Status: DRAFT: For Review

Introduction

This profile sets minimum expectations for the QuestionnaireResponse resource. We use the questionnaireResponse structure definition as a base to this profile.

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.

Each time a questionnaire is completed for a different subject or at a different time, a distinct QuestionnaireResponse is generated, though it may be possible for a previously entered set of answers to be edited or updated.

Questionnaire responses cover the need to communicate data originating from forms used in medical history examinations, research questionnaires and sometimes full clinical specialty records. In many systems this data is collected using user-defined screens and forms. Questionnaire responses record specifics about data capture - exactly what questions were asked, in what order, what answers were given, etc. Each of these questions is part of the Questionnaire, and as such the Questionnaire is a separately identifiable Resource, whereas the individual questions are not.

Mandatory fields

The following mandatory fields are defined:

1. status - This is a mandatory field which describes the status of the Questionnaire Response. The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

• Please note that following codes from the FHIR code system are deemed irrelevent for shared care record and are not supported. in-progress - This QuestionnaireResponse has been partially filled out with answers but changes or additions are still expected to be made to it. stopped - This QuestionnaireResponse has been partially filled out with answers but has been abandoned. It is unknown whether changes or additions are expected to be made to it.

1. Subject - The subject of the questionnaire response. Every Questionnaire Response must be linked to a patient.

2. Authored - The date and/or time that answers were gathered for this questionnaire response.

3. Author - The individual or device that received and interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

QuestionnaireResponses can be authored by clinicians, patients, or patients' relatives . Clinicians may author questionnaire responses, where the answers are provided by others on behalf of the patient. Additionally, information gathered on behalf of a patient may be about the patient's relatives (e.g. in family anamnesis). Therefore, QuestionnaireResponse makes a distinction between the author, the subject and the source of information.

Must Support fields

In addition the following fields are "Must Support" - ie they must be populated if relevant and known.

1. Context - The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated. This is likely to be very useful and should be provided if at all possible.

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

   • item.linkId - Mandatory if element 'item' is provided. The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
   • item.text - Mandatory if element 'item' is provided. Text that is displayed above the contents of the group or as the text of the question being answered. This allows the questionnaire response to be read without access to the questionnaire.
   • item.answer - The respondent's answer(s) to the question.
   • item.answer.item - 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.
   • item.item - Questions or sub-groups nested beneath a question or group.

Nested Items QuestioinnaireResponse has two different mechanisms to support nesting of items - item.item and item.answer.item. The former is used when nesting items within a 'group' and the latter is always used when nesting items within a question. This is because items nested within a question always nest within each answer to the question. If the question allows multiple answers, each will have its own set of nested items.

Note - The Interweave portal only supports flat structure within questionnaireResponse.item element at this time, although there is an intention to support nested items structure in the future.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

• Based on - Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon. The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.

• Questionnaire - A Questionnaire is an organized collection of questions intended to solicit information from patients, providers or other individuals involved in the healthcare domain. They may be simple flat lists of questions or can be hierarchically organized in groups and sub-groups, each containing questions. The Questionnaire defines the questions to be asked, how they are ordered and grouped, any intervening instructional text and what the constraints are on the allowed answers.

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.). The order of questions within groups, groups within groups and groups within questions is relevant and must be retained for display and capture. The hierarchy items within the Questionnaire SHALL mirror the hierarchy of the corresponding Questionnaire (if any).

• Source - The individual that answered the questions about a subject that is minor and/or is incapable of answering.

Discouraged or Removed fields

• Part Of - This field is discouraged as it does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of Observation/procedure resources which introduces a lot of complexity for a data consumer.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from QuestionnaireResponse

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	QuestionnaireResponse	A structured set of questions and their answers
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
partOf		0..*	Reference(Observation | Procedure)	Discouraged. A procedure or observation that this questionnaire was performed as part of the execution of.
status	S	1..1	code	completed | amended | entered-in-error Binding: InterweaveQuestionnaireResponseStatus (required)
subject	S	1..1	Reference(InterweavePatient)	The subject of the questions
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
authored	S	1..1	dateTime	Date the answers were gathered
author	S	1..1	Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)	Person who received and recorded the answers
item	S	0..*	BackboneElement	Groups and questions
text	S	1..1	string	Name for group or question text
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
QuestionnaireResponse.status	required	InterweaveQuestionnaireResponseStatus https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-CodesQuestionnaireResponseStatus from this IG

