A structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.

To support structured, hierarchical registration of data gathered using digital forms and other questionnaires. Questionnaires provide greater control over presentation and allow capture of data in a domain-independent way (i.e. capturing information that would otherwise require multiple distinct types of resources).

An absolute URI that is used to identify this questionnaire when it is referenced in a specification, model, design or an instance. instance; also called its canonical identifier. This SHALL be a URL, SHOULD be globally unique, unique and SHOULD be an a literal address at which an authoritative instance of this questionnaire is (or will be) published. The This URL SHOULD include can be the major version target of a canonical reference. It SHALL remain the questionnaire. For more information see Technical and Business Versions . same when the questionnaire is stored on different servers.

… Allows the questionnaire to be referenced by a single globally unique identifier.

This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.

Can be a urn:uuid: or a urn:oid:, urn:oid: but real http: addresses are preferred. Multiple instances may share the same url URL if they have a distinct version.

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions .

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

The name of the referenced questionnaire can be conveyed using the http://hl7.org/fhir/StructureDefinition/display extension.

Questionnaire.url SHOULD always be populated unless the Questionnaire is a contained resource (in which case it will be pointed to by the containing resource using id, not url. E.g. QuestionnaireResponse.questionnaire using '#[ContainedQuestionnaire.id]')

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.

Allows externally provided and/or usable business identifiers to be easily associated with the module. questionnaire.

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 questionnaires that have the same identifier url but different versions. The version can be appended to the url in a reference to allow a refrence reference to a particular business version of the questionnaire with the format [url]|[version]. format. The version SHOULD NOT contain a '#' - see Business Version .

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 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.

Support human navigation and Supports code generation.

The name is not expected to be globally unique. The name should be a simple alpha-numeric alphanumeric type no-whitespace name to ensure that it is computable machine-processing 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 status URL of a Questionnaire that this questionnaire. Enables tracking Questionnaire is based on.

Allows a Questionnaire to be created based on another Questionnaire.

This element covers a broad range of relationships, from 'somewhat inspired by' to 'fully compliant with'. There is a standard extensionthat allows clearer differentiation between the life-cycle specifics of the content. derivation relationship where this is needed - e.g. to determine substitutability and validation expectations - http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType .

The current state of this questionnaire.

Enables tracking the lifecycle of the content and filtering of questionnaires that are appropriate for use versus not.

Allows filtering A nominal state-transition diagram can be found in the] documentation

Unknown does not represent 'other' - one of questionnaires that are appropriate for use vs. not. This the defined statuses must apply. Unknown is used when the authoring system is labeled as "Is Modifier" because applications should not use a retired questionnaire without due consideration. sure what the current status is.

See guidance around (not) making local changes to elements here .

A boolean Boolean value to indicate that this questionnaire is authored for testing purposes (or education/evaluation/marketing), education/evaluation/marketing) and is not intended to no version of this resource will ever be used intended for genuine usage.

Enables experimental content to be developed following the same lifecycle that would be used for a production-level questionnaire.

Allows filtering of questionnaire questionnaires that are appropriate for use vs. not. This is labeled as "Is Modifier" because applications should not use an experimental questionnaire versus not.. Experimental resources might include example instances in production. implementation guides, instances created solely for testing purposes, etc

The types of subjects that can be the subject of responses created for the questionnaire.

Allows enforcing that a QuestionnaireResponse only has a .subject element of the appropriate type.

If none are specified, then the subject is unlimited.

The date (and optionally time) when the questionnaire was published. last significantly changed. The date must change if and 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.

The date is often not tracked until the resource is published, but may be present on draft content. 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.

See guidance around (not) making local changes to elements here .

The name of the individual or organization that published or individual responsible for the release and ongoing maintenance of the questionnaire.

Helps establish the "authority/credibility" "authority/credibility" of the questionnaire. May also allow for contact.

Usually an organization, 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.

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.

See guidance around (not) making local changes to elements here .

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. context. (E.g. the language of the profile questionnaire is presumed to be the predominant language in the place the profile questionnaire was created).

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 questionnaires.

Assist in searching for appropriate content.

When multiple useContexts are specified, there is no expectation that all or even any of the contexts apply.

A legal or geographic region in which the authority that maintains the resource is operating. In general, the jurisdiction is also found in the useContext. The useContext may reference additional jurisdictions because the defining jurisdiction does not necessarily limit the jurisdictions of use.

