Example Usage Scenarios:

The following are example usage scenarios for this profile:

• Query for survey screening results for a patient.
• Record or update screening results results belonging to a Patient

Mandatory and Must Support Data Elements

In addition to the Mandatory and Must Support data elements in the SDC QuestionnaireResponse Profile, the following data-elements must always be present (Mandatory definition]) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements. Note that the Key Elements Table view aggregates all the Must Support elements between this profile and its parent profiles.

Each QuestionnaireResponse Must Have:

1. a reference back to the assessment upon which it is based
2. a status
3. a patient
4. the date the answers were gathered

Each QuestionnaireResponse Must Support:

1. a practitioner who recorded the answers
2. the questions and decimal, string, and coded type answers
   • each question must have a identifier the pointing to question

Profile Specific Implementation Guidance:

• *The SDC profile (from which this profile is derived) focuses on the constraints appropriate to capturing the “answer(s)” to a FHIR Questionnaire and demands that the Questionnaire’s canonical URL be specified. If the QuestionnaireResponse is based on a non-FHIR form:
  1. Construct a FHIR Questionnaire which represents at least the relevant metadata (in other words, the actual questions may be omitted).
  2. Communicates the identifier of the non-FHIR form instead of the canonical URI using the US Core Extension Questionnaire URI extension.
• See the Screening and Assessments guidance page for how this profile or alternatively Observations can be used represent SDOH assessments.
• QuestionnaireResponse can be searched using the standard FHIR RESTful API search parameters. Example searches are shown in the Quick Start section below. Although search chains through the associated Questionnaire can be used to query QuestionnaireResponse by item, individual responses are not directly searchable in QuestionnaireResponse. In order to search directly for individual responses, they must be “parsed” into a searchable form - i.e. to a local FHIR or non-FHIR data store such as a database or FHIR Observations.
• The basic workflow for the creation, discovery and retrieval and data-extraction of FHIR Questionnaire and QuestionnaireResponse is thoroughly documented in the Structured Data Capture (SDC) implementation guide.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from SDCQuestionnaireResponse

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	SDCQuestionnaireResponse	US Core Profile based on SDC QuestionnaireResponse
questionnaire	S	1..1	canonical(SDCBaseQuestionnaire)	Form being answered
url	S	0..1	uri	The location where a non-FHIR questionnaire/survey form can be found. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
status	S	1..1	code	in-progress | completed | amended | entered-in-error | stopped
subject	S	1..1	Reference(US Core Patient Profile S | Resource)	The subject of the questions
authored	S	1..1	dateTime	Date the answers were gathered
author	S	0..1	Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | Device | US Core RelatedPerson Profile)	Person who received and recorded the answers
item	S	0..*	BackboneElement	Groups and questions
linkId	S	1..1	string	Pointer to specific item from Questionnaire
answer
value[x]	S	0..1		Single-valued answer to the question
valueBoolean			boolean
valueDate			date
valueDateTime			dateTime
valueTime			time
valueDecimal			decimal S
valueInteger			integer
valueString			string S
valueCoding			Coding S
valueUri			uri
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Any)
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse	C	0..*	SDCQuestionnaireResponse	US Core Profile based on SDC QuestionnaireResponse
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
signature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
completionMode		0..1	CodeableConcept	E.g. Verbal, written, electronic URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..1	Identifier	Unique id for this set of answers
questionnaire	SΣ	1..1	canonical(SDCBaseQuestionnaire)	Form being answered
questionnaireDisplay	S	0..1	string	Display name for canonical reference URL: http://hl7.org/fhir/StructureDefinition/display
url	S	0..1	uri	The location where a non-FHIR questionnaire/survey form can be found. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
status	?!SΣ	1..1	code	in-progress | completed | amended | entered-in-error | stopped Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
subject	SΣ	1..1	Reference(US Core Patient Profile)	The subject of the questions
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	0..1	Reference(US Core Practitioner Profile)	Person who received and recorded the answers
item	SC	0..*	BackboneElement	Groups and questions
itemMedia		0..1	Attachment	Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
ItemSignature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId	S	1..1	string	Pointer to specific item from Questionnaire
text	S	0..1	string	Name for group or question text
answer	S	0..*	BackboneElement	The response(s) to the question
itemAnswerMedia		0..1	Attachment	Answer Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
ordinalValue		0..1	decimal	Assigned Ordinal Value URL: http://hl7.org/fhir/StructureDefinition/ordinalValue
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	S	0..1		Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
valueDecimal			decimal
valueString			string
valueCoding			Coding
item	S	0..*	See item (QuestionnaireResponse)	Nested groups and questions
item	S	0..*	See item (QuestionnaireResponse)	Nested questionnaire response items
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
QuestionnaireResponse.status	required	QuestionnaireResponseStatus
QuestionnaireResponse.item.answer.value[x]	example	QuestionnaireAnswerCodes (a valid code from SNOMED CT)

