Structured Data Capture
4.0.0-ballot - STU 4 ballot International flag

This page is part of the Structured Data Capture FHIR IG (v4.0.0-ballot: STU 4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: SDCQuestionnaireResponseAdapt - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 4

Definitions for the sdc-questionnaireresponse-adapt resource profile.

Guidance on how to interpret the contents of this table can be found here

0. QuestionnaireResponse
ShortAdaptive Questionnaire Response
2. QuestionnaireResponse.contained
Comments

The referenced Questionnaire SHALL be sent as a contained resource.

Control1..?
Must Supporttrue
4. QuestionnaireResponse.questionnaire
Typecanonical(Adaptive Questionnaire)contained
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension

Guidance on how to interpret the contents of this table can be found here

0. QuestionnaireResponse
Definition

Sets expectations for supported capabilities for questionnaire responses for SDC-conformant systems.


A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to.

ShortAdaptive Questionnaire ResponseA structured set of questions and their answers
Comments

The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.

Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesForm, QuestionnaireAnswers, Form Data
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
sdcqr-1: 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: 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())
sdcqr-3: Can either have source or source extension, but not both (source.count() + extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-QuestionnaireResponse.source').count() <=1)
2. QuestionnaireResponse.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. QuestionnaireResponse.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

ShortContained, inline Resources
Comments

The referenced Questionnaire SHALL be sent as a contained resource.


This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Control10..*
TypeResource
Is Modifierfalse
Must Supporttrue
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
6. QuestionnaireResponse.extension:adheresTo
Slice NameadheresTo
Definition

The action represented by this resource has been determined to satisfy the expectations established by the referenced Definition resource.

ShortFollows rules from
Comments

If changes are made to this event record, the determination must be made whether, with the change, the action still complies with the referenced Definition. Revisions may result in adheresTo assertions being removed, or - if the system has an algorithm for determining which targets are appropriate - being added.

Also see the notes in the workflow extensions area for more guidance on this element.

Control0..*
TypeExtension(adheres to) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), uri)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. QuestionnaireResponse.extension:adheresTo.extension
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

ShortExtensionAdditional content defined by implementations
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..0*
TypeExtension
Is Modifierfalse
Summaryfalse
Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 10. QuestionnaireResponse.extension:adheresTo.url
    Definition

    Source of the definition for the extension code - a logical name or a URL.

    Shortidentifies the meaning of the extension
    Comments

    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

    Control1..1
    Typeuri
    Is Modifierfalse
    XML FormatIn the XML format, this property is represented as an attribute.
    Summaryfalse
    Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-adheresTo
    12. QuestionnaireResponse.extension:adheresTo.value[x]
    Definition

    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

    ShortValue of extension
    Control10..1
    This element is affected by the following invariants: ext-1
    TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. QuestionnaireResponse.extension:triggeredBy
    Slice NametriggeredBy
    Definition

    This resource came into being as a result of expectations set in the referenced Definition resource. I.e. This resource represents a 'step' dictated within the protocol/order set/etc.

    ShortCreated because of following
    Comments

    See the notes in the workflow extensions area for more guidance on this element.

    Control0..1
    TypeExtension(Triggered by) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), uri)
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    16. QuestionnaireResponse.extension:triggeredBy.extension
    Definition

    An Extension


    May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

    ShortExtensionAdditional content defined by implementations
    Comments

    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

    Control0..0*
    TypeExtension
    Is Modifierfalse
    Summaryfalse
    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 18. QuestionnaireResponse.extension:triggeredBy.url
      Definition

      Source of the definition for the extension code - a logical name or a URL.

      Shortidentifies the meaning of the extension
      Comments

      The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

      Control1..1
      Typeuri
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
      20. QuestionnaireResponse.extension:triggeredBy.value[x]
      Definition

      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).


      Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

      ShortValue of extension
      Control10..1
      This element is affected by the following invariants: ext-1
      TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri, date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. QuestionnaireResponse.extension:signature
      Slice Namesignature
      Definition

      Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

      ShortA signature attesting to the content
      Control0..*
      TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      24. QuestionnaireResponse.extension:completionMode
      Slice NamecompletionMode
      Definition

      Indicates how the individual completing the QuestionnaireResponse provided their responses.

      ShortE.g. Verbal, written, electronic
      Control0..1
      TypeExtension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      26. QuestionnaireResponse.extension:source
      Slice Namesource
      Definition

      Optional Extension Element - found in all resources.