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	QuestionnaireResponse	A structured set of questions and their answers
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
partOf	Σ	0..*	Reference(Observation | Procedure)	Discouraged. A procedure or observation that this questionnaire was performed as part of the execution of.
status	?!SΣ	1..1	code	completed | amended | entered-in-error Binding: InterweaveQuestionnaireResponseStatus (required)
subject	SΣ	1..1	Reference(InterweavePatient)	The subject of the questions
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	1..1	Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)	Person who received and recorded the answers
item	SC	0..*	BackboneElement	Groups and questions qrs-1: Nested item can't be beneath both item and answer
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId		1..1	string	Pointer to specific item from Questionnaire
text	S	1..1	string	Name for group or question text
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
QuestionnaireResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
QuestionnaireResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
QuestionnaireResponse.status	required	InterweaveQuestionnaireResponseStatus https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-CodesQuestionnaireResponseStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	QuestionnaireResponse	A structured set of questions and their answers
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Unique id for this set of answers
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest)	Request fulfilled by this QuestionnaireResponse
partOf	Σ	0..*	Reference(Observation | Procedure)	Discouraged. A procedure or observation that this questionnaire was performed as part of the execution of.
questionnaire	Σ	0..1	canonical(Questionnaire)	Form being answered
status	?!SΣ	1..1	code	completed | amended | entered-in-error Binding: InterweaveQuestionnaireResponseStatus (required)
subject	SΣ	1..1	Reference(InterweavePatient)	The subject of the questions
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	1..1	Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)	Person who received and recorded the answers
source	Σ	0..1	Reference(Patient | Practitioner | PractitionerRole | RelatedPerson)	The person who answered the questions
item	SC	0..*	BackboneElement	Groups and questions qrs-1: Nested item can't be beneath both item and answer
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId		1..1	string	Pointer to specific item from Questionnaire
definition		0..1	uri	ElementDefinition - details for the item
text	S	1..1	string	Name for group or question text
answer		0..*	BackboneElement	The response(s) to the question
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]		0..1		Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
valueBoolean			boolean
valueDecimal			decimal
valueInteger			integer
valueDate			date
valueDateTime			dateTime
valueTime			time
valueString			string
valueUri			uri
valueAttachment			Attachment
valueCoding			Coding
valueQuantity			Quantity
valueReference			Reference(Resource)
item		0..*	See item (QuestionnaireResponse)	Nested groups and questions
item		0..*	See item (QuestionnaireResponse)	Nested questionnaire response items
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
QuestionnaireResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
QuestionnaireResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
QuestionnaireResponse.status	required	InterweaveQuestionnaireResponseStatus https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-CodesQuestionnaireResponseStatus from this IG
QuestionnaireResponse.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
QuestionnaireResponse.encounter.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
QuestionnaireResponse.item.answer.value[x]	example	QuestionnaireAnswerCodes (a valid code from SNOMED CT) http://hl7.org/fhir/ValueSet/questionnaire-answers from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()

