Generated Narrative: StructureDefinition sdc-questionnaire-extr-smap Name Flags Card. Type Description & Constraints Questionnaire 0..* SDCBaseQuestionnaire Extractable Questionnaire - StructureMap #xD; Slices for extension Content/Rules for all slices #xD; extension:targetStructureMap S 0..* canonical(StructureMap) Map to artifacts that can be populated from this Questionnaire URL: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap #xD; item #xD; Slices for extension Content/Rules for all slices #xD; extension:unit S 0..1 Coding Unit for numeric answer URL: http://hl7.org/fhir/StructureDefinition/questionnaire-unit #xD; extension:itemHidden 0..1 boolean Don't display to user URL: http://hl7.org/fhir/StructureDefinition/questionnaire-hidden #xD; Documentation for this format
Extractable Questionnaire - StructureMap
Defines elements that allow conversion of a QuestionnaireResponse to a FHIR resource or Bundle of FHIR resources using the StructureMap-based extraction mechanism
Defines elements that allow conversion of a QuestionnaireResponse to a FHIR resource or Bundle of FHIR resources using the StructureMap-based extraction mechanism.
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Name should be usable as an identifier for the module by machine processing applications such as code generation
not(exists(f:name/@value)) or matches(f:name/@value, '[A-Z]([A-Za-z0-9_]){0,254}')
The link ids for groups and questions must be unique within the questionnaire
name.exists() implies name.matches('^[A-Z]([A-Za-z0-9_]){1,254}$')
not(f:name) or matches(f:name/@value, '^[A-Z]([A-Za-z0-9_]){1,254}$')
If version is present, versionAlgorithm must be present.
version.exists() implies extension.where(url='http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm').exists()
not(exists(f:version)) or exists(f:extension[@url='http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm'])
Semver is the preferred version algorithm - package machinery doesn't work well with artifacts using alternate versioning schemes
extension.where(url='http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm').all(value.ofType(Coding).where(system='http://hl7.org/fhir/version-algorithm' and code='semver').exists())
not(f:extension[@url='http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm' and not(exists(f:valueCoding[f:system/@value='http://hl7.org/fhir/version-algorithm' and f:code/@value='semver'])))
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 might not always be associated with version changes to the resource.
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
A set of rules under which this content was created
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.
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.
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
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).
Text summary of the resource, for human interpretation
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.
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.
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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
Indicates the terminology server(s) that are known to be capable of returning and potentially expanding the value set(s) associated with the resource or a particular portion of the resource (depending on where the extension appears). If a full URL is not provided AND the requested query is a terminology operation (e.g. $lookup or $expand) the client SHOULD execute the operation against (one of) the preferredTerminologyServer(s) rather than the local repository. Systems SHOULD evaluate value sets using terminology servers as follows: First, try any terminology servers declared on the element in question. If there are more then one, try them in the order they appear. Then try any servers that appear on ancestor elements in order of closest ancestor up to any on the resource root If there are no declared servers or none of the ones listed provide a useful response, the form filler may then try any of the typical servers it would normally use. A 'useful response' means a response that provides a valid (though potentially empty) expansion. Clients MAY wish to log/report errors returned by terminology servers.
exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])
Indicates the mechanism used to compare versions to determine which is more current.
If set as a string, this is a FHIRPath expression that has two additional context variables passed in - %version1 and %version2 and will return a negative number if version1 is newer, a positive number if version2 and a 0 if the version ordering can't be successfully be determined.
A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are resctricted. (e.g. 'All rights reserved', 'Some rights reserved').
Defines the content expected to be rendered in all representations of the artifact. The (c) symbol should NOT be included in this string. It is expected to be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.
Information captured by the author/maintainer of the questionnaire for development purposes, not intended to be seen by users.
Allows capture of todos, rationale for design decisions, etc. It can also be used to capture comments about the completion of the form in general. Allows commentary to be captured during the process of answering a questionnaire (if not already supported by the form design) as well as after the form is completed. Comments are not part of the "data" of the form. If a form prompts for a comment, this should be captured in an answer, not in this element. Formal assessments of the QuestionnaireResponse would use [Observation].