      ShortOptional Extensions Element
      Control0..1
      This element is affected by the following invariants: ele-1
      TypeExtension(Extension Definition for QuestionnaireResponse.source for Version 5.0) (Extension Type: Reference(Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson))
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      28. QuestionnaireResponse.extension:source.extension
      Definition

      An Extension


      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortExtensionAdditional content defined by implementations
      Comments

      There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

      Control0..0*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 30. QuestionnaireResponse.extension:source.url
        Definition

        Source of the definition for the extension code - a logical name or a URL.

        Shortidentifies the meaning of the extension
        Comments

        The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

        Control1..1
        Typeuri
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-QuestionnaireResponse.source
        32. QuestionnaireResponse.extension:source.value[x]
        Definition

        Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

        ShortValue of extension
        Control10..1
        TypeReference(Device, Organization), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. QuestionnaireResponse.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
        Summaryfalse
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        36. QuestionnaireResponse.identifier
        Definition

        A business identifier assigned to a particular completed (or partially completed) questionnaire.

        ShortUnique id for this set of answers
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..1
        TypeIdentifier
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Used for tracking, registration and other business purposes.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. QuestionnaireResponse.questionnaire
        Definition

        The Questionnaire that defines and organizes the questions for which answers are being provided.

        ShortForm being answered
        Comments

        If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).

        Control10..1
        Typecanonical(Adaptive Questionnaire, Questionnaire)contained
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

        Alternate NamesForm
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. QuestionnaireResponse.status
        Definition

        The position of the questionnaire response within its overall lifecycle.

        Shortin-progress | completed | amended | entered-in-error | stopped
        Comments

        This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from QuestionnaireResponseStatushttp://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1
        (required to http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1)

        Lifecycle status of the questionnaire response.

        Typecode
        Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. QuestionnaireResponse.subject
        Definition

        The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.

        ShortThe subject of the questions
        Comments

        If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types. If subject is omitted - because the QuestionnaireResponse is not associated with a specific subject, ensure that QuestionnaireRsponse.identifier is present or the QuestionnaireResponse is referenced somewhere (e.g. Task.output, Composition.section.entry, etc.) to allow tracking and retrieval of the QuestionnaireResponse


        If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.

        Control0..1
        TypeReference(Resource)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows linking the answers to the individual the answers describe. May also affect access control.

        Alternate NamesPatient, Focus
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. QuestionnaireResponse.authored
        Definition

        Identifies when this version of the answer set was created. Changes whenever the answers are updated.


        The date and/or time that this set of answers were last changed.

        ShortDate the answers were gathered
        Comments

        May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured.

        This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.

        Control10..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Requirements

        Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.

        Alternate NamesDate Created, Date published, Date Issued, Date updated
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. QuestionnaireResponse.author
        Definition

        Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.

        ShortPerson who received and recorded the answers
        Comments

        Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.

        Control0..1
        TypeReference(Device, Practitioner, PractitionerRole, Patient, RelatedPerson, Organization)
        Is Modifierfalse
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summarytrue
        Requirements

        Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

        Alternate NamesLaboratory, Service, Practitioner, Department, Company, Performer
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. QuestionnaireResponse.item
        Definition

        A group or question item from the original questionnaire for which answers are provided.

        ShortGroups and questions
        Comments

        Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        qrs-1: Nested item can't be beneath both item and answer ((answer.exists() and item.exists()).not())
        qrs-2: Repeated answers are combined in the answers array of a single item (repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue())
        qrs-1: Nested item can't be beneath both item and answer ((answer.exists() and item.exists()).not())
        50. QuestionnaireResponse.item.extension:itemMedia
        Slice NameitemMedia
        Definition

        Media to render/make available as an accompaniment to the question being asked

        ShortMedia to display
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Item Media) (Extension Type: Attachment)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        52. QuestionnaireResponse.item.extension:ItemSignature
        Slice NameItemSignature
        Definition

        Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

        ShortA signature attesting to the content
        Control0..*
        TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        54. QuestionnaireResponse.item.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        56. QuestionnaireResponse.item.linkId
        Definition

        The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.

        ShortPointer to specific item from Questionnaire
        Control1..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Requirements

        Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. QuestionnaireResponse.item.text
        Definition

        Text that is displayed above the contents of the group or as the text of the question being answered.