Differential View

This structure is derived from QuestionnaireResponse

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	QuestionnaireResponse	A structured set of questions and their answers
id	S	0..1	id	Logical id of this artifact
meta
id		0..0
versionId	S	0..1	id	Version specific identifier
lastUpdated	S	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	S	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security		0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers
Slices for tag		0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system
tag:Source	S	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
version		0..0
code	S	1..1	code	The Data Provider Id of the system supplying the data
display	S	1..1	string	Name of the system supplying the data
tag:Provenance	S	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
id		0..0
system		1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
version		0..0
code	S	1..1	code	The ODS Code of the organisation responsible for the data
display	S	1..1	string	Name of the organisation supplying the data
implicitRules		0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation)
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
partOf		0..*	Reference(Observation | Procedure)	Discouraged. A procedure or observation that this questionnaire was performed as part of the execution of.
status	S	1..1	code	completed | amended | entered-in-error Binding: InterweaveQuestionnaireResponseStatus (required)
subject	S	1..1	Reference(InterweavePatient)	The subject of the questions
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		1..1	string	Description of the referenced resource
encounter	S	0..1	Reference(InterweaveEncounter)	Encounter created as part of
reference		1..1	string	Reference to a resource (could be Contained)
identifier		0..1	Identifier	If relevant could include an id
display		0..1	string	If relevant, description of the referenced resource
authored	S	1..1	dateTime	Date the answers were gathered
author	S	1..1	Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)	Person who received and recorded the answers
item	S	0..*	BackboneElement	Groups and questions
text	S	1..1	string	Name for group or question text
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
QuestionnaireResponse.status	required	InterweaveQuestionnaireResponseStatus https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-CodesQuestionnaireResponseStatus from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	QuestionnaireResponse	A structured set of questions and their answers
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
partOf	Σ	0..*	Reference(Observation | Procedure)	Discouraged. A procedure or observation that this questionnaire was performed as part of the execution of.
status	?!SΣ	1..1	code	completed | amended | entered-in-error Binding: InterweaveQuestionnaireResponseStatus (required)
subject	SΣ	1..1	Reference(InterweavePatient)	The subject of the questions
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	1..1	Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)	Person who received and recorded the answers
item	SC	0..*	BackboneElement	Groups and questions qrs-1: Nested item can't be beneath both item and answer
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId		1..1	string	Pointer to specific item from Questionnaire
text	S	1..1	string	Name for group or question text
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
QuestionnaireResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
QuestionnaireResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
QuestionnaireResponse.status	required	InterweaveQuestionnaireResponseStatus https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-CodesQuestionnaireResponseStatus from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
QuestionnaireResponse		0..*	QuestionnaireResponse	A structured set of questions and their answers
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
source	Σ	0..1	uri	Identifies where the resource comes from
profile	SΣ	0..*	canonical(StructureDefinition)	Profiles this resource claims to conform to. Should list (i) this profile (ii) base profile for this resource.
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://fhir.interweavedigital.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	Σ	0..1	Identifier	Unique id for this set of answers
basedOn	Σ	0..*	Reference(CarePlan | ServiceRequest)	Request fulfilled by this QuestionnaireResponse
partOf	Σ	0..*	Reference(Observation | Procedure)	Discouraged. A procedure or observation that this questionnaire was performed as part of the execution of.
questionnaire	Σ	0..1	canonical(Questionnaire)	Form being answered
status	?!SΣ	1..1	code	completed | amended | entered-in-error Binding: InterweaveQuestionnaireResponseStatus (required)
subject	SΣ	1..1	Reference(InterweavePatient)	The subject of the questions
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
encounter	SΣ	0..1	Reference(InterweaveEncounter)	Encounter created as part of
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
type	Σ	0..1	uri	Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
authored	SΣ	1..1	dateTime	Date the answers were gathered
author	SΣ	1..1	Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)	Person who received and recorded the answers
source	Σ	0..1	Reference(Patient | Practitioner | PractitionerRole | RelatedPerson)	The person who answered the questions
item	SC	0..*	BackboneElement	Groups and questions qrs-1: Nested item can't be beneath both item and answer
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
linkId		1..1	string	Pointer to specific item from Questionnaire
definition		0..1	uri	ElementDefinition - details for the item
text	S	1..1	string	Name for group or question text
answer		0..*	BackboneElement	The response(s) to the question
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
value[x]		0..1		Single-valued answer to the question Binding: QuestionnaireAnswerCodes (example): Code indicating the response provided for a question.
valueBoolean			boolean
valueDecimal			decimal
valueInteger			integer
valueDate			date
valueDateTime			dateTime
valueTime			time
valueString			string
valueUri			uri
valueAttachment			Attachment
valueCoding			Coding
valueQuantity			Quantity
valueReference			Reference(Resource)
item		0..*	See item (QuestionnaireResponse)	Nested groups and questions
item		0..*	See item (QuestionnaireResponse)	Nested questionnaire response items
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet	URI
QuestionnaireResponse.meta.security	extensible	All Security Labels http://hl7.org/fhir/ValueSet/security-labels from the FHIR Standard
QuestionnaireResponse.meta.tag	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Source	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.meta.tag:Provenance	example	CommonTags http://hl7.org/fhir/ValueSet/common-tags from the FHIR Standard
QuestionnaireResponse.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
QuestionnaireResponse.status	required	InterweaveQuestionnaireResponseStatus https://fhir.interweavedigital.nhs.uk/R4/ValueSet/Interweave-CodesQuestionnaireResponseStatus from this IG
QuestionnaireResponse.subject.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
QuestionnaireResponse.encounter.type	extensible	ResourceType http://hl7.org/fhir/ValueSet/resource-types from the FHIR Standard
QuestionnaireResponse.item.answer.value[x]	example	QuestionnaireAnswerCodes (a valid code from SNOMED CT) http://hl7.org/fhir/ValueSet/questionnaire-answers from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-2	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	QuestionnaireResponse	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	QuestionnaireResponse	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	QuestionnaireResponse	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
qrs-1	error	QuestionnaireResponse.item	Nested item can't be beneath both item and answer : (answer.exists() and item.exists()).not()

This structure is derived from QuestionnaireResponse

Summary

Mandatory: 5 elements(8 nested mandatory elements)
Must-Support: 17 elements
Fixed: 2 elements
Prohibited: 5 elements

Structures

This structure refers to these other structures:

• InterweavePatient (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Patient)
• InterweaveEncounter (https://fhir.interweavedigital.nhs.uk/R4/StructureDefinition/Interweave-Encounter)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of QuestionnaireResponse.meta.tag