Resource that can record answers to this Questionnaire
Indicates the types of resources that can record answers to a Questionnaire. Open Issue: Should this extension be moved to core?
If present, indicates that this questionnaire has expectations with respect to assembly. Specifically, indicates whether this form requires assembly (i.e. it can't be used directly without invoking the [$assemble](OperationDefinition-Questionnaire-assemble.html) operation operation on it) and/or whether it is intended for use only as a 'child' in an assembly process. The assembly processs might mean filling in item metadata based on information looked up from item.definitions and/or retrieving sub-questionnaires pointed to by [sub-questionnaire](StructureDefinition-sdc-questionnaire-subQuestionnaire.html) extensions.
SDC-conformant Questionnaires **SHALL** declare this extension if they require an assembly process prior to use. If not declared, then the Questionnaire is not necessarily safe for use as a child form and does not require assembly prior to use.
Map to artifacts that can be populated from this Questionnaire
StructureMaps that have QuestionnaireResponses of this Questionnaire as 'source'- i.e. that can be used to create other artifacts from QuestionnaireResponses that are valid against this Questionnaire.
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).
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.
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Canonical identifier for this questionnaire, represented as a URI (globally unique)
An absolute URI that is used to identify this questionnaire when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this questionnaire is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the questionnaire is stored on different servers.
The name of the referenced questionnaire can be conveyed using the http://hl7.org/fhir/StructureDefinition/display extension.
… This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.
Warning Questionnaire.url URL should not contain | or # - these characters make processing canonical references problematic
not(@value) or matches(@value, '^[^|# ]+$')
Additional identifier for the questionnaire
A formal identifier that is used to identify this questionnaire when it is represented in other formats, or referenced in a specification, model, design or an instance.
Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this questionnaire outside of FHIR, where it is not possible to use the logical URI.
Allows externally provided and/or usable business identifiers to be easily associated with the module.
The identifier that is used to identify this version of the questionnaire when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the questionnaire author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.
There may be different questionnaire instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the questionnaire with the format [url]|[version].
Name for this questionnaire (computer friendly)
A natural language name identifying the questionnaire. This name should be usable as an identifier for the module by machine processing applications such as code generation.
The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.
Support human navigation and code generation.
Name for this questionnaire (human friendly)
A short, descriptive, user-friendly title for the questionnaire.
This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.
The URL of a Questionnaire that this Questionnaire is based on.
Allows a Questionnaire to be created based on another Questionnaire.
.outboundRelationship[typeCode=DRIV].target[classCode=OBS, moodCode=DEFN]
The status of this questionnaire. Enables tracking the life-cycle of the content.
Allows filtering of questionnaires that are appropriate for use versus not.
This is labeled as "Is Modifier" because applications should not use a retired {{title}} without due consideration
A Boolean value to indicate that this questionnaire is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.
Enables experimental content to be developed following the same lifecycle that would be used for a production-level questionnaire.
Resource that can be subject of QuestionnaireResponse
The types of subjects that can be the subject of responses created for the questionnaire.
If none are specified, then the subject is unlimited.
A Questionnaire SHOULD specify the subject. However, it is optional to support legacy questionnaires.
One of the resource types defined as part of this version of FHIR.
.outboundRelationship[typeCode=META].target[classCode=OBS, moodCode=DEFN, isCriterion=true].participation.role.classCode
unique id for the element within a resource (for internal references)
R5: `Questionnaire.subjectType` additional codes
Element `Questionnaire.subjectType` is mapped to FHIR R4 element `Questionnaire.subjectType` as `RelatedTo`. The mappings for `Questionnaire.subjectType` do not allow expression of the necessary codes, per the bindings on the source and target. If none are specified, then the subject is unlimited.
The date (and optionally time) when the questionnaire was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the questionnaire changes.
Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the questionnaire. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.
Name of the publisher (organization or individual)
The name of the organization or individual that published the questionnaire.
