Structured Data Capture 2.5.0 - Edition 3(STU), For Comment 2018Sep Ballot
This page is part of the Structured Data Capture FHIR IG (v2.5.0: STU 3 Ballot 1) based on FHIR v3.5.0. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "Questionnaire",
"id" : "questionnaire-sdc-profile-example-render",
"text" : {
"status" : "generated",
"div" : "<div xmlns="http://www.w3.org/1999/xhtml">
<pre>
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
<head>
<meta content="text/html;charset=utf-8" http-equiv="Content-Type"/>
<title>Advanced Rendering Questionnaire Demonstration</title>
</head>
<body>
<div id="questionnaire-title">
<h1>
<span style="color:blue;">
<b>Advanced</b>
<i>Rendering</i>
<u>Questionnaire</u>
<b>
<i>Demonstration</i>
</b>
</span>
</h1>
</div>
<div id="linkitem-1" class="group">
<h2><span style="color:red;"><u>1</u></span> Demographics</h2>
<div id="linkitem-1.0" class="display">
<p>
<span style="color:green;"><i>Please</i> complete the questionnaire</span>
</p>
<!-- Instructions | The text provides guidance on how to populate or use a portion of the questionnaire (or the questionnaire as a whole). -->
<span id="linkitem-1.0-displayCategory" style="display:none;">Instructions | The text provides guidance on how to populate or use a portion of the questionnaire (or the questionnaire as a whole).</span>
</div>
<div id="linkitem-1.1" class="string">
<form action="http://hl7.org/fhir/">
First Name
<input id="linkitem-1.1-input" type="text"/>
</form>
<!-- optionalDisplay=true -->
</div>
<div id="linkitem-1.2" class="string" style="display:none;">
<form action="http://hl7.org/fhir/">
Hidden Name
<input id="linkitem-1.2-input" type="text"/>
</form>
</div>
<div id="linkitem-1.3" class="string">
<form action="http://hl7.org/fhir/">
<a href="http://hl7.org/fhir/">Middle Name</a>
<input id="linkitem-1.3-input" type="text"/>
</form>
</div>
<div id="linkitem-1.4" class="string">
<form action="http://hl7.org/fhir/">
Last Name
<input id="linkitem-1.4-input" type="text"/>
</form>
</div>
<div id="linkitem-1.5" class="string">
<form action="http://hl7.org/fhir/">
Gender
<input id="linkitem-1.5-f" type="radio" name="Gender" value="F" checked="checked"/>(a) Female
<input id="linkitem-1.5-m" type="radio" name="Gender" value="M"/>Male
<input id="linkitem-1.5-o" type="radio" name="Gender" value="O"/>Other
<input id="linkitem-1.5-u" type="radio" name="Gender" value="U"/>Unknown
</form>
</div>
</div>
<div id="linkitem-2" class="group">
<h2>2 Medical History</h2>
<form action="http://hl7.org/fhir/">
<table border="1">
<col width="65%"/>
<col width="35%"/>
<tr>
<td>
Diabetes
</td>
<td>
Other Information
</td>
</tr>
<tr>
<td>
<input id="linkitem-2.1-choice1" type="checkbox" name="diabetes-type1" value="diabetes-type1"/>Type 1
</td>
<td>
<input id="linkitem-2.2-choice1" type="checkbox" name="otherinformation-hypertension" value="otherinformation-hypertension"/>Hypertension
</td>
</tr>
<tr>
<td>
<input id="linkitem-2.1-choice2" type="checkbox" name="diabetes-type2" value="diabetes-type2"/>Type 2
</td>
<td>
<input id="linkitem-2.2-choice2" type="checkbox" name="otherinformation-smoker" value="otherinformation-smoker"/>Smoker
</td>
</tr>
</table>
</form>
</div>
<div id="linkitem-3" class="group">
<h2>3 Slider demonstration</h2>
<div id="linkitem-3.1" class="slidecontainer">
Adjust the slider<br/>
<form action="http://hl7.org/fhir/">
<input type="range" min="0" max="100" value="50" step="10" class="slider" id="linkitem-3.1-slider"/>
</form>
</div>
</div>
</body>
</html>
</pre>
</div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-provenanceSignatureRequired",
"valueBoolean" : false
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.1",
"display" : "Author's Signature"
}
],
"text" : "the signature of the primary or sole author of a health information document. There can be only one primary author of a health information document."
