Release 4 4B

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Questionnaire-cqf-example.json

FHIR Infrastructure Work Group Maturity Level : N/A Standards Status : Informative Compartments : Not linked to any defined compartments

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

Questionnaire used to define the questions involved in the PHQ-9 health questionnaire 

{
  "resourceType": "Questionnaire",
  "id": "phq-9-questionnaire",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/cqf-questionnaire"
    ]

  "resourceType" : "Questionnaire",
  "id" : "phq-9-questionnaire",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/StructureDefinition/cqf-questionnaire"]

  },
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">PHQ-9 Questionnaire with dynamic logic</div>"

  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">PHQ-9 Questionnaire with dynamic logic</div>"

  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/cqf-library",
      "valueCanonical": "Library/phq-9-logic"
    }
  ],
  "identifier": [
    {
      "use": "official",
      "value": "phq-9"
    }
  ],
  "version": "1.0.0",
  "title": "Patient Health Questionnaire (PHQ-9)",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "code": [
    {
      "system": "http://loinc.org",
      "code": "44249-1",
      "display": "PHQ-9 quick depression assessment panel:-:Pt:^Patient:-:Report.PHQ-9"
    }
  ],
  "item": [
    {
      "linkId": "LittleInterest",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44250-9"
        }
      ],
      "text": "Little interest or pleasure in doing things",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "FeelingDown",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44255-8"
        }
      ],
      "text": "Feeling down, depressed, or hopeless",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "TroubleSleeping",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44259-0"
        }
      ],
      "text": "Trouble falling or staying asleep",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "FeelingTired",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44254-1"
        }
      ],
      "text": "Feeling tired or having little energy",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "BadAppetite",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44251-7"
        }
      ],
      "text": "Poor appetite or overeating",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "FeelingBadAboutSelf",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44258-2"
        }
      ],
      "text": "Feeling bad about yourself - or that you are a failure or have let yourself or your family down",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "TroubleConcentrating",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44252-5"
        }
      ],
      "text": "Trouble concentrating on things, such as reading the newspaper or watching television",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "linkId": "MovingSpeaking",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44253-3"
        }
      ],
      "text": "Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
          "valueExpression": {
            "language": "text/cql",
            "expression": "CalculateTotalScore"
          }
        }
      ],
      "linkId": "TotalScore",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44261-6"
        }
      ],
      "text": "Total score",
      "type": "integer",
      "required": true
    },
    {
      "linkId": "Difficulty",
      "code": [
        {
          "system": "http://loinc.org",
          "code": "44256-6"
        }
      ],
      "text": "If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://loinc.org/vs/LL358-3"
    }
  ]

  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-library",
    "valueCanonical" : "http://example.org/fhir/Library/phq-9-logic"
  }],
  "identifier" : [{
    "use" : "official",
    "value" : "phq-9"
  }],
  "version" : "1.0.0",
  "title" : "Patient Health Questionnaire (PHQ-9)",
  "status" : "draft",
  "experimental" : true,
  "subjectType" : ["Patient"],
  "code" : [{
    "system" : "http://loinc.org",
    "code" : "44249-1",
    "display" : "PHQ-9 quick depression assessment panel:-:Pt:^Patient:-:Report.PHQ-9"
  }],
  "item" : [{
    "linkId" : "LittleInterest",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44250-9"
    }],
    "text" : "Little interest or pleasure in doing things",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "FeelingDown",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44255-8"
    }],
    "text" : "Feeling down, depressed, or hopeless",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "TroubleSleeping",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44259-0"
    }],
    "text" : "Trouble falling or staying asleep",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "FeelingTired",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44254-1"
    }],
    "text" : "Feeling tired or having little energy",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "BadAppetite",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44251-7"
    }],
    "text" : "Poor appetite or overeating",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "FeelingBadAboutSelf",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44258-2"
    }],
    "text" : "Feeling bad about yourself - or that you are a failure or have let yourself or your family down",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "TroubleConcentrating",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44252-5"
    }],
    "text" : "Trouble concentrating on things, such as reading the newspaper or watching television",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "linkId" : "MovingSpeaking",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44253-3"
    }],
    "text" : "Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  },
  {
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
      "valueExpression" : {
        "language" : "text/cql",
        "expression" : "CalculateTotalScore"
      }
    }],
    "linkId" : "TotalScore",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44261-6"
    }],
    "text" : "Total score",
    "type" : "integer",
    "required" : true
  },
  {
    "linkId" : "Difficulty",
    "code" : [{
      "system" : "http://loinc.org",
      "code" : "44256-6"
    }],
    "text" : "If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people",
    "type" : "choice",
    "required" : true,
    "answerValueSet" : "http://loinc.org/vs/LL358-3"
  }]

}

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.