Usually an organization but may be an individual. The publisher (or steward) of the questionnaire is the organization or individual primarily responsible for the maintenance and upkeep of the questionnaire. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the questionnaire. This item SHOULD be populated unless the information is available from context.
Helps establish the "authority/credibility" of the questionnaire. May also allow for contact.
Contact details to assist a user in finding and communicating with the publisher.
May be a web site, an email address, a telephone number, etc.
Natural language description of the questionnaire
A free text natural language description of the questionnaire from a consumer's perspective.
This description can be used to capture details such as why the questionnaire was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the questionnaire as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the questionnaire is presumed to be the predominant language in the place the questionnaire was created).
The context that the content is intended to support
The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate questionnaire instances.
When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.
Assist in searching for appropriate content.
Intended jurisdiction for questionnaire (if applicable)
A legal or geographic region in which the questionnaire is intended to be used.
It may be possible for the questionnaire to be used in jurisdictions other than those for which it was originally designed or intended.
Countries and regions within which this artifact is targeted for use.
Explanation of why this questionnaire is needed and why it has been designed as it has.
This element does not describe the usage of the questionnaire. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this questionnaire.
A copyright statement relating to the questionnaire and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the questionnaire.
Consumers must be able to determine any legal restrictions on the use of the questionnaire and/or its content.
When the questionnaire was approved by publisher
The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.
The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.
When the questionnaire was last reviewed
The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.
If specified, this date follows the original approval date.
Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.
.outboundRelationship[typeCode="SUBJ"; subsetCode="RECENT"].act[classCode=CACT;moodCode=EVN;code="review"].effectiveTime
When the questionnaire is expected to be used
The period during which the questionnaire content was or is planned to be in active use.
The effective period for a questionnaire determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.
Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the questionnaire are or are expected to be used instead.
Concept that represents the overall questionnaire
An identifier for this question or group of questions in a particular terminology such as LOINC.
Allows linking of the complete Questionnaire resources to formal terminologies. It's common for "panels" of questions to be identified by a code.
Codes for questionnaires, groups and individual questions.
Questions and sections within the Questionnaire
A particular question, question grouping or display text that is part of the questionnaire.
The content of the questionnaire is constructed from an ordered, hierarchical collection of items.
Group items must have nested items, display items cannot have nested items
(type='group' implies item.empty().not()) and (type.trace('type')='display' implies item.trace('item').empty())
not((f:type/@value='group' and not(f:item)) or (f:type/@value='display' and f:item))
Display items cannot have a "code" asserted
A question cannot have both answerOption and answerValueSet
answerOption.empty() or answerValueSet.empty()
not(f:answerValueSet and f:answerOption)
Only 'choice' and 'open-choice' items can have answerValueSet
(type ='choice' or type = 'open-choice' or type = 'decimal' or type = 'integer' or type = 'date' or type = 'dateTime' or type = 'time' or type = 'string' or type = 'quantity') or (answerValueSet.empty() and answerOption.empty())
f:type/@value=('choice','open-choice','decimal','integer','date','dateTime','time','string','quantity',') or not(f:answerOption or f:answerValueSet)
Required and repeat aren't permitted for display items
type!='display' or (required.empty() and repeats.empty())
not(f:type/@value='display' and (f:required or f:repeats))
Initial values can't be specified for groups or display items
(type!='group' and type!='display') or initial.empty()
not(f:type/@value=('group', 'display') and f:*[starts-with(local-name(.), 'initial')])
Read-only can't be specified for "display" items
Maximum length can only be declared for simple question types
(type in ('boolean' | 'decimal' | 'integer' | 'string' | 'text' | 'url' | 'open-choice')) or maxLength.empty()
f:type/@value=('boolean', 'decimal', 'integer', 'open-choice', 'string', 'text', 'url') or not(f:maxLength)
If one or more answerOption is present, initial[x] must be missing
not(f:answerOption) or not(count(f:*[starts-with(local-name(.), 'initial')]))
If there are more than one enableWhen, enableBehavior must be specified
enableWhen.count() > 2 implies enableBehavior.exists()
Can only have multiple initial values for repeating items
f:repeats/@value='true' or count(f:initial)<=1
An item cannot have an answerExpression if answerOption or answerValueSet is already present.
