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Questionnaire-example.json

Example Questionnaire/3141 (JSON)

Maturity Level : N/A
Responsible Owner: FHIR Infrastructure Work Group Standards Status : Informative Compartments : Not linked to any No defined compartments

Raw JSON ( canonical form + also see JSON Format Specification )

General questionnaire example 

{
  "resourceType": "Questionnaire",
  "id": "3141",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      <pre>\n            1.Comorbidity?\n              1.1 Cardial Comorbidity\n                1.1.1 Angina?\n                1.1.2 MI?\n              1.2 Vascular Comorbidity?\n              ...\n            Histopathology\n              Abdominal\n                pT category?\n              ...\n          </pre>\n    </div>"

  "resourceType" : "Questionnaire",
  "id" : "3141",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n      \n      <pre>\n            1.Comorbidity?\n              1.1 Cardial Comorbidity\n                1.1.1 Angina?\n                1.1.2 MI?\n              1.2 Vascular Comorbidity?\n              ...\n            Histopathology\n              Abdominal\n                pT category?\n              ...\n          </pre>\n    \n    </div>"

  },
  "url": "http://hl7.org/fhir/Questionnaire/3141",
  "title": "Cancer Quality Forum Questionnaire 2012",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "date": "2012-01",
  "item": [
    {
      "linkId": "1",
      "code": [
        {
          "system": "http://example.org/system/code/sections",
          "code": "COMORBIDITY"
        }
      ],
      "type": "group",
      "item": [
        {
          "linkId": "1.1",
          "code": [
            {
              "system": "http://example.org/system/code/questions",
              "code": "COMORB"
            }
          ],
          "prefix": "1",
          "type": "choice",
          "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow",
          "item": [

  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fhir"
  }],
  "url" : "http://hl7.org/fhir/Questionnaire/3141",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.20.2"
  }],
  "name" : "CancerQualityForumQuestionnaire2012",
  "title" : "Cancer Quality Forum Questionnaire 2012",
  "status" : "draft",
  "subjectType" : ["Patient"],
  "date" : "2012-01",
  "publisher" : "HL7 International / FHIR Infrastructure",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/fiwg"
    }]
  }],
  "description" : "Cancer Quality Forum Questionnaire 2012",
  "item" : [{
    "linkId" : "1",
    "code" : [{
      "system" : "http://example.org/system/code/sections",
      "code" : "COMORBIDITY"
    }],
    "type" : "group",
    "item" : [{
      "linkId" : "1.1",
      "code" : [{
        "system" : "http://example.org/system/code/questions",
        "code" : "COMORB"
      }],
      "prefix" : "1",
      "type" : "coding",
      "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow",
      "item" : [{
        "linkId" : "1.1.1",
        "code" : [{
          "system" : "http://example.org/system/code/sections",
          "code" : "CARDIAL"
        }],
        "type" : "group",
        "enableWhen" : [{
          "question" : "1.1",
          "operator" : "=",
          "answerCoding" : {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0136",
            "code" : "Y"
          }
        }],
        "item" : [{
          "linkId" : "1.1.1.1",
          "code" : [{
            "system" : "http://example.org/system/code/questions",
            "code" : "COMORBCAR"
          }],
          "prefix" : "1.1",
          "type" : "coding",
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow",
          "item" : [{
            "linkId" : "1.1.1.1.1",
            "code" : [{
              "system" : "http://example.org/system/code/questions",
              "code" : "COMCAR00",
              "display" : "Angina Pectoris"
            },

            {
              "linkId": "1.1.1",
              "code": [
                {
                  "system": "http://example.org/system/code/sections",
                  "code": "CARDIAL"
                }
              ],
              "type": "group",
              "enableWhen": [
                {
                  "question": "1.1",
                  "operator": "=",
                  "answerCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v2-0136",
                    "code": "Y"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "1.1.1.1",
                  "code": [
                    {
                      "system": "http://example.org/system/code/questions",
                      "code": "COMORBCAR"
                    }
                  ],
                  "prefix": "1.1",
                  "type": "choice",
                  "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow",
                  "item": [
                    {
                      "linkId": "1.1.1.1.1",
                      "code": [
                        {
                          "system": "http://example.org/system/code/questions",
                          "code": "COMCAR00",
                          "display": "Angina Pectoris"
                        },
                        {
                          "system": "http://snomed.info/sct",
                          "code": "194828000",
                          "display": "Angina (disorder)"
                        }
                      ],
                      "prefix": "1.1.1",
                      "type": "choice",
                      "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
                    },
                    {
                      "linkId": "1.1.1.1.2",
                      "code": [
                        {
                          "system": "http://snomed.info/sct",
                          "code": "22298006",
                          "display": "Myocardial infarction (disorder)"
                        }
                      ],
                      "prefix": "1.1.2",
                      "type": "choice",
                      "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
                    }
                  ]
                },
                {
                  "linkId": "1.1.1.2",
                  "code": [
                    {
                      "system": "http://example.org/system/code/questions",
                      "code": "COMORBVAS"
                    }
                  ],
                  "prefix": "1.2",
                  "type": "choice",
                  "answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "linkId": "2",
      "code": [
        {
          "system": "http://example.org/system/code/sections",
          "code": "HISTOPATHOLOGY"
        }
      ],
      "type": "group",
      "item": [

              "system" : "http://snomed.info/sct",
              "code" : "194828000",
              "display" : "Angina (disorder)"
            }],
            "prefix" : "1.1.1",
            "type" : "coding",
            "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow"
          },
          {
            "linkId" : "1.1.1.1.2",
            "code" : [{
              "system" : "http://snomed.info/sct",
              "code" : "22298006",
              "display" : "Myocardial infarction (disorder)"
            }],
            "prefix" : "1.1.2",
            "type" : "coding",
            "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow"
          }]
        },

        {
          "linkId": "2.1",
          "code": [
            {
              "system": "http://example.org/system/code/sections",
              "code": "ABDOMINAL"
            }
          ],
          "type": "group",
          "item": [
            {
              "linkId": "2.1.2",
              "code": [
                {
                  "system": "http://example.org/system/code/questions",
                  "code": "STADPT",
                  "display": "pT category"
                }
              ],
              "type": "choice"
            }
          ]
        }
      ]
    }
  ]

          "linkId" : "1.1.1.2",
          "code" : [{
            "system" : "http://example.org/system/code/questions",
            "code" : "COMORBVAS"
          }],
          "prefix" : "1.2",
          "type" : "coding",
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/yesnodontknow"
        }]
      }]
    }]
  },
  {
    "linkId" : "2",
    "code" : [{
      "system" : "http://example.org/system/code/sections",
      "code" : "HISTOPATHOLOGY"
    }],
    "type" : "group",
    "item" : [{
      "linkId" : "2.1",
      "code" : [{
        "system" : "http://example.org/system/code/sections",
        "code" : "ABDOMINAL"
      }],
      "type" : "group",
      "item" : [{
        "linkId" : "2.1.2",
        "code" : [{
          "system" : "http://example.org/system/code/questions",
          "code" : "STADPT",
          "display" : "pT category"
        }],
        "type" : "coding"
      }]
    }]
  }]

}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.