        ShortName for group or question text
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Requirements

        Allows the questionnaire response to be read without access to the questionnaire.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. QuestionnaireResponse.item.answer
        Definition

        The respondent's answer(s) to the question.

        ShortThe response(s) to the question
        Comments

        The value is nested because we cannot have a repeating structure that has variable type.

        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
        Slice NameitemAnswerMedia
        Definition

        Media to render/make available as an accompaniment to a specific answer option

        ShortAnswer Media to display
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(Item Answer Media) (Extension Type: Attachment)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        64. QuestionnaireResponse.item.answer.extension:itemWeight
        Slice NameitemWeight
        Definition

        A numeric value that allows the comparison (less than, greater than) or other numerical manipulation of a concept (e.g. Adding up components of a score). Scores are usually a whole number, but occasionally decimals are encountered in scores. In the CodeSystem and ValueSet resources, the item weight is represented using the itemWeight property

        ShortAssigned Ordinal Value
        Comments

        Inclusion of weights in QRs can increase performance when calculating based on weights.

        Control0..1
        TypeExtension(Item Weight) (Extension Type: decimal)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        66. QuestionnaireResponse.item.answer.modifierExtension
        Definition

        May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

        Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

        ShortExtensions that cannot be ignored even if unrecognized
        Comments

        There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

        Control0..*
        TypeExtension
        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
        Summarytrue
        Requirements

        Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

        Alternate Namesextensions, user content, modifiers
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        68. QuestionnaireResponse.item.answer.value[x]
        Definition

        The answer (or one of the answers) provided by the respondent to the question.

        ShortSingle-valued answer to the question
        Comments

        More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.

        Control0..1
        BindingFor example codes, see QuestionnaireAnswerCodeshttp://hl7.org/fhir/ValueSet/questionnaire-answers
        (example to http://hl7.org/fhir/ValueSet/questionnaire-answers)

        Code indicating the response provided for a question.

        TypeChoice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference(Resource)
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Summaryfalse
        Requirements

        Ability to retain a single-valued answer to a question.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. QuestionnaireResponse.item.answer.item
        Definition

        Nested groups and/or questions found within this particular answer.

        ShortNested groups and questions
        Control0..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. QuestionnaireResponse.item.item
        Definition

        Questions or sub-groups nested beneath a question or group.

        ShortNested questionnaire response items
        Control0..*
        TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Requirements

        Reports can consist of complex nested groups.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

        Guidance on how to interpret the contents of this table can be found here

        0. QuestionnaireResponse
        Definition

        Sets expectations for supported capabilities for questionnaire responses for SDC-conformant systems.

        ShortAdaptive Questionnaire Response
        Comments

        The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.

        Control0..*
        Is Modifierfalse
        Summaryfalse
        Alternate NamesForm, QuestionnaireAnswers, Form Data
        Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
        dom-3: 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: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
        dom-6: A resource should have narrative for robust management (text.`div`.exists())
        sdcqr-1: 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: 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())
        sdcqr-3: Can either have source or source extension, but not both (source.count() + extension.where(url='http://hl7.org/fhir/5.0/StructureDefinition/extension-QuestionnaireResponse.source').count() <=1)
        2. QuestionnaireResponse.id
        Definition

        The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

        ShortLogical id of this artifact
        Comments

        The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

        Control0..1
        Typeid
        Is Modifierfalse
        Summarytrue
        4. QuestionnaireResponse.meta
        Definition

        The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

        ShortMetadata about the resource
        Control0..1
        TypeMeta
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        6. QuestionnaireResponse.implicitRules
        Definition

        A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

        ShortA set of rules under which this content was created
        Comments

        Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

        Control0..1
        Typeuri
        Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        8. QuestionnaireResponse.language
        Definition

        The base language in which the resource is written.

        ShortLanguage of the resource content
        Comments

        Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

        Control0..1
        BindingThe codes SHOULD be taken from CommonLanguages
        (preferred to http://hl7.org/fhir/ValueSet/languages)

        A human language.

        Additional BindingsPurpose
        AllLanguagesMax Binding
        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        10. QuestionnaireResponse.text
        Definition

        A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

        ShortText summary of the resource, for human interpretation
        Comments

        Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

        Control0..1
        TypeNarrative
        Is Modifierfalse
        Summaryfalse
        Alternate Namesnarrative, html, xhtml, display
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        12. QuestionnaireResponse.contained
        Definition

        These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

        ShortContained, inline Resources
        Comments

        The referenced Questionnaire SHALL be sent as a contained resource.