extension('http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression').empty().not() implies (answerOption.empty() and answerValueSet.empty())
f:extension[@url='http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression'] and (not(f:answerOption) and not(f:answerValueSet))
Group items must have nested items when Questionanire is complete
(type='group' and %resource.status='complete') implies item.empty().not()
not(f:type/@value='group' and ancestor::f:Questionnaire/f:status/@value='complete') or exists(f:item)
not(f:type/@value='display') or not(exists(f:item))
Can only have answerConstraint if answerOption, answerValueSet, or answerExpression are present. (This is a warning because other extensions may serve the same purpose)
extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.item.answerConstraint').exists() implies answerOption.exists() or answerValueSet.exists() or extension('http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression').exists()
not(exists(f:extension[@url='http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.item.answerConstraint'])) or exists(f:answerOption) or exists(f:answerValueSet) or exists(f:extension[@url='http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression'])
./form_design/*[self::header or self::footer or self::section]
.outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=DEF]
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
If true, indicates that the extended item should not be displayed to the user.
If an item is hidden, all descendant items are hidden as well. See additional guidance and examples in the [SDC implementation guide](http://hl7.org/fhir/uv/sdc/2025Jan/rendering.html#hidden).
R5: `Questionnaire.item.disabledDisplay` (new:code)
Element `Questionnaire.item.disabledDisplay` has a context of Questionnaire.item based on following the parent source element upwards and mapping to `Questionnaire`. Element `Questionnaire.item.disabledDisplay` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element). If not specified, rendering behavior is up to the client. This element is only meaningful if enableWhen or an equivalent extension is present
R5: optionsOnly | optionsOrType | optionsOrString (new)
R5: `Questionnaire.item.answerConstraint` (new:code)
Element `Questionnaire.item.answerConstraint` has a context of Questionnaire.item based on following the parent source element upwards and mapping to `Questionnaire`. Element `Questionnaire.item.answerConstraint` has no mapping targets in FHIR R4. Typically, this is because the element has been added (is a new element).
Allows capture of todos, rationale for design decisions, etc. It can also be used to capture comments about specific groups or questions within it. Allows commentary to be captured during the process of answering a questionnaire (if not already supported by the form design) as well as after the form is completed. Comments are not part of the "data" of the form. If a form prompts for a comment, this should be captured in an answer, not in this element. Formal assessments of the QuestionnaireResponse would use [Observation].
This extension is used when defining high-level questionnaires that will then be used as a basis for 'derived' Questionnaires that are further refined for use in specific organizations or contexts. If the extension is present and set to 'true', it means that this item should be considered to be 'optional' from an adaptation perspective and that the question can be removed (i.e. not displayed) in derived questionnaires without impacting the validity of the instrument. Alternatively, the element can be marked as 'hidden' and 'readOnly' and have a value or descendant item values declared using initialValue or initialExpression. If the element with 'optionalDisplay=true' is marked as 'required=true', then this second approach is the only means to exclude the element from display.
If a group or question that contains other groups or questions is marked as "optional", all of its contents are automatically also treated as optional.
Provides a computable unit of measure associated with numeric questions to support subsequent computation on responses. This is for use on items of type integer and decimal, and it's purpose is to support converting the integer or decimal answer into a Quantity when extracting the data into a resource.
The human-readable unit is conveyed as a display element. This element is for computation purposes.
Extensions that cannot be ignored even if unrecognized
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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
An identifier that is unique within the Questionnaire allowing linkage to the equivalent item in a QuestionnaireResponse resource.
This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.
[QuestionnaireResponse](http://hl7.org/fhir/R4/questionnaireresponse.html#) does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.