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()
sdcqr-1	best practice	QuestionnaireResponse	Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject. : subject.exists()
sdcqr-2	best practice	QuestionnaireResponse	When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers. : (QuestionnaireResponse|repeat(answer|item)).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse	C	0..*	SDCQuestionnaireResponse	US Core Profile based on SDC QuestionnaireResponse
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
signature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
completionMode		0..1	CodeableConcept	E.g. Verbal, written, electronic URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	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	SΣ	1..1	canonical(SDCBaseQuestionnaire)	Form being answered
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
questionnaireDisplay	S	0..1	string	Display name for canonical reference URL: http://hl7.org/fhir/StructureDefinition/display
url	S	0..1	uri	The location where a non-FHIR questionnaire/survey form can be found. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
value		0..1	string	Primitive value for canonical
status	?!SΣ	1..1	code	in-progress | completed | amended | entered-in-error | stopped Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
subject	SΣ	1..1	Reference(US Core Patient Profile S | Resource)	The subject of the questions
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	0..1	Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | Device | US Core RelatedPerson Profile)	Person who received and recorded the answers
source	Σ	0..1	Reference(Patient | Practitioner | PractitionerRole | RelatedPerson)	The person who answered the questions
item	SC	0..*	BackboneElement	Groups and questions
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
itemMedia		0..1	Attachment	Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
ItemSignature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId	S	1..1	string	Pointer to specific item from Questionnaire
definition		0..1	uri	ElementDefinition - details for the item
text	S	0..1	string	Name for group or question text
answer	S	0..*	BackboneElement	The response(s) to the question
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
itemAnswerMedia		0..1	Attachment	Answer Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
ordinalValue		0..1	decimal	Assigned Ordinal Value URL: http://hl7.org/fhir/StructureDefinition/ordinalValue
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	S	0..1		Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
valueBoolean			boolean
valueDate			date
valueDateTime			dateTime
valueTime			time
valueDecimal			decimal S
valueInteger			integer
valueString			string S
valueCoding			Coding S
valueUri			uri
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Any)
item	S	0..*	See item (QuestionnaireResponse)	Nested groups and questions
item	S	0..*	See item (QuestionnaireResponse)	Nested questionnaire response items
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
QuestionnaireResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
QuestionnaireResponse.status	required	QuestionnaireResponseStatus
QuestionnaireResponse.item.answer.value[x]	example	QuestionnaireAnswerCodes (a valid code from SNOMED CT)

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()
sdcqr-1	best practice	QuestionnaireResponse	Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject. : subject.exists()
sdcqr-2	best practice	QuestionnaireResponse	When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers. : (QuestionnaireResponse|repeat(answer|item)).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()

Differential View

This structure is derived from SDCQuestionnaireResponse

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	SDCQuestionnaireResponse	US Core Profile based on SDC QuestionnaireResponse
questionnaire	S	1..1	canonical(SDCBaseQuestionnaire)	Form being answered
url	S	0..1	uri	The location where a non-FHIR questionnaire/survey form can be found. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
status	S	1..1	code	in-progress | completed | amended | entered-in-error | stopped
subject	S	1..1	Reference(US Core Patient Profile S | Resource)	The subject of the questions
authored	S	1..1	dateTime	Date the answers were gathered
author	S	0..1	Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | Device | US Core RelatedPerson Profile)	Person who received and recorded the answers
item	S	0..*	BackboneElement	Groups and questions
linkId	S	1..1	string	Pointer to specific item from Questionnaire
answer
value[x]	S	0..1		Single-valued answer to the question
valueBoolean			boolean
valueDate			date
valueDateTime			dateTime
valueTime			time
valueDecimal			decimal S
valueInteger			integer
valueString			string S
valueCoding			Coding S
valueUri			uri
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Any)
Documentation for this format

