Release 5 R6 Ballot (3rd Draft)
This page is part of the FHIR Specification (v5.0.0: R5 - STU ). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

Publish-box (todo)

Example QuestionnaireResponse/f201 (XML)

FHIR Infrastructure Work Group Maturity Level : N/A Standards Status : Informative Compartments : Device , Encounter , Patient , Practitioner , RelatedPerson

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

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Real-world lifelines questionnaire response (fictively taken from the patient) (id = "f201") 

<?xml version="1.0" encoding="UTF-8"?>

<QuestionnaireResponse xmlns="http://hl7.org/fhir">
 
   border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align:
       top;border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align:
         topvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
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           solid; padding:0px 4px 0px 4pxborder: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         whitevertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
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         #F7F7F7vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image:
           url(tbl_bck10.png)vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         whitevertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         #F7F7F7vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image:
           url(tbl_bck110.png)vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         whitevertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         #F7F7F7vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image:
           url(tbl_bck110.png)vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         whitevertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         #F7F7F7vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image:
           url(tbl_bck01.png)vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         whitevertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0
           solid; padding:0px 4px 0px 4px
border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color:
         #F7F7F7vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image:
           url(tbl_bck000.png)vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4pxvertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px
           #F0F0F0 solid; padding:0px 4px 0px 4px

  <id value="f201"/> 
  <questionnaire> 
    <extension url="http://hl7.org/fhir/StructureDefinition/display">
      <valueString value="Lifelines"/> 
    </extension> 
   
   
      

  </questionnaire> 
  <status value="completed"/> 
  <!--  Fictive, only the below answers are non-fictive  -->
  <subject> 
    <reference value="Patient/f201"/> 
    <display value="Roel"/> 
  </subject> 
  <authored value="2013-06-18T00:00:00+01:00"/> 
  <author> 
    <reference value="Practitioner/f201"/> 
  </author> 
  <source> 
    <reference value="Practitioner/f201"/> 
  </source> 
  <item> 
    <linkId value="1"/> 
    <text value="Do you have allergies?"/> 
    <answer> 
      <valueBoolean value="true"/> 
    </answer> 
  </item> 
  <item> 
        

    <!--  Answers to general questions  -->
    <linkId value="2"/> 
    <text value="General questions"/> 
    <item> 
      <linkId value="2.1"/> 
      <text value="What is your gender?"/> 
      <answer> 
        <valueString value="Male"/> 
      </answer> 
    </item> 
    <item> 
      <linkId value="2.2"/> 
      <text value="What is your date of birth?"/> 
      <answer> 
        <valueDate value="1960-03-13"/> 
      </answer> 
    </item> 
    <item> 
      <linkId value="2.3"/> 
      <text value="What is your country of birth?"/> 
      <answer> 
        <valueString value="The Netherlands"/> 
      </answer> 
    </item> 
    <item> 
      <linkId value="2.4"/> 
      <text value="What is your marital status?"/> 
      <answer> 
        <valueString value="married"/> 
      </answer> 
    </item> 
  </item> 
  <item> 
        

    <!--  Answers to intoxications  -->
    <linkId value="3"/> 
    <text value="Intoxications"/> 
    <item> 
      <linkId value="3.1"/> 
      <text value="Do you smoke?"/> 
      <answer> 
        <valueBoolean value="false"/> 
      </answer> 
    </item> 
    <item> 
      <linkId value="3.2"/> 
      <text value="Do you drink alchohol?"/> 
      <answer> 
        <valueBoolean value="false"/> 
      </answer> 
    </item> 
  </item> 


</

QuestionnaireResponse

>

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.