Single Institutional Review Board (sIRB) Implementation Guide
0.1.0 - STU 1 ballot

This page is part of the Single Institutional Review Board (sIRB) Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

: Initiate a Study Questionnaire Response - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="INITIATE-QR"/>
  <meta>
    <versionId value="2"/>
    <lastUpdated value="2021-07-25T19:47:30.979+00:00"/>
    <source value="#jPrXQW4xZAW3qV7B"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>questionnaire</b>: <a href="http://hl7.org/fhir/us/sirb/Questionnaire/sirb-initiate-study-questionnaire">http://hl7.org/fhir/us/sirb/Questionnaire/sirb-initiate-study-questionnaire</a></p><p><b>status</b>: completed</p><p><b>authored</b>: Jul 23, 2021 5:52:41 AM</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in1</p><p><b>text</b>: Research Study Details</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in1.1</p><p><b>text</b>: Study Title</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in1.2</p><p><b>text</b>: Study Title (Short)</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in1.3</p><p><b>text</b>: IRB Protocol Number</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in1.4</p><p><b>text</b>: Study Type</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5</p><p><b>text</b>: Other Organization(s) Involved</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.1</p><p><b>text</b>: Relationship Type</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.2</p><p><b>text</b>: Organization Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.3</p><p><b>text</b>: Phone</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.4</p><p><b>text</b>: Sponsor or Funding Source Protocol Number, if applicable</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5</p><p><b>text</b>: Other Organization(s) Involved</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.1</p><p><b>text</b>: Relationship Type</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.2</p><p><b>text</b>: Organization Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.3</p><p><b>text</b>: Phone</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5</p><p><b>text</b>: Other Organization(s) Involved</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.1</p><p><b>text</b>: Relationship Type</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.2</p><p><b>text</b>: Organization Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in5.3</p><p><b>text</b>: Phone</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6</p><p><b>text</b>: sIRB (Reviewing Institution)</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.1</p><p><b>text</b>: sIRB (Reviewing Institution) Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.3</p><p><b>text</b>: Institution Street Address</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.4</p><p><b>text</b>: Institution City</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.5</p><p><b>text</b>: Institution State</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.6</p><p><b>text</b>: Institution Zip Code</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.7</p><p><b>text</b>: Institution Country</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.8</p><p><b>text</b>: Is a Federal Wide Assurance (FWA) Number assigned?</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in6.9</p><p><b>text</b>: Federal Wide Assurance Number (if assigned)</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7</p><p><b>text</b>: Overall Principal Investigator for the Study</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.1</p><p><b>text</b>: Overall Principal Investigator First Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.2</p><p><b>text</b>: Overall Principal Investigator Last Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.3</p><p><b>text</b>: Overall Principal Investigator Suffix</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.4</p><p><b>text</b>: Academic and Professional Degrees associated with the Overall Principal Investigator</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.5</p><p><b>text</b>: Overall Principal Investigator Institution Name</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.6</p><p><b>text</b>: Department Name or Division</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.7</p><p><b>text</b>: Street Address</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.8</p><p><b>text</b>: City</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.9</p><p><b>text</b>: State</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.10</p><p><b>text</b>: Zip Code</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.11</p><p><b>text</b>: Country</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.12</p><p><b>text</b>: Overall Principal Investigator Phone</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in7.13</p><p><b>text</b>: Overall Principal Investigator Email Address</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in8</p><p><b>text</b>: Confirmed or Potential Relying Site(s)</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in8.1</p><p><b>text</b>: Confirmed or Potential Relying Site Overview</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in8.3</p><p><b>text</b>: Site Principal Investigator at Relying Site</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in8</p><p><b>text</b>: Confirmed or Potential Relying Site(s)</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in8.1</p><p><b>text</b>: Confirmed or Potential Relying Site Overview</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in8.3</p><p><b>text</b>: Site Principal Investigator at Relying Site</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in9</p><p><b>text</b>: Questionnaire Version Details</p><blockquote><p><b>item</b></p><p><b>linkId</b>: in9.1</p><p><b>text</b>: Questionnaire Version</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: in9.2</p><p><b>text</b>: Questionnaire Version Date</p></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: ADMIN00</p><p><b>text</b>: Administrative Use Only  (will be hidden in the future)</p><blockquote><p><b>item</b></p><p><b>linkId</b>: ADMIN01</p><p><b>text</b>: Link ID prefix</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: ADMIN02</p><p><b>text</b>: Questionnaire Response ID for the parent Questionnaire Response (such as the Initiate a Study Questionnaire Response), if any</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: ADMIN03</p><p><b>text</b>: ID of the Research Study FHIR Resource associated with the study Questionnaire Responses</p></blockquote></blockquote></div>