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse	C	0..*	SDCQuestionnaireResponse	US Core Profile based on SDC QuestionnaireResponse
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
signature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
completionMode		0..1	CodeableConcept	E.g. Verbal, written, electronic URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..1	Identifier	Unique id for this set of answers
questionnaire	SΣ	1..1	canonical(SDCBaseQuestionnaire)	Form being answered
questionnaireDisplay	S	0..1	string	Display name for canonical reference URL: http://hl7.org/fhir/StructureDefinition/display
url	S	0..1	uri	The location where a non-FHIR questionnaire/survey form can be found. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
status	?!SΣ	1..1	code	in-progress | completed | amended | entered-in-error | stopped Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
subject	SΣ	1..1	Reference(US Core Patient Profile)	The subject of the questions
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	0..1	Reference(US Core Practitioner Profile)	Person who received and recorded the answers
item	SC	0..*	BackboneElement	Groups and questions
itemMedia		0..1	Attachment	Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
ItemSignature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId	S	1..1	string	Pointer to specific item from Questionnaire
text	S	0..1	string	Name for group or question text
answer	S	0..*	BackboneElement	The response(s) to the question
itemAnswerMedia		0..1	Attachment	Answer Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
ordinalValue		0..1	decimal	Assigned Ordinal Value URL: http://hl7.org/fhir/StructureDefinition/ordinalValue
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	S	0..1		Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
valueDecimal			decimal
valueString			string
valueCoding			Coding
item	S	0..*	See item (QuestionnaireResponse)	Nested groups and questions
item	S	0..*	See item (QuestionnaireResponse)	Nested questionnaire response items
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
QuestionnaireResponse.status	required	QuestionnaireResponseStatus
QuestionnaireResponse.item.answer.value[x]	example	QuestionnaireAnswerCodes (a valid code from SNOMED CT)

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()
sdcqr-1	best practice	QuestionnaireResponse	Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject. : subject.exists()
sdcqr-2	best practice	QuestionnaireResponse	When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers. : (QuestionnaireResponse|repeat(answer|item)).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse	C	0..*	SDCQuestionnaireResponse	US Core Profile based on SDC QuestionnaireResponse
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
signature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
completionMode		0..1	CodeableConcept	E.g. Verbal, written, electronic URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-completionMode Binding: QuestionnaireResponseMode (required): Codes indicating how the questionnaire was completed.
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	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	SΣ	1..1	canonical(SDCBaseQuestionnaire)	Form being answered
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
questionnaireDisplay	S	0..1	string	Display name for canonical reference URL: http://hl7.org/fhir/StructureDefinition/display
url	S	0..1	uri	The location where a non-FHIR questionnaire/survey form can be found. URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri
value		0..1	string	Primitive value for canonical
status	?!SΣ	1..1	code	in-progress | completed | amended | entered-in-error | stopped Binding: QuestionnaireResponseStatus (required): Lifecycle status of the questionnaire response.
subject	SΣ	1..1	Reference(US Core Patient Profile S | Resource)	The subject of the questions
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	0..1	Reference(US Core Practitioner Profile S | US Core Organization Profile | US Core Patient Profile | PractitionerRole | Device | US Core RelatedPerson Profile)	Person who received and recorded the answers
source	Σ	0..1	Reference(Patient | Practitioner | PractitionerRole | RelatedPerson)	The person who answered the questions
item	SC	0..*	BackboneElement	Groups and questions
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
itemMedia		0..1	Attachment	Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemMedia
ItemSignature		0..*	Signature	A signature attesting to the content URL: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId	S	1..1	string	Pointer to specific item from Questionnaire
definition		0..1	uri	ElementDefinition - details for the item
text	S	0..1	string	Name for group or question text
answer	S	0..*	BackboneElement	The response(s) to the question
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
itemAnswerMedia		0..1	Attachment	Answer Media to display URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemAnswerMedia
ordinalValue		0..1	decimal	Assigned Ordinal Value URL: http://hl7.org/fhir/StructureDefinition/ordinalValue
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]	S	0..1		Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
valueBoolean			boolean
valueDate			date
valueDateTime			dateTime
valueTime			time
valueDecimal			decimal S
valueInteger			integer
valueString			string S
valueCoding			Coding S
valueUri			uri
valueQuantity			Quantity
valueAttachment			Attachment
valueReference			Reference(Any)
item	S	0..*	See item (QuestionnaireResponse)	Nested groups and questions
item	S	0..*	See item (QuestionnaireResponse)	Nested questionnaire response items
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
QuestionnaireResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
QuestionnaireResponse.status	required	QuestionnaireResponseStatus
QuestionnaireResponse.item.answer.value[x]	example	QuestionnaireAnswerCodes (a valid code from SNOMED CT)