It may be possible for the questionnaire to be used in jurisdictions other than those for which it was originally designed or intended.

DEPRECATION NOTE: For consistency, implementations are encouraged to migrate to using the new 'jurisdiction' code in the useContext element. (I.e. useContext.code indicating http://terminology.hl7.org/CodeSystem/usage-context-type#jurisdiction and useContext.valueCodeableConcept indicating the jurisdiction.)

Explaination 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 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 notices of intellectual property ownership and can include restrictions on the use and publishing of the questionnaire.

Consumers of the questionnaire must be able to determine any legal restrictions on the use of the artifact and/or its content.

A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are restricted. (e.g. 'All rights reserved', 'Some rights reserved').

Defines the content expected to be rendered in all representations of the artifact.

The copyright symbol and the '(c)' textual representation SHOULD NOT be included in this string. It will be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.

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.

See guidance around (not) making local changes to elements here .

The date on which the resource content was last reviewed. Review happens periodically after approval, approval but doesn't does not change the original approval date.

Gives a sense of how "current" "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

If specified, this is usually after date follows the original approval date.

See guidance around (not) making local changes to elements here .

The period during which the questionnaire content was or is planned to be in active use.

Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of a the questionnaire are or are expected to be used instead.

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 questionnaire intended to be used for the year 2016 might be published in 2015.

The content was developed with a focus and intent of supporting the contexts that are listed. These terms may be used See guidance around (not) making local changes to assist with indexing and searching for appropriate questionnaire instances. elements here .

When multiple useContexts are specified, there is no expectation whether all or any An identifier for this collection of the contexts apply. 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.

Contact details to assist a user in finding and communicating with A particular question, question grouping or display text that is part of the publisher. questionnaire.

May be a web site, The content of the questionnaire is constructed from an email address, a telephone number, etc. ordered, hierarchical collection of items.

An identifier that is unique within the Questionnaire allowing linkage to the equivalent item in a QuestionnaireResponse resource.

QuestionnaireResponse does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.

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.

LinkIds can have whitespaces and slashes by design. Tooling should not rely on linkIds being valid XHTML element IDs, and should not directly embed them as such

A reference This element is a URI that refers to an ElementDefinition or to an ObservationDefinition that provides the details for the item. If a definition is provided, then the following element values can be inferred from the definition: code (ElementDefinition.code) type (ElementDefinition.type) required (ElementDefinition.min) repeats (ElementDefinition.max) maxLength (ElementDefinition.maxLength) options (ElementDefinition.binding) Any information provided about this item, including information that might otherwise be included in these elements on a the instance of the Questionnaire Item overrides resource. A detailed description of the information from construction of the definition. URI is shown in Comments , below.

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.

the URI The uri refers to an ElementDefinition in either a StructureDefinition or a DataElement , to an ObservationDefinition and always starts with the canonical URL for the target resource. When referring to a StructureDefinition, a fragment identifier is used to specify the element definition by its id 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. Note that LOINC codes implicitly define DataElement resources.

A terminology code that corresponds to this group or question (e.g. a code from LOINC, which defines many questions and answers).

Allows linking of groups of questions to formal terminologies.

The value may come from the ElementDefinition referred to by .definition.

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.

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.

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 Typically, these won't be used for "display" "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.

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.

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, Coding, etc.).

Defines the format in which the user is to be prompted for the answer.

Additional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.

A constraint indicating that this item should only be enabled (displayed/allow answers to be captured) when the specified condition is true.

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 multiple repetitions of this extension are present, the interpretation is driven by enableBehavior (either all repetitions must evaluate to true for this item should to be enabled when enabled, or only one must evaluate to true for the item to be enabled). If the enableWhen.question has multiple answers, the condition for evaluates to true if any of the repetitions is true. I.e. treat "enableWhen"s as being joined by an "or" clause. answers for the referenced item match the enableWhen condition. This element is a modifier because if enableWhen is present for an item, "required" "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. If enableWhen logic depends on an item that is disabled, the logic should proceed as though the item is not valued - even if a default value or other value might be retained in memory in the event of the item being re-enabled. In some cases, the comparison between the indicated answer and the specified value may differ only by precision. For example, the enableWhen might be Q1 > 1970, but the answer to Q1 is 1970-10-15. There is not a clear answer as to whether 1970-10-15 should be considered 'greater' than 1970, given that it is an imprecise value. In these indeterminate situations, the form filler has the option of refusing to render the form. If the form is displayed, items where enableWhen is indeterminate SHOULD be treated as enabled with a warning indicating that the questionnaire logic was faulty and it is possible that the item should not be enabled. Questionnaires SHOULD be designed to take into account challenges around varying precision to minimize non-deterministic situations by setting constraints around expected precision, etc.