  </text>
  <questionnaire
                 value="http://hl7.org/fhir/us/sirb/Questionnaire/sirb-initiate-study-questionnaire"/>
  <status value="completed"/>
  <authored value="2021-07-23T05:52:41.328Z"/>
  <item>
    <linkId value="in1"/>
    <text value="Research Study Details"/>
    <item>
      <linkId value="in1.1"/>
      <text value="Study Title"/>
      <answer>
        <valueString
                     value="Double blind, placebo-controlled trial of a new class of arthritis medication"/>
      </answer>
    </item>
    <item>
      <linkId value="in1.2"/>
      <text value="Study Title (Short)"/>
      <answer>
        <valueString value="Testing a new arthritis medication"/>
      </answer>
    </item>
    <item>
      <linkId value="in1.3"/>
      <text value="IRB Protocol Number"/>
      <answer>
        <valueString value="SUMC-1234567"/>
      </answer>
    </item>
    <item>
      <linkId value="in1.4"/>
      <text value="Study Type"/>
      <answer>
        <valueCoding>
          <system value="http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes"/>
          <code value="INT"/>
          <display value="Interventional"/>
        </valueCoding>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="in5"/>
    <text value="Other Organization(s) Involved"/>
    <item>
      <linkId value="in5.1"/>
      <text value="Relationship Type"/>
      <answer>
        <valueCoding>
          <system value="http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes"/>
          <code value="SFS"/>
          <display value="Sponsor or Funding Source"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="in5.2"/>
      <text value="Organization Name"/>
      <answer>
        <valueString value="NIH"/>
      </answer>
    </item>
    <item>
      <linkId value="in5.3"/>
      <text value="Phone"/>
      <answer>
        <valueString value="800-123-1234"/>
      </answer>
    </item>
    <item>
      <linkId value="in5.4"/>
      <text value="Sponsor or Funding Source Protocol Number, if applicable"/>
      <answer>
        <valueString value="NIH-2021-123456"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="in5"/>
    <text value="Other Organization(s) Involved"/>
    <item>
      <linkId value="in5.1"/>
      <text value="Relationship Type"/>
      <answer>
        <valueCoding>
          <system value="http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes"/>
          <code value="SFS"/>
          <display value="Sponsor or Funding Source"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="in5.2"/>
      <text value="Organization Name"/>
      <answer>
        <valueString value="Organization of Arthritis Patients Foundatio"/>
      </answer>
    </item>
    <item>
      <linkId value="in5.3"/>
      <text value="Phone"/>
      <answer>
        <valueString value="123-123-1234"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="in5"/>
    <text value="Other Organization(s) Involved"/>
    <item>
      <linkId value="in5.1"/>
      <text value="Relationship Type"/>
      <answer>
        <valueCoding>
          <system value="http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes"/>
          <code value="CRO"/>
          <display value="Contract Research Organization (CRO)"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="in5.2"/>
      <text value="Organization Name"/>
      <answer>
        <valueString value="Sample CRO, Inc."/>
      </answer>
    </item>
    <item>
      <linkId value="in5.3"/>
      <text value="Phone"/>
      <answer>
        <valueString value="234-123-1234"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="in6"/>
    <text value="sIRB (Reviewing Institution)"/>
    <item>
      <linkId value="in6.1"/>
      <text value="sIRB (Reviewing Institution) Name"/>
      <answer>
        <valueString value="Sample University Medical Center"/>
      </answer>
    </item>
    <item>
      <linkId value="in6.3"/>
      <text value="Institution Street Address"/>
      <answer>
        <valueString value="100 Sample University Drive"/>
      </answer>
    </item>
    <item>
      <linkId value="in6.4"/>
      <text value="Institution City"/>
      <answer>
        <valueString value="Sample City"/>
      </answer>
    </item>
    <item>
      <linkId value="in6.5"/>
      <text value="Institution State"/>
      <answer>
        <valueString value="NC"/>
      </answer>
    </item>
    <item>
      <linkId value="in6.6"/>
      <text value="Institution Zip Code"/>
      <answer>
        <valueString value="12345"/>
      </answer>
    </item>
    <item>
      <linkId value="in6.7"/>
      <text value="Institution Country"/>
      <answer>
        <valueString value="United States"/>
      </answer>
    </item>
    <item>
      <linkId value="in6.8"/>
      <text value="Is a Federal Wide Assurance (FWA) Number assigned?"/>
      <answer>
        <valueCoding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
          <code value="Y"/>
          <display value="Yes"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="in6.9"/>
      <text value="Federal Wide Assurance Number (if assigned)"/>
      <answer>
        <valueInteger value="56789"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="in7"/>
    <text value="Overall Principal Investigator for the Study"/>
    <item>