ElementDefinition - details for the item
This element is a URI that refers to an [ElementDefinition](http://hl7.org/fhir/R4/elementdefinition.html) that provides information about this item, including information that might otherwise be included in the instance of the Questionnaire resource. A detailed description of the construction of the URI is shown in Comments, below. If this element is present then the following element values MAY be derived from the Element Definition if the corresponding elements of this Questionnaire resource instance have no value: * code (ElementDefinition.code) * type (ElementDefinition.type) * required (ElementDefinition.min) * repeats (ElementDefinition.max) * maxLength (ElementDefinition.maxLength) * answerValueSet (ElementDefinition.binding) * options (ElementDefinition.binding).
The uri refers to an ElementDefinition in a [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) and always starts with the [canonical URL](http://hl7.org/fhir/R4/references.html#canonical) for the target resource. When referring to a StructureDefinition, a fragment identifier is used to specify the element definition by its id [Element.id](http://hl7.org/fhir/R4/element-definitions.html#Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. In the absence of a fragment identifier, the first/root element definition in the target is the matching element definition.
A common pattern is to define a set of data elements and then build multiple questionnaires for different circumstances to gather the data. This element provides traceability to the common definition and allows the content for the question to come from the underlying definition.
.outboundRelationship[typeCode=INST].target[classCode=OBS, moodCode=DEF]
Corresponding concept for this item in a terminology
A terminology code that corresponds to this group or question (e.g. a code from LOINC, which defines many questions and answers).
The value may come from the ElementDefinition referred to by .definition.
Allows linking of groups of questions to formal terminologies.
A short label for a particular group, question or set of display text within the questionnaire used for reference by the individual completing the questionnaire.
These are generally unique within a questionnaire, though this is not guaranteed. Some questionnaires may have multiple questions with the same label with logic to control which gets exposed. Typically, these won't be used for "display" items, though such use is not prohibited. Systems SHOULD NOT generate their own prefixes if prefixes are defined for any items within a Questionnaire.
Separating the label from the question text allows improved rendering. Also, instructions will often refer to specific prefixes, so there's a need for the questionnaire design to have control over what labels are used.
The name of a section, the text of a question or text content for a display item.
When using this element to represent the name of a section, use group type item and also make sure to limit the text element to a short string suitable for display as a section heading. Group item instructions should be included as a display type item within the group. This is optional only to support form assembly situations where the text may be generated from another source. In an assembled Questionnaire, it should always be present.
Form Design/designation[context="primary?"/definition/ ./section_instruction/label
group | display | boolean | decimal | integer | date | dateTime +
The type of questionnaire item this is - whether text for display, a grouping of other items or a particular type of data to be captured (string, integer, coded choice, etc.).
Time is handled using "string". File is handled using Attachment. (Content can be sent as a contained binary).
Defines the format in which the user is to be prompted for the answer.
Distinguishes groups from questions and display text and indicates data type for questions.
A constraint indicating that this item should only be enabled (displayed/allow answers to be captured) when the specified condition is true.
If multiple repetitions of this extension are present, the item should be enabled when the condition for *any* of the repetitions is true. I.e. treat "enableWhen"s as being joined by an "or" clause. This element is a modifier because if enableWhen is present for an item, "required" is ignored unless one of the enableWhen conditions is met. When an item is disabled, all of its descendants are disabled, regardless of what their own enableWhen logic might evaluate to.
Allows questionnaires to adapt based on answers to other questions. E.g. If physical gender is specified as a male, no need to capture pregnancy history. Also allows conditional display of instructions or groups of questions.
If the operator is 'exists', the value must be a boolean
operator = 'exists' implies (answer is Boolean)
f:operator/@value != 'exists' or exists(f:answerBoolean)
If enableWhen is present and the condition evaluates to false, then the Questionnaire behaves as though the elements weren't actually present
Additional content defined by implementations
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.
Question that determines whether item is enabled
The linkId for the question whose answer (or lack of answer) governs whether this item is enabled.
If multiple question occurrences are present for the same question (same linkId), then this refers to the nearest question occurrence reachable by tracing first the "ancestor" axis and then the "preceding" axis and then the "following" axis.