        Control1..*
        TypeResource
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Alternate Namesinline resources, anonymous resources, contained resources
        14. QuestionnaireResponse.extension
        Definition

        An Extension

        ShortExtension
        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        SlicingThis element introduces a set of slices on QuestionnaireResponse.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 16. QuestionnaireResponse.extension:adheresTo
          Slice NameadheresTo
          Definition

          The action represented by this resource has been determined to satisfy the expectations established by the referenced Definition resource.

          ShortFollows rules from
          Comments

          If changes are made to this event record, the determination must be made whether, with the change, the action still complies with the referenced Definition. Revisions may result in adheresTo assertions being removed, or - if the system has an algorithm for determining which targets are appropriate - being added.

          Also see the notes in the workflow extensions area for more guidance on this element.

          Control0..*
          TypeExtension(adheres to) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), uri)
          Is Modifierfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          18. QuestionnaireResponse.extension:adheresTo.id
          Definition

          Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

          ShortUnique id for inter-element referencing
          Control0..1
          This element is affected by the following invariants: ele-1
          Typeid
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          20. QuestionnaireResponse.extension:adheresTo.extension
          Definition

          An Extension

          ShortExtension
          Control0..0
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 22. QuestionnaireResponse.extension:adheresTo.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-adheresTo
            24. QuestionnaireResponse.extension:adheresTo.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control1..1
            This element is affected by the following invariants: ext-1
            TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri
            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. QuestionnaireResponse.extension:triggeredBy
            Slice NametriggeredBy
            Definition

            This resource came into being as a result of expectations set in the referenced Definition resource. I.e. This resource represents a 'step' dictated within the protocol/order set/etc.

            ShortCreated because of following
            Comments

            See the notes in the workflow extensions area for more guidance on this element.

            Control0..1
            TypeExtension(Triggered by) (Extension Type: Choice of: canonical(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), Reference(ActivityDefinition, Measure, OperationDefinition, PlanDefinition, Questionnaire), uri)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            28. QuestionnaireResponse.extension:triggeredBy.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            This element is affected by the following invariants: ele-1
            Typeid
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            30. QuestionnaireResponse.extension:triggeredBy.extension
            Definition

            An Extension

            ShortExtension
            Control0..0
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 32. QuestionnaireResponse.extension:triggeredBy.url
              Definition

              Source of the definition for the extension code - a logical name or a URL.

              Shortidentifies the meaning of the extension
              Comments

              The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

              Control1..1
              Typeuri
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              Fixed Valuehttp://hl7.org/fhir/StructureDefinition/workflow-triggeredBy
              34. QuestionnaireResponse.extension:triggeredBy.value[x]
              Definition

              Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

              ShortValue of extension
              Control1..1
              This element is affected by the following invariants: ext-1
              TypeChoice of: canonical(ActivityDefinition, PlanDefinition), Reference(ActivityDefinition, PlanDefinition), uri
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. QuestionnaireResponse.extension:signature
              Slice Namesignature
              Definition

              Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

              ShortA signature attesting to the content
              Control0..*
              TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              38. QuestionnaireResponse.extension:completionMode
              Slice NamecompletionMode
              Definition

              Indicates how the individual completing the QuestionnaireResponse provided their responses.

              ShortE.g. Verbal, written, electronic
              Control0..1
              TypeExtension(QuestionnaireResponse Completion Mode) (Extension Type: CodeableConcept)
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              40. QuestionnaireResponse.extension:source
              Slice Namesource
              Definition

              Optional Extension Element - found in all resources.

              ShortOptional Extensions Element
              Control0..1
              This element is affected by the following invariants: ele-1
              TypeExtension(Extension Definition for QuestionnaireResponse.source for Version 5.0) (Extension Type: Reference(Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson))
              Is Modifierfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              42. QuestionnaireResponse.extension:source.id
              Definition

              Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

              ShortUnique id for inter-element referencing
              Control0..1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              44. QuestionnaireResponse.extension:source.extension
              Definition

              An Extension

              ShortExtension
              Control0..0
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
              SlicingThis element introduces a set of slices on QuestionnaireResponse.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 46. QuestionnaireResponse.extension:source.url
                Definition

                Source of the definition for the extension code - a logical name or a URL.

