Questionnaire-example.xml

General questionnaire example (id = "3141")

Raw XML

<Questionnaire xmlns="http://hl7.org/fhir">
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <pre>
            Comorbidity? YES
              Cardial Comorbidity? YES
                Angina? YES
                MI? NO
              Vascular Comorbidity?
                (no answers)
              ...
            Histopathology
              Abdominal
                pT category: 1a
              ...
          </pre>
    </div>
  </text>
  <contained>
    <Patient id="patsub">
      <identifier>
        <system value="http://cancer.questionnaire.org/systems/id/patientnr"/>
        <value value="A34442332"/>
      </identifier>
      <identifier>
        <label value="Dutch BSN"/>
        <system value="urn:oid:2.16.840.1.113883.2.4.6.3"/>
        <value value="188912345"/>
      </identifier>
      <gender>
        <coding>
          <system value="http://hl7.org/fhir/v3/AdministrativeGender"/>
          <code value="M"/>
        </coding>
      </gender>
      <birthDate value="1972-11-30"/>

    </Patient>
  </contained>
  <contained>
    <Practitioner id="questauth">
      <identifier>
        <label value="AUMC, Den Helder"/>
        <system value="http://cancer.questionnaire.org/systems/id/org"/>
        <value value="AUMC"/>
      </identifier>
    </Practitioner>
  </contained>
  <contained>
    <Observation id="obs.pt-category">
      <name>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="53786006"/>
          <display value="pT1 category"/>
        </coding>
      </name>
      <valueCodeableConcept>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="443357004"/>
          <display value="pT1a category"/>
        </coding>
      </valueCodeableConcept>
      <status value="final"/>
      <reliability value="unknown"/>
    </Observation>
  </contained>
  <status value="completed"/>
  <authored value="2013-02-19T14:15:00"/>
  <subject>
    <reference value="#patsub"/>
  </subject>
  <author>
    <reference value="#questauth"/>
  </author>
  <name>
    <text value="Cancer Quality Forum Questionnaire 2012"/>
  </name>
  <group>
    <group>
      <!--   COMORBIDITY   -->
      <!--   First main section of the form, questions about comorbidity   -->
      <name>
        <coding>
          <system value="http://cancer.questionnaire.org/system/code/sections"/>
          <code value="COMORBIDITY"/>
        </coding>
      </name>
      <!--   section contains one question: whether there is comorbidity   -->
      <question>
        <name>
          <coding>
            <system value="http://cancer.questionnaire.org/system/code/questions"/>
            <code value="COMORB"/>
          </coding>
        </name>
        <choice>
          <system value="http://cancer.questionnaire.org/system/code/yesno"/>
          <code value="1"/>
          <display value="Yes"/>
        </choice>
        <group>
          <!--   COMORBIDITY/CARDIAL   -->
          <!--   Subsection about specific comorbidity: cardial   -->
          <name>
            <coding>
              <system value="http://cancer.questionnaire.org/system/code/sections"/>
              <code value="CARDIAL"/>
            </coding>
          </name>
          <question>
            <name>
              <coding>
                <system value="http://cancer.questionnaire.org/system/code/questions"/>
                <code value="COMORBCAR"/>
              </coding>
            </name>
            <choice>
              <system value="http://cancer.questionnaire.org/system/code/yesno"/>
              <code value="1"/>
            </choice>
          </question>
          <question>
            <!--   This answer carries both the questionnaire-specific name and an equivalent SNOMED CT
             code   -->
            <name>
              <coding>
                <system value="http://cancer.questionnaire.org/system/code/questions"/>
                <code value="COMCAR00"/>
                <display value="Angina Pectoris"/>
              </coding>
              <coding>
                <system value="http://snomed.info/sct"/>
                <code value="194828000"/>
                <display value="Angina (disorder)"/>
              </coding>
            </name>
            <choice>
              <system value="http://cancer.questionnaire.org/system/code/yesno"/>
              <code value="1"/>
            </choice>
          </question>
          <question>
            <name>
              <coding>
                <system value="http://snomed.info/sct"/>
                <code value="22298006"/>
                <display value="Myocardial infarction (disorder)"/>
              </coding>
            </name>
            <choice>
              <system value="http://cancer.questionnaire.org/system/code/yesno"/>
              <code value="0"/>
            </choice>
          </question>
        </group>
        <group>
          <!--   COMORBIDITY/VASCULAR   -->
          <name>
            <coding>
              <system value="http://cancer.questionnaire.org/system/code/sections"/>
              <code value="VASCULAR"/>
            </coding>
          </name>
        </group>
      </question>
    </group>
    <group>
      <!--   HISTOPATHOLOGY   -->
      <name>
        <coding>
          <system value="http://cancer.questionnaire.org/system/code/sections"/>
          <code value="HISTOPATHOLOGY"/>
        </coding>
      </name>
      <group>
        <name>
          <coding>
            <system value="http://cancer.questionnaire.org/system/code/sections"/>
            <code value="ABDOMINAL"/>
          </coding>
        </name>
        <question>
          <name>
            <coding>
              <system value="http://cancer.questionnaire.org/system/code/questions"/>
              <code value="STADPT"/>
              <display value="pT category"/>
            </coding>
          </name>
          <dataResource>
            <reference value="#obs.pt-category"/>
          </dataResource>
        </question>
      </group>
    </group>
  </group>
</Questionnaire>