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive",
"valueBoolean" : true
}
],
"url" : "http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-render",
"version" : "2.5.0",
"title" : "Advanced Rendering Questionnaire Profile Demonstration",
"_title" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString" : "color:blue;"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString" : "<b>Advanced</b> <i>Rendering</i> <u>Questionnaire</u> <b><i>Demonstration</i></b>"
}
]
},
"status" : "draft",
"subjectType" : [
"Patient"
],
"date" : "2018-08",
"item" : [
{
"linkId" : "1",
"code" : [
{
"system" : "http://example.org/system/code/sections",
"code" : "DEMOGRAPHICS"
}
],
"prefix" : "1",
"_prefix" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString" : "color:red;"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString" : "<u>1</u>"
}
]
},
"text" : "Demographics",
"type" : "group",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-display-category",
"code" : "instructions",
"display" : "Instructions"
}
],
"text" : "The text provides guidance on how to populate or use a portion of the questionnaire (or the questionnaire as a whole)."
}
}
],
"linkId" : "1.0",
"text" : "Please complete the questionnaire",
"_text" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString" : "color:green;"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString" : "<i>Please</i> complete the questionnaire"
}
]
},
"type" : "display"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-optionalDisplay",
"valueBoolean" : true
}
],
"linkId" : "1.1",
"text" : "First Name",
"type" : "string"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean" : true
}
],
"linkId" : "1.2",
"text" : "Hidden Name",
"type" : "string"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-supportLink",
"valueUri" : "http://hl7.org/fhir/"
}
],
"linkId" : "1.3",
"text" : "Middle Name",
"type" : "string"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "urn:iso-astm:E1762-95:2013",
"code" : "1.2.840.10065.1.12.1.8",
"display" : "Signature Witness Signature"
}
],
"text" : "the signature of a witness to any other signature."
}
}
],
"modifierExtension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-usageMode",
"valueCode" : "capture"
}
],
"linkId" : "1.4",
"text" : "Last Name",
"type" : "string"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode" : "horizontal"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "radio-button",
"display" : "Radio Button"
}
],
"text" : "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others."
}
}
],
"linkId" : "1.5",
"text" : "Gender",
"type" : "choice",
"answerOption" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "(a)"
}
],
"valueCoding" : {
"code" : "F",
"display" : "Female"
},
"initialSelected" : true
},
{
"valueCoding" : {
"code" : "M",
"display" : "Male"
}
},
{
"valueCoding" : {
"code" : "O",
"display" : "Other"
}
},
{
"valueCoding" : {
"code" : "U",
"display" : "Unknown"
}
}
]
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "htable",
"display" : "Horizontal Answer Table"
}
],
"text" : "Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions."
}
}
],
"linkId" : "2",
"code" : [
{
"system" : "http://example.org/system/code/sections",
"code" : "FAMILYDOC"
}
],
"prefix" : "2",
"text" : "Family Physician Name",
"type" : "group",
"item" : [
{
"linkId" : "2.1",
"text" : "Diabetes",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"code" : "diabetes-type1",
"display" : "Type 1"
}
},
{
"valueCoding" : {
"code" : "diabetes-type2",
"display" : "Type 2"
}
}
]
},
{
"linkId" : "2.2",
"text" : "Other Information",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"code" : "otherinformation-hypertension",
"display" : "Hypertension"
}
},
{
"valueCoding" : {
"code" : "otherinformation-smoker",
"display" : "Smoker"
}
}
]
}
]
},
{
"linkId" : "3",
"code" : [
{
"system" : "http://example.org/system/code/sections",
"code" : "SLIDER"
}
],
"prefix" : "3",
"text" : "Slider demonstration",
"type" : "group",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "slider",
"display" : "Slider"
}
],
"text" : "A control where an axis is displayed between the high and low values and the control can be visually manipulated to select a value anywhere on the axis."
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue",
"valueInteger" : 10
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger" : 0
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger" : 100
}
],
"linkId" : "3.1",
"text" : "Adjust the slider",
"type" : "integer",
"initial" : [
{
"valueInteger" : 50
}
]
}
]
}
]
}
© 2015+ HL7 International (OO work group). Based on FHIR version (3.5.0-14923). IG generated on Fri, Aug 31, 2018 16:04+1000.
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