                Shortidentifies the meaning of the extension
                Comments

                The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                Control1..1
                Typeuri
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                Fixed Valuehttp://hl7.org/fhir/5.0/StructureDefinition/extension-QuestionnaireResponse.source
                48. QuestionnaireResponse.extension:source.value[x]
                Definition

                Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                ShortValue of extension
                Control1..1
                TypeReference(Device, Organization)
                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. QuestionnaireResponse.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
                Summaryfalse
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                52. QuestionnaireResponse.identifier
                Definition

                A business identifier assigned to a particular completed (or partially completed) questionnaire.

                ShortUnique id for this set of answers
                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                TypeIdentifier
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Used for tracking, registration and other business purposes.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                54. QuestionnaireResponse.basedOn
                Definition

                The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.

                ShortRequest fulfilled by this QuestionnaireResponse
                Control0..*
                TypeReference(CarePlan, ServiceRequest)
                Is Modifierfalse
                Summarytrue
                Requirements

                Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.

                Alternate Namesorder
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. QuestionnaireResponse.partOf
                Definition

                A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.

                ShortPart of this action
                Comments

                Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.

                Control0..*
                TypeReference(Observation, Procedure)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                58. QuestionnaireResponse.questionnaire
                Definition

                The Questionnaire that defines and organizes the questions for which answers are being provided.

                ShortForm being answered
                Comments

                If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).

                Control1..1
                Typecanonical(Adaptive Questionnaire)contained
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

                Alternate NamesForm
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                60. QuestionnaireResponse.status
                Definition

                The position of the questionnaire response within its overall lifecycle.

                Shortin-progress | completed | amended | entered-in-error | stopped
                Comments

                This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

                Control1..1
                BindingThe codes SHALL be taken from QuestionnaireResponseStatus
                (required to http://hl7.org/fhir/ValueSet/questionnaire-answers-status|4.0.1)

                Lifecycle status of the questionnaire response.

                Typecode
                Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                62. QuestionnaireResponse.subject
                Definition

                The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.

                ShortThe subject of the questions
                Comments

                If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types. If subject is omitted - because the QuestionnaireResponse is not associated with a specific subject, ensure that QuestionnaireRsponse.identifier is present or the QuestionnaireResponse is referenced somewhere (e.g. Task.output, Composition.section.entry, etc.) to allow tracking and retrieval of the QuestionnaireResponse

                Control0..1
                TypeReference(Resource)
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Allows linking the answers to the individual the answers describe. May also affect access control.

                Alternate NamesPatient, Focus
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                64. QuestionnaireResponse.encounter
                Definition

                The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.

                ShortEncounter created as part of
                Comments

                This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

                Control0..1
                TypeReference(Encounter)
                Is Modifierfalse
                Summarytrue
                Requirements

                Provides context for the information that was captured. May also affect access control.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                66. QuestionnaireResponse.authored
                Definition

                Identifies when this version of the answer set was created. Changes whenever the answers are updated.

                ShortDate the answers were gathered
                Comments

                May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured.

                This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.

                Control1..1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Requirements

                Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.

                Alternate NamesDate Created, Date published, Date Issued, Date updated
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. QuestionnaireResponse.author
                Definition

                Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.

                ShortPerson who received and recorded the answers
                Comments

                Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.

                Control0..1
                TypeReference(Device, Practitioner, PractitionerRole, Patient, RelatedPerson, Organization)
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Requirements

                Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

                Alternate NamesLaboratory, Service, Practitioner, Department, Company, Performer
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. QuestionnaireResponse.source
                Definition

                The person who answered the questions about the subject.

                ShortThe person who answered the questions
                Comments

                If not specified, no inference can be made about who provided the data.

                Control0..1
                TypeReference(Patient, Practitioner, PractitionerRole, RelatedPerson)
                Is Modifierfalse
                Summarytrue
                Requirements

                When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                72. QuestionnaireResponse.item
                Definition

                A group or question item from the original questionnaire for which answers are provided.

                ShortGroups and questions
                Comments

                Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                qrs-1: Nested item can't be beneath both item and answer ((answer.exists() and item.exists()).not())
                qrs-2: Repeated answers are combined in the answers array of a single item (repeat(answer|item).select(item.where(answer.value.exists()).linkId.isDistinct()).allTrue())
                74. QuestionnaireResponse.item.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                76. QuestionnaireResponse.item.extension
                Definition

                An Extension

                ShortExtension
                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                SlicingThis element introduces a set of slices on QuestionnaireResponse.item.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 78. QuestionnaireResponse.item.extension:itemMedia
                  Slice NameitemMedia
                  Definition

                  Media to render/make available as an accompaniment to the question being asked

                  ShortMedia to display
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  TypeExtension(Item Media) (Extension Type: Attachment)
                  Is Modifierfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  80. QuestionnaireResponse.item.extension:ItemSignature
                  Slice NameItemSignature
                  Definition

                  Represents a wet or electronic signature for either the form overall or for the question or item it's associated with.

