DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 2). 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

Questionnaire-example.xml

Raw XML (canonical form)

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.