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()
sdcqr-1	best practice	QuestionnaireResponse	Subject SHOULD be present (searching is difficult without subject). Almost all QuestionnaireResponses should be with respect to some sort of subject. : subject.exists()
sdcqr-2	best practice	QuestionnaireResponse	When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers. : (QuestionnaireResponse|repeat(answer|item)).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue()

This structure is derived from SDCQuestionnaireResponse

Summary

Mandatory: 1 element
Must-Support: 9 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
• US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri

Maturity: 3

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

• The syntax used to describe the interactions is described here.
• See the General Requirements section for additional rules and expectations when a server requires status parameters.
• See the General Guidance section for additional guidance on searching for multiple patients.

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

1. SHALL support both read QuestionnaireResponse by id AND QuestionnaireResponse search using the _id search parameter:

   GET [base]/QuestionnaireResponse/[id] or GET [base]/QuestionnaireResponse?_id=[id]

   Example:

   1. GET [base]/!QuestionnaireResponse/AHC-HRSN-screening-example
   2. GET [base]/!QuestionnaireResponse/?_id=AHC-HRSN-screening-example

   Implementation Notes: (how to search by the logical id of the resource)

2. SHALL support searching for all questionnaireresponses for a patient using the patient search parameter:

   GET [base]/QuestionnaireResponse?patient={Type/}[id]

   Example:

   1. GET [base]/QuestionnaireResponse?patient=1032702

   Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient (how to search by reference)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

1. SHOULD support searching using the combination of the patient and status search parameters:
   • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

   GET [base]/QuestionnaireResponse?patient={Type/}[id]&status={system|}[code]{,{system|}[code],...}

   Example:

   1. GET [base]/QuestionnaireResponse?patient=1137192&status=completed

   Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient and status (how to search by reference and how to search by token)

2. SHOULD support searching using the combination of the patient and authored search parameters:
   • including support for these authored comparators: gt,lt,ge,le
   • including optional support for AND search on authored (e.g.authored=[date]&authored=[date]]&...)

   GET [base]/QuestionnaireResponse?patient={Type/}[id]&authored={gt|lt|ge|le}[date]{&authored={gt|lt|ge|le}[date]&...}

   Example:

   1. GET [base]/QuestionnaireResponse?patient=113192&date=ge2021

   Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient and date (how to search by reference and how to search by date)

3. SHOULD support searching using the combination of the patient and questionnaire search parameters:

   GET [base]/QuestionnaireResponse?patient={Type/}[id]&questionnaire={Type/}[id]

   Example:

   1. GET [base]/QuestionnaireResponse?patient=113192&questionnaire=http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnaireHungerVitalSign

   Implementation Notes: Fetches a bundle of all QuestionnaireResponse resources for the specified patient that have been completed against a specified form. (how to search by reference)

Searching QuestionnaireResponse by Context

Searching a patient’s QuestionnaireResponses by specific context such as those defined in US Core Category can be achieved by querying the metadata on the associated Questionnaire. Specifically, Questionnaire.useContext with a code=”focus” and value of “sdoh”/”functionalStatus”/etc. could be accomplished using a chained search:

GET [base]/QuestionnaireResponse?subject=Patient/123&questionnaire.context-type-value=focus$sdoh