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.

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.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

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. Usually modifier elements provide negation or qualification. In order 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.

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.

The position of the questionnaire response within its overall lifecycle.

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

Lifecycle status of the questionnaire response.

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

R5: QuestionnaireResponse.basedOn additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.basedOn is mapped to FHIR STU3 element QuestionnaireResponse.basedOn as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.basedOn do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.basedOn with unmapped reference targets: CarePlan, ServiceRequest.

R5: QuestionnaireResponse.partOf additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.partOf is mapped to FHIR STU3 element QuestionnaireResponse.parent as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.partOf do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.partOf with unmapped reference targets: Observation, Procedure. Not to be used to link an questionnaire response to an Encounter - use 'context' for that.

Composition of questionnaire responses will be handled using the Assemble operation defined in the SDC IG. For relationships to referrals, and other types of requests, use basedOn.

R5: QuestionnaireResponse.questionnaire additional types (canonical(http://hl7.org/fhir/StructureDefinition/Questionnaire)) additional types from child elements (value)

Element QuestionnaireResponse.questionnaire is mapped to FHIR STU3 element QuestionnaireResponse.questionnaire as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.questionnaire do not cover the following types: canonical. The mappings for QuestionnaireResponse.questionnaire do not cover the following types based on type expansion: value. If a QuestionnaireResponse references a Questionnaire that can be resolved, 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.). It is possible to have a QuestionnaireResponse whose 'questionnaire' element does not resolve. It is also possible for the questionnaire element to not have a value but only extensions (e.g. conveying the title or identifier for the questionnaire). This may happen for legacy data. If there is no formally defined Questionnaire, it is undefined what the 'correct' values for the linkId elements should be and it is possible that linkIds might be inconsistent for QuestionnaireResponses for the same form if captured by distinct systems.

R5: QuestionnaireResponse.subject additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.subject is mapped to FHIR STU3 element QuestionnaireResponse.subject as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.subject do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.subject with unmapped reference targets: Resource. If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.

R5: QuestionnaireResponse.encounter additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.encounter is mapped to FHIR STU3 element QuestionnaireResponse.context as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.encounter do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.encounter with unmapped reference targets: Encounter. This will typically be the encounter the questionnaire response was created during, but some questionnaire responses may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission forms). A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

R5: QuestionnaireResponse.author

Element QuestionnaireResponse.author is mapped to FHIR STU3 element QuestionnaireResponse.author as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.author with unmapped reference targets: Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson. 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. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.

R5: QuestionnaireResponse.source

Element QuestionnaireResponse.source is mapped to FHIR STU3 element QuestionnaireResponse.source as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.source with unmapped reference targets: Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson. If not specified, no inference can be made about who provided the data. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.

R5: QuestionnaireResponse.item.answer.value[x]

Element QuestionnaireResponse.item.answer.value[x] is mapped to FHIR STU3 element QuestionnaireResponse.item.answer.value[x] as RelatedTo. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.item.answer.value[x] with unmapped reference targets: Resource. Source element QuestionnaireResponse.item.answer.value[x] has unmapped reference types. While the target element QuestionnaireResponse.item.answer.value[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. 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. Note that a question is answered using one of the possible choices defined with answerOption, answerValueSet or some other means and the answer has a complex data type, all elements within the answer in the QuestionnaireResponse SHOULD match the elements defined corresponding choice value in the Questionnaire. However, it is possible that not all elements will be propagated. Also, some systems might use language translations resulting in different displays. Comparison of value to the values defined in the Questionnaire (whether by answerOption, answerValueSet or answerExpression) SHALL NOT pay attention to Coding.display, Reference.display, Quantity.unit unless those are the only elements present. As well, systems are not required to check for a match on any extensions (e.g. ordinal values, translations, etc.). Systems MAY enforce that if extensions such as ordinal values are present in both Questionnaire and QuestionnaireResponse, they match.

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.

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.

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

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

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

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.

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.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

The base language in which the resource is written.

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).

Unless not suitable, these codes SHALL be taken from Common Languages
(extensible to http://hl7.org/fhir/ValueSet/languages|3.0.2)

A human language.

A human-readable narrative that contains a summary of the resource, and may 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.

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 in formation is added later.

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.

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.

May be used to represent additional information that is not part of the basic definition of the resource. In order 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.

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.

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. Usually modifier elements provide negation or qualification. In order 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.

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.

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

Used for tracking, registration and other business purposes.

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

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

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

An Extension

R5: QuestionnaireResponse.basedOn additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.basedOn is mapped to FHIR STU3 element QuestionnaireResponse.basedOn as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.basedOn do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.basedOn with unmapped reference targets: CarePlan, ServiceRequest.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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.

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.

