Release 4

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Questionnaire-example.xml

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Not linked to any defined compartments

Raw XML (canonical form + also see XML Format Specification)

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General questionnaire example (id = "3141")

<?xml version="1.0" encoding="UTF-8"?>

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="3141"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <pre> 
            1.Comorbidity?
              1.1 Cardial Comorbidity
                1.1.1 Angina?
                1.1.2 MI?
              1.2 Vascular Comorbidity?
              ...
            Histopathology
              Abdominal
                pT category?
              ...
          </pre> 
    </div> 
  </text> 
  <url value="http://hl7.org/fhir/Questionnaire/3141"/> 
  <title value="Cancer Quality Forum Questionnaire 2012"/> 
  <status value="draft"/> 
  <subjectType value="Patient"/> 
  <date value="2012-01"/> 
  <item> 
    <linkId value="1"/> 
    <code> 
      <system value="http://example.org/system/code/sections"/> 
      <code value="COMORBIDITY"/> 
    </code> 
    <type value="group"/> 
    <item> 
      <linkId value="1.1"/> 
      <code> 
        <system value="http://example.org/system/code/questions"/> 
        <code value="COMORB"/> 
      </code> 
      <prefix value="1"/> 
      <type value="choice"/> 
      <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/> 
      <item> 
        <linkId value="1.1.1"/> 
        <code> 
          <system value="http://example.org/system/code/sections"/> 
          <code value="CARDIAL"/> 
        </code> 
        <type value="group"/> 
        <enableWhen> 
          <question value="1.1"/> 
          <operator value="="/> 
          <answerCoding> 
            <system value="http://terminology.hl7.org/CodeSystem/v2-0136"/> 
            <code value="Y"/> 
          </answerCoding> 
        </enableWhen> 
        <item> 
          <linkId value="1.1.1.1"/> 
          <code> 
            <system value="http://example.org/system/code/questions"/> 
            <code value="COMORBCAR"/> 
          </code> 
          <prefix value="1.1"/> 
          <type value="choice"/> 
          <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/> 
          <item> 
            <linkId value="1.1.1.1.1"/> 
            <code> 
              <system value="http://example.org/system/code/questions"/> 
              <code value="COMCAR00"/> 
              <display value="Angina Pectoris"/> 
            </code> 
            <code> 
              <system value="http://snomed.info/sct"/> 
              <code value="194828000"/> 
              <display value="Angina (disorder)"/> 
            </code> 
            <prefix value="1.1.1"/> 
            <type value="choice"/> 
            <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/> 
          </item> 
          <item> 
            <linkId value="1.1.1.1.2"/> 
            <code> 
              <system value="http://snomed.info/sct"/> 
              <code value="22298006"/> 
              <display value="Myocardial infarction (disorder)"/> 
            </code> 
            <prefix value="1.1.2"/> 
            <type value="choice"/> 
            <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/> 
          </item> 
        </item> 
        <item> 
          <linkId value="1.1.1.2"/> 
          <code> 
            <system value="http://example.org/system/code/questions"/> 
            <code value="COMORBVAS"/> 
          </code> 
          <prefix value="1.2"/> 
          <type value="choice"/> 
          <answerValueSet value="http://hl7.org/fhir/ValueSet/yesnodontknow"/> 
        </item> 
      </item> 
    </item> 
  </item> 
  <item> 
    <linkId value="2"/> 
    <code> 
      <system value="http://example.org/system/code/sections"/> 
      <code value="HISTOPATHOLOGY"/> 
    </code> 
    <type value="group"/> 
    <item> 
      <linkId value="2.1"/> 
      <code> 
        <system value="http://example.org/system/code/sections"/> 
        <code value="ABDOMINAL"/> 
      </code> 
      <type value="group"/> 
      <item> 
        <linkId value="2.1.2"/> 
        <code> 
          <system value="http://example.org/system/code/questions"/> 
          <code value="STADPT"/> 
          <display value="pT category"/> 
        </code> 
        <type value="choice"/> 
      </item> 
    </item> 
  </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.