      <linkId value="in7.1"/>
      <text value="Overall Principal Investigator First Name"/>
      <answer>
        <valueString value="John"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.2"/>
      <text value="Overall Principal Investigator Last Name"/>
      <answer>
        <valueString value="Doe"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.3"/>
      <text value="Overall Principal Investigator Suffix"/>
      <answer>
        <valueString value="IV"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.4"/>
      <text
            value="Academic and Professional Degrees associated with the Overall Principal Investigator"/>
      <answer>
        <valueString value="MD"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.5"/>
      <text value="Overall Principal Investigator Institution Name"/>
      <answer>
        <valueString value="Sample University Medical Center"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.6"/>
      <text value="Department Name or Division"/>
      <answer>
        <valueString value="Orthopedics"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.7"/>
      <text value="Street Address"/>
      <answer>
        <valueString value="105 Sample University Ct."/>
      </answer>
    </item>
    <item>
      <linkId value="in7.8"/>
      <text value="City"/>
      <answer>
        <valueString value="Sample City"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.9"/>
      <text value="State"/>
      <answer>
        <valueString value="NC"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.10"/>
      <text value="Zip Code"/>
      <answer>
        <valueString value="12345"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.11"/>
      <text value="Country"/>
      <answer>
        <valueString value="United States"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.12"/>
      <text value="Overall Principal Investigator Phone"/>
      <answer>
        <valueString value="567-123-1234"/>
      </answer>
    </item>
    <item>
      <linkId value="in7.13"/>
      <text value="Overall Principal Investigator Email Address"/>
      <answer>
        <valueString value="drjohndoe@sampleuniversity.edu"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="in8"/>
    <text value="Confirmed or Potential Relying Site(s)"/>
    <item>
      <linkId value="in8.1"/>
      <text value="Confirmed or Potential Relying Site Overview"/>
      <item>
        <linkId value="in8.1.1"/>
        <text value="Relying Institution Name"/>
        <answer>
          <valueString value="Test Example University"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.3"/>
        <text value="Relying Institution Phone"/>
        <answer>
          <valueString value="6781233456"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.4"/>
        <text value="Is a Federal Wide Assurance (FWA) Number assigned?"/>
        <answer>
          <valueCoding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
            <code value="Y"/>
            <display value="Yes"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.5"/>
        <text value="Federal Wide Assurance Number (if assigned)"/>
        <answer>
          <valueInteger value="34567"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.6"/>
        <text value="Reliance Status"/>
        <answer>
          <valueCoding>
            <system
                    value="http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes"/>
            <code value="APPROVED"/>
            <display value="Approved for reliance"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.7"/>
        <text value="Relying Site Address"/>
        <item>
          <linkId value="in8.1.7.1"/>
          <text value="Street Address"/>
          <answer>
            <valueString value="100 Test Example Circle"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.2"/>
          <text value="City"/>
          <answer>
            <valueString value="Example"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.3"/>
          <text value="State"/>
          <answer>
            <valueString value="MA"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.4"/>
          <text value="Zip Code"/>
          <answer>
            <valueString value="67890"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.5"/>
          <text value="Country"/>
          <answer>
            <valueString value="United States"/>
          </answer>
        </item>
      </item>
    </item>
    <item>
      <linkId value="in8.3"/>
      <text value="Site Principal Investigator at Relying Site"/>
      <item>
        <linkId value="in8.3.1"/>
        <text value="Relying Site Principal Investigator First Name"/>
        <answer>
          <valueString value="Xi"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.2"/>
        <text value="Relying Site Principal Investigator Last Name"/>
        <answer>
          <valueString value="Lee"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.4"/>
        <text
              value="Academic and Professional Degrees associated with the Relying Site Principal Investigator"/>
        <answer>
          <valueString value="MD, PhD"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.5"/>
        <text value="Phone"/>
        <answer>
          <valueString value="6781233456"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.6"/>
        <text value="Email address"/>
        <answer>
          <valueString value="xi.lee@teu.med.ed"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.7"/>
        <text value="Address of Relying Site Principal Investigator"/>
        <item>
          <linkId value="in8.3.7.1"/>
          <text value="Street Address"/>
          <answer>
            <valueString value="200 Test Example Circle"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.2"/>
          <text value="City"/>
          <answer>
            <valueString value="Example"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.3"/>