                  ShortA signature attesting to the content
                  Control0..*
                  TypeExtension(QuestionnaireResponse Signature) (Extension Type: Signature)
                  Is Modifierfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  82. QuestionnaireResponse.item.modifierExtension
                  Definition

                  May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                  Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                  ShortExtensions that cannot be ignored even if unrecognized
                  Comments

                  There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                  Control0..*
                  TypeExtension
                  Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                  Summarytrue
                  Requirements

                  Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                  Alternate Namesextensions, user content, modifiers
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  84. QuestionnaireResponse.item.linkId
                  Definition

                  The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.

                  ShortPointer to specific item from Questionnaire
                  Control1..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  86. QuestionnaireResponse.item.definition
                  Definition

                  A reference to an ElementDefinition that provides the details for the item.

                  ShortElementDefinition - details for the item
                  Comments

                  The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].

                  There is no need for this element if the item pointed to by the linkId has a definition listed.

                  Control0..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Requirements

                  A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  88. QuestionnaireResponse.item.text
                  Definition

                  Text that is displayed above the contents of the group or as the text of the question being answered.

                  ShortName for group or question text
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Summaryfalse
                  Requirements

                  Allows the questionnaire response to be read without access to the questionnaire.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  90. QuestionnaireResponse.item.answer
                  Definition

                  The respondent's answer(s) to the question.

                  ShortThe response(s) to the question
                  Comments

                  The value is nested because we cannot have a repeating structure that has variable type.

                  Control0..*
                  TypeBackboneElement
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  92. QuestionnaireResponse.item.answer.id
                  Definition

                  Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                  ShortUnique id for inter-element referencing
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  94. QuestionnaireResponse.item.answer.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on QuestionnaireResponse.item.answer.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 96. QuestionnaireResponse.item.answer.extension:itemAnswerMedia
                    Slice NameitemAnswerMedia
                    Definition

                    Media to render/make available as an accompaniment to a specific answer option

                    ShortAnswer Media to display
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    TypeExtension(Item Answer Media) (Extension Type: Attachment)
                    Is Modifierfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    98. QuestionnaireResponse.item.answer.extension:itemWeight
                    Slice NameitemWeight
                    Definition

                    A numeric value that allows the comparison (less than, greater than) or other numerical manipulation of a concept (e.g. Adding up components of a score). Scores are usually a whole number, but occasionally decimals are encountered in scores. In the CodeSystem and ValueSet resources, the item weight is represented using the itemWeight property

                    ShortAssigned Ordinal Value
                    Comments

                    Inclusion of weights in QRs can increase performance when calculating based on weights.

                    Control0..1
                    TypeExtension(Item Weight) (Extension Type: decimal)
                    Is Modifierfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    100. QuestionnaireResponse.item.answer.modifierExtension
                    Definition

                    May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

                    There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                    Control0..*
                    TypeExtension
                    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                    Summarytrue
                    Requirements

                    Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                    Alternate Namesextensions, user content, modifiers
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    102. QuestionnaireResponse.item.answer.value[x]
                    Definition

                    The answer (or one of the answers) provided by the respondent to the question.

                    ShortSingle-valued answer to the question
                    Comments

                    More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.

                    Control0..1
                    BindingFor example codes, see QuestionnaireAnswerCodes
                    (example to http://hl7.org/fhir/ValueSet/questionnaire-answers)

                    Code indicating the response provided for a question.

                    TypeChoice of: boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference(Resource)
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Must Supporttrue
                    Must Support TypesNo must-support rules about the choice of types/profiles
                    Summaryfalse
                    Requirements

                    Ability to retain a single-valued answer to a question.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    104. QuestionnaireResponse.item.answer.item
                    Definition

                    Nested groups and/or questions found within this particular answer.

                    ShortNested groups and questions
                    Control0..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    106. QuestionnaireResponse.item.item
                    Definition

                    Questions or sub-groups nested beneath a question or group.

                    ShortNested questionnaire response items
                    Control0..*
                    TypeSeettp://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    Reports can consist of complex nested groups.

                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))