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" "ancestor" axis and then the "preceding" "preceding" axis and then the "following" "following" axis. If there are multiple items with the same linkId and all are equadistant (e.g. a question references a question that appears in a separate repeating group), that is an error. (Consider using the enableWhenExpression extension to define logic to handle such a situation.)

An indication that this item should be enabled only if Specifies the criteria by which the specified question is answered (hasAnswer=true) or not answered (hasAnswer=false). enabled.

An answer A value that the referenced question must match is tested using the specified operator in order for the item to be enabled. If there are multiple answers, a match on any of the answers suffices. If different behavior is desired (all must match, at least 2 must match, etc.), consider using the enableWhenExpression extension.

Controls how multiple enableWhen values are interpreted - whether all or any must be true.

The dataType of this This element must be the same as the data type of the question being referenced. specified if more than one enableWhen value is provided.

Indicates if and how items that are disabled (because enableWhen evaluates to 'false') should be displayed.

If not specified, rendering behavior is up to the client. This element is only meaningful if enableWhen or an equivalent extension is present

An indication, if true, that the item must be present in a "completed" "completed" QuestionnaireResponse. If false, the item may be skipped when answering the questionnaire.

If the required item is a question, it must have a direct answer (i.e. an answer to the question itself, not merely answers to child questions) in order for the QuestionnaireResponse to be complete. If the required item is a group, it must have at least one descendant question which has an answer Questionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. It also only has meaning if the parent element is present. If a non-required 'group' item contains a 'required' question item, it's completely fine to omit the group (because it's not required) despite it having a required child. Similarly, 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). descendant item with a populated answer). The value for 'required' may come from the ElementDefinition referred to by .definition.

An indication, if true, that the a QuestionnaireResponse for this item may occur multiple times in the response, collecting include multiple answers answers for questions associated with a single instance of this item (for question-type items) or multiple sets repetitions of answers for groups. the item (for group-type items).

Items may be used to create set of (related) questions that can be repeated to give multiple answers to such a set.

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 list each allow entry/selection of the multiple answers beneath for the question. (Which question (repeat the answers). Which is most appropriate visually may depend on the type of answer as well as whether there are nested items.). 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. When repeats=true for a group, it'll be represented with multiple items with the same linkId in the QuestionnaireResponse. For a question, it'll be represented by a single item with that linkId with multiple answers.

An indication, when true, that the value cannot be changed by a human respondent to the Questionnaire.

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.

If specified on a 'group', then all items beneath the specified group are read only. For questions, this only marks the answer associated with the specific item read only. Descendant questions are not impacted. 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.

The maximum number of characters that are permitted in the answer to be considered a "valid" "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.

For items that have a defined set of allowed answers (via answerOption or answerValueSet), indicates whether values other than those specified can be selected.

Introduces the ability for questions to have 'other' answers

A reference to a value set containing a list of codes values representing permitted answers for a "choice" or "open-choice" question.

LOINC defines many useful value sets for questionnaire responses. See LOINC Answer Lists . The value may come from the ElementDefinition referred to by .definition.

For items of type Coding, the value set indicates the allowed code + system matches. For items of type 'string' the display values in the value set expansion are taken as the allowed values for the item. For items of type 'uri', the code values in the value set expansion are taken as the allowed values for the item. If the ValueSet requires a terminology server to provide an expansion, a preferred terminology server can be provided with an extension on the Questionnaire item, an ancestor item, or the Questionnaire root.

One of the permitted answers for a "choice" or "open-choice" the question.

This element can be used when the value set machinery of options answerValueSet is deemed too cumbersome or when there's a need to capture options 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.

The Indicates whether the answer value is selected when the list of possible answers is initially shown.

One or more values that should be defaulted pre-populated in the answer when initially rendering the questionnaire for user input.

In some workflows, having defaults saves time.

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.answer[x] must agree with the item.type, and only repeating items can have more then one initial value.

The actual value to for an initial answer.

The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change type of the value, then this initial value will must be persisted when consistent with the QuestionnaireResponse is initially created. Note that default values can influence results. The data type of initial[x] must agree with the item.type. item.

Text, questions and other groups to be nested beneath a question or group.

Reports can consist of complex nested groups.

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.