          <text value="State"/>
          <answer>
            <valueString value="MA"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.4"/>
          <text value="Zip Code"/>
          <answer>
            <valueString value="67890"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.5"/>
          <text value="Country"/>
          <answer>
            <valueString value="United States"/>
          </answer>
        </item>
      </item>
    </item>
  </item>
  <item>
    <linkId value="in8"/>
    <text value="Confirmed or Potential Relying Site(s)"/>
    <item>
      <linkId value="in8.1"/>
      <text value="Confirmed or Potential Relying Site Overview"/>
      <item>
        <linkId value="in8.1.1"/>
        <text value="Relying Institution Name"/>
        <answer>
          <valueString value="Central Campus Test University"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.3"/>
        <text value="Relying Institution Phone"/>
        <answer>
          <valueString value="8901231234"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.4"/>
        <text value="Is a Federal Wide Assurance (FWA) Number assigned?"/>
        <answer>
          <valueCoding>
            <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
            <code value="NI"/>
            <display value="No Information"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.6"/>
        <text value="Reliance Status"/>
        <answer>
          <valueCoding>
            <system
                    value="http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes"/>
            <code value="POSSIBLE"/>
            <display value="Potential/possible"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="in8.1.7"/>
        <text value="Relying Site Address"/>
        <item>
          <linkId value="in8.1.7.1"/>
          <text value="Street Address"/>
          <answer>
            <valueString value="100 Central St."/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.2"/>
          <text value="City"/>
          <answer>
            <valueString value="Central"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.3"/>
          <text value="State"/>
          <answer>
            <valueString value="MI"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.4"/>
          <text value="Zip Code"/>
          <answer>
            <valueString value="23456"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.1.7.5"/>
          <text value="Country"/>
          <answer>
            <valueString value="United States"/>
          </answer>
        </item>
      </item>
    </item>
    <item>
      <linkId value="in8.3"/>
      <text value="Site Principal Investigator at Relying Site"/>
      <item>
        <linkId value="in8.3.1"/>
        <text value="Relying Site Principal Investigator First Name"/>
        <answer>
          <valueString value="Maria"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.2"/>
        <text value="Relying Site Principal Investigator Last Name"/>
        <answer>
          <valueString value="Smith"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.4"/>
        <text
              value="Academic and Professional Degrees associated with the Relying Site Principal Investigator"/>
        <answer>
          <valueString value="PhD"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.5"/>
        <text value="Phone"/>
        <answer>
          <valueString value="8901231234"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.6"/>
        <text value="Email address"/>
        <answer>
          <valueString value="maria.smith@CCTU.med.edu"/>
        </answer>
      </item>
      <item>
        <linkId value="in8.3.7"/>
        <text value="Address of Relying Site Principal Investigator"/>
        <item>
          <linkId value="in8.3.7.1"/>
          <text value="Street Address"/>
          <answer>
            <valueString value="200 Central St."/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.2"/>
          <text value="City"/>
          <answer>
            <valueString value="Central"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.3"/>
          <text value="State"/>
          <answer>
            <valueString value="MI"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.4"/>
          <text value="Zip Code"/>
          <answer>
            <valueString value="23456"/>
          </answer>
        </item>
        <item>
          <linkId value="in8.3.7.5"/>
          <text value="Country"/>
          <answer>
            <valueString value="United States"/>
          </answer>
        </item>
      </item>
    </item>
  </item>
  <item>
    <linkId value="in9"/>
    <text value="Questionnaire Version Details"/>
    <item>
      <linkId value="in9.1"/>
      <text value="Questionnaire Version"/>
      <answer>
        <valueString value="1"/>
      </answer>
    </item>
    <item>
      <linkId value="in9.2"/>
      <text value="Questionnaire Version Date"/>
      <answer>
        <valueDate value="2021-06-01"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="ADMIN00"/>
    <text value="Administrative Use Only  (will be hidden in the future)"/>
    <item>
      <linkId value="ADMIN01"/>
      <text value="Link ID prefix"/>
      <answer>
        <valueString value="in"/>
      </answer>
    </item>
    <item>
      <linkId value="ADMIN02"/>
      <text
            value="Questionnaire Response ID for the parent Questionnaire Response (such as the Initiate a Study Questionnaire Response), if any"/>
      <answer>
        <valueString value="temporarily unavailable"/>
      </answer>
    </item>
    <item>
      <linkId value="ADMIN03"/>
      <text
            value="ID of the Research Study FHIR Resource associated with the study Questionnaire Responses"/>
      <answer>
        <valueString value="temporarily unavailable"/>
      </answer>
    </item>
  </item>
</QuestionnaireResponse>