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

An Extension

R5: QuestionnaireResponse.partOf additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.partOf is mapped to FHIR STU3 element QuestionnaireResponse.parent as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.partOf do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.partOf with unmapped reference targets: Observation, Procedure. Not to be used to link an questionnaire response to an Encounter - use 'context' for that.

Composition of questionnaire responses will be handled using the Assemble operation defined in the SDC IG. For relationships to referrals, and other types of requests, use basedOn.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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

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.).

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

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

An Extension

R5: QuestionnaireResponse.questionnaire additional types (canonical(http://hl7.org/fhir/StructureDefinition/Questionnaire)) additional types from child elements (value)

Element QuestionnaireResponse.questionnaire is mapped to FHIR STU3 element QuestionnaireResponse.questionnaire as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.questionnaire do not cover the following types: canonical. The mappings for QuestionnaireResponse.questionnaire do not cover the following types based on type expansion: value. If a QuestionnaireResponse references a Questionnaire that can be resolved, 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.). It is possible to have a QuestionnaireResponse whose 'questionnaire' element does not resolve. It is also possible for the questionnaire element to not have a value but only extensions (e.g. conveying the title or identifier for the questionnaire). This may happen for legacy data. If there is no formally defined Questionnaire, it is undefined what the 'correct' values for the linkId elements should be and it is possible that linkIds might be inconsistent for QuestionnaireResponses for the same form if captured by distinct systems.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The position of the questionnaire response within its overall lifecycle.

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

Lifecycle status of the questionnaire response.

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

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.

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

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

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

An Extension

R5: QuestionnaireResponse.subject additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.subject is mapped to FHIR STU3 element QuestionnaireResponse.subject as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.subject do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.subject with unmapped reference targets: Resource. If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The encounter or episode of care with primary association to the questionnaire response.

A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

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

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

An Extension

R5: QuestionnaireResponse.encounter additional types from child elements (display, identifier, reference, type)

Element QuestionnaireResponse.encounter is mapped to FHIR STU3 element QuestionnaireResponse.context as SourceIsBroaderThanTarget. The mappings for QuestionnaireResponse.encounter do not cover the following types based on type expansion: display, identifier, reference, type. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.encounter with unmapped reference targets: Encounter. This will typically be the encounter the questionnaire response was created during, but some questionnaire responses may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission forms). A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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

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 may not know the value, however it SHOULD be populated if possible.

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

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

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.

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

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

An Extension

R5: QuestionnaireResponse.author

Element QuestionnaireResponse.author is mapped to FHIR STU3 element QuestionnaireResponse.author as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.author with unmapped reference targets: Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson. 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. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The person who answered the questions about the subject.

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

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

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

An Extension

R5: QuestionnaireResponse.source

Element QuestionnaireResponse.source is mapped to FHIR STU3 element QuestionnaireResponse.source as SourceIsBroaderThanTarget. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.source with unmapped reference targets: Device, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson. If not specified, no inference can be made about who provided the data. Device should only be used if it directly determined the answers, not if it was merely used as a capture tool to record answers provided by others. In the latter case, information about the physical device, software, etc. would be captured using Provenance.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

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

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).

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

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

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

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

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

The ElementDefinition must be in a StructureDefinition or a DataElement, 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.

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.

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

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

More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.

Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.

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

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

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

May be used to represent additional information that is not part of the basic definition of the element. In order 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.

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.

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 that contains it. Usually modifier elements provide negation or qualification. In order 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.

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.

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

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.

Code indicating the response provided for a question.

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

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

An Extension

R5: QuestionnaireResponse.item.answer.value[x]

Element QuestionnaireResponse.item.answer.value[x] is mapped to FHIR STU3 element QuestionnaireResponse.item.answer.value[x] as RelatedTo. The standard extension alternate-reference has been mapped as the representation of FHIR R5 element QuestionnaireResponse.item.answer.value[x] with unmapped reference targets: Resource. Source element QuestionnaireResponse.item.answer.value[x] has unmapped reference types. While the target element QuestionnaireResponse.item.answer.value[x] is a choice type and does not allow extensions, the alternate-reference extension can be applied to Reference values within it. 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. Note that a question is answered using one of the possible choices defined with answerOption, answerValueSet or some other means and the answer has a complex data type, all elements within the answer in the QuestionnaireResponse SHOULD match the elements defined corresponding choice value in the Questionnaire. However, it is possible that not all elements will be propagated. Also, some systems might use language translations resulting in different displays. Comparison of value to the values defined in the Questionnaire (whether by answerOption, answerValueSet or answerExpression) SHALL NOT pay attention to Coding.display, Reference.display, Quantity.unit unless those are the only elements present. As well, systems are not required to check for a match on any extensions (e.g. ordinal values, translations, etc.). Systems MAY enforce that if extensions such as ordinal values are present in both Questionnaire and QuestionnaireResponse, they match.

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

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

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

Reports can consist of complex nested groups.