" : "<dateTime>",
"valueTime" : "<time>",
"valueString" : "<string>",
"valueUri" : "<uri>",
"valueAttachment" : { Attachment },
"valueCoding" : { Coding },
"valueQuantity" : { Quantity },
"valueReference" : { Reference(Any) },
"item" : [{ Content as for QuestionnaireResponse.item }] // Nested groups and questions
}],
"item" : [{ Content as for QuestionnaireResponse.item }] // Nested questionnaire response items
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since Release 3
| QuestionnaireResponse | |
| QuestionnaireResponse.status |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 5 tests that all execute ok. 1 fail round-trip testing and 5 r3 resources are invalid (0 errors).)
See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis
| Path | Definition | Type | Reference |
|---|---|---|---|
| QuestionnaireResponse.status | Required | QuestionnaireResponseStatus | |
| QuestionnaireResponse.item.answer.value[x] | Example | QuestionnaireAnswerCodes |
| id | Level | Location | Description | Expression |
| qrs-1 | Rule | QuestionnaireResponse.item | Nested item can't be beneath both item and answer | (answer.exists() and item.exists()).not() |
,
CDA Documents frequently used named sections with
Observations to model questionnaires. Such use cases should now utilize the QuestionnaireResponse resource instead.Refer to additional guidance provided in the Questionnaire resource dealing with the design of questionnaires.
A QuestionnaireResponse may be stand-alone or may point to the definition of the questions in Questionnaire.
If the QuestionnaireResponse refers to a Questionnaire:
linkId elementdisplay. This might also include items
that were >not enabled when the Questionnaire was answered, though of course these will not have answersQuestionnaireResponse resources can have answers with values of type Attachment. These attachments will typically be selected by the user answering the questionnaire and this selection may be done in an uncontrolled environment. Systems should ensure that the attachment is of the desired type and should take precautions before rendering or executing any attached content.
For most resources, the type of information that can be conveyed in the resource is determined by the resource, and the key attributes that determine the sensitivity level of the information are also known; e.g., drug, observation type, clinical trial randomization status, etc. However, for QuestionnaireResponse, the sensitivity of an instance is dependent on what type of Questionnaire it is associated with. And the data elements that determine that sensitivity could be the answers to any of the questions. This makes automatically enforcing access control rules more challenging. Designers should take these challenges into account and may need to place stricter access controls around QuestionnaireResponse to ensure that access to information is not granted improperly.
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| author | reference | The author of the questionnaire response | QuestionnaireResponse.author (Practitioner, Organization, Device, Patient, PractitionerRole, RelatedPerson) | |
| authored | date | When the questionnaire response was last changed | QuestionnaireResponse.authored | |
| based-on | reference | Plan/proposal/order fulfilled by this questionnaire response | QuestionnaireResponse.basedOn (CarePlan, ServiceRequest) | |
| encounter | reference | Encounter associated with the questionnaire response | QuestionnaireResponse.encounter (Encounter) | |
| identifier | token | The unique identifier for the questionnaire response | QuestionnaireResponse.identifier | |
| part-of | reference | Procedure or observation this questionnaire response was performed as a part of | QuestionnaireResponse.partOf (Observation, Procedure) | |
| patient | reference | The patient that is the subject of the questionnaire response | QuestionnaireResponse.subject.where(resolve() is Patient) (Any) | |
| questionnaire | reference | The questionnaire the answers are provided for | QuestionnaireResponse.questionnaire (Questionnaire) | |
| source | reference | The individual providing the information reflected in the questionnaire respose | QuestionnaireResponse.source (Practitioner, Patient, PractitionerRole, RelatedPerson) | |
| status | token | The status of the questionnaire response | QuestionnaireResponse.status | |
| subject | reference | The subject of the questionnaire response | QuestionnaireResponse.subject (Any) |
FHIR ®© HL7.org 2011+. FHIR R4B Ballot #1 hl7.fhir.core#4.3.0-snapshot1 generated on Mon, Dec 20, 2021 14:15+1100.
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