Specifies the criteria by which the question is enabled.
The criteria by which a question is enabled.
Value for question comparison based on operator
A value that the referenced question is tested using the specified operator in order for the item to be enabled.
Controls how multiple enableWhen values are interpreted - whether all or any must be true.
This element must be specified if more than one enableWhen value is provided.
Whether the item must be included in data results
An indication, if true, that the item must be present in a "completed" QuestionnaireResponse. If false, the item may be skipped when answering the questionnaire.
Questionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. If an item that contains other items is marked as required, that does not automatically make the contained elements required (though required groups must contain at least one child element). The value may come from the ElementDefinition referred to by .definition.
Items are generally assumed not to be required unless explicitly specified. Systems SHOULD always populate this value
An indication, if true, that a QuestionnaireResponse for this item may include multiple answers associated with a single instance of this item (for question-type items) or multiple repetitions of the item (for group-type items)
If a question is marked as repeats=true, then multiple answers can be provided for the question in the corresponding QuestionnaireResponse. When rendering the questionnaire, it is up to the rendering software whether to render the question text for each answer repetition (i.e. "repeat the question") or to simply allow entry/selection of multiple answers for the question (repeat the answers). Which is most appropriate visually may depend on the type of answer as well as whether there are nested items. The resulting QuestionnaireResponse will be populated the same way regardless of rendering - one 'question' item with multiple answer values. The value may come from the ElementDefinition referred to by .definition.
Items may be used to create set of (related) questions that can be repeated to give multiple answers to such a set.
Items are generally assumed not to repeat unless explicitly specified. Systems SHOULD always populate this value
An indication, when true, that the value cannot be changed by a human respondent to the Questionnaire.
The value of readOnly elements can be established by asserting extensions for defaultValues, linkages that support pre-population and/or extensions that support calculation based on other answers.
Allows certain information to be phrased (and rendered) as a question and an answer, while keeping users from changing it. May also be useful for preventing changes to pre-populated portions of a questionnaire, for calculated values, etc.
./*_Field/default_value_read_only ./default_element/read_only
The maximum number of characters that are permitted in the answer to be considered a "valid" QuestionnaireResponse.
For base64binary, reflects the number of characters representing the encoded data, not the number of bytes of the binary data. The value may come from the ElementDefinition referred to by .definition.
./*_Field/maximum_character_quantity | ./*_Field/datatype/string/maximum_characters
A reference to a value set containing a list of codes representing permitted answers for a "choice" or "open-choice" question.
LOINC defines many useful value sets for questionnaire responses. See [LOINC Answer Lists](http://hl7.org/fhir/R4/loinc.html#alist). The value may come from the ElementDefinition referred to by .definition.
One of the permitted answers for a "choice" or "open-choice" question.
This element can be used when the value set machinery of answerValueSet is deemed too cumbersome or when there's a need to capture possible answers that are not codes.
A potential answer that's allowed as the answer to this question.
The data type of the value must agree with the item.type.
AnswerOption.valueCoding must have at least one of code or display
Reference must have at least one of reference, display, and identifier
reference.exists() or display.exists() or identifier.exists()
Indicates whether the answer value is selected when the list of possible answers is initially shown.
Use this instead of initial[v] if answerValueSet is present.
Only selected items explicitly marked to be selected
Initial value(s) when item is first rendered
One or more values that should be pre-populated in the answer when initially rendering the questionnaire for user input.
The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created. Note that initial values can influence results. The data type of initial[x] must agree with the item.type, and only repeating items can have more then one initial value.
In some workflows, having defaults saves time.
Actual value for initializing the question
The actual value to for an initial answer.
The type of the initial value must be consistent with the type of the item.
./default_value ./default_element/default/value ./default_element/list_item_identifier (resolve)
Text, questions and other groups to be nested beneath a question or group.
There is no specified limit to the depth of nesting. However, Questionnaire authors are encouraged to consider the impact on the user and user interface of overly deep nesting.
Reports can consist of complex nested groups.