. Page versions: R5 R4B R4 R3 R2This page is part of the FHIR Specification (v0.11: DSTU 1 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2
Example Index:
| General questionnaire example | XML | JSON |
| Real-world lifelines questionnaire (fictively taken from the patient) | XML | JSON |
General questionnaire example
General questionnaire example (id = "3141")
<Questionnaire xmlns="http://hl7.org/fhir"> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <pre> Comorbidity? YES Cardial Comorbidity? YES Angina? YES MI? NO Vascular Comorbidity? (no answers) ... Histopathology Abdominal pT category: 1 ... </pre> </div> </text> <contained> <Patient id="patsub"> <identifier> <system value="http://cancer.questionnaire.org/systems/id/patientnr"/> <key value="A34442332"/> </identifier> <identifier> <label value="Dutch BSN"/> <system value="urn:oid:2.16.840.1.113883.2.4.6.3"/> <key value="188912345"/> </identifier> <gender> <coding> <system value="http://hl7.org/fhir/v3/AdministrativeGender"/> <code value="M"/> </coding> </gender> <birthDate value="1972-11-30"/> </Patient> </contained> <contained> <Practitioner id="questauth"> <identifier> <label value="AUMC, Den Helder"/> <system value="http://cancer.questionnaire.org/systems/id/org"/> <key value="AUMC"/> </identifier> </Practitioner> </contained> <contained> <Observation id="obs.pt-category"> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/questions"/> <code value="53786006"/> <display value="pT1 category"/> </coding> </name> <status value="final"/> <reliability value="unknown"/> </Observation> </contained> <status value="final"/> <authored value="2013-02-19T14:15:00"/> <subject> <type value="Patient"/> <reference value="#patsub"/> </subject> <author> <type value="Practitioner"/> <reference value="#questauth"/> </author> <name> <text value="Cancer Quality Forum Questionnaire 2012"/> </name> <group> <!-- COMORBIDITY --> <!-- First main section of the form, questions about comorbidity --> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/sections"/> <code value="COMORBIDITY"/> </coding> </name> <!-- section contains one question: whether there is comorbidity --> <question> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/questions"/> <code value="COMORB"/> </coding> </name> <choice> <system value="http://cancer.questionnaire.org/system/code/yesno"/> <code value="1"/> <display value="Yes"/> </choice> </question> <group> <!-- COMORBIDITY/CARDIAL --> <!-- Subsection about specific comorbidity: cardial --> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/sections"/> <code value="CARDIAL"/> </coding> </name> <question> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/questions"/> <code value="COMORBCAR"/> </coding> </name> <choice> <system value="http://cancer.questionnaire.org/system/code/yesno"/> <code value="1"/> </choice> </question> <question> <!-- This answer carries both the questionnaire-specific name and an equivalent SNOMED-CT code --> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/questions"/> <code value="COMCAR00"/> <display value="Angina Pectoris"/> </coding> <coding> <system value="http://snomed.info/sct"/> <code value="194828000"/> <display value="Angina (disorder)"/> </coding> </name> <choice> <system value="http://cancer.questionnaire.org/system/code/yesno"/> <code value="1"/> </choice> </question> <question> <name> <coding> <system value="http://snomed.info/sct"/> <code value="22298006"/> <display value="Myocardial infarction (disorder)"/> </coding> </name> <choice> <system value="http://cancer.questionnaire.org/system/code/yesno"/> <code value="0"/> </choice> </question> </group> <!-- COMORBIDITY/CARDIAL --> <group> <!-- COMORBIDITY/VASCULAR --> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/sections"/> <code value="VASCULAR"/> </coding> </name> </group> <!-- COMORBIDITY/VASCULAR --> </group> <!-- COMORBIDITY --> <group> <!-- HISTOPATHOLOGY --> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/sections"/> <code value="HISTOPATHOLOGY"/> </coding> </name> <group> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/sections"/> <code value="ABDOMINAL"/> </coding> </name> <question> <name> <coding> <system value="http://cancer.questionnaire.org/system/code/questions"/> <code value="STADPT"/> <display value="pT category"/> </coding> </name> <dataResource> <type value="Observation"/> <reference value="#obs.pt-category"/> </dataResource> </question> </group> </group> <!-- HISTOPATHOLOGY --> </Questionnaire>
JSON Equivalent
General questionnaire example
{
"Questionnaire":{
"text":{
"status":{
"value":"generated"
},
"div":"<div>\n <pre>\n Comorbidity? YES\n Cardial Comorbidity? YES\n Angina? YES\n MI? NO\n Vascular Comorbidity?\n (no answers)\n ...\n Histopathology\n Abdominal\n pT category: 1\n ...\n <\/pre>\n <\/div>"
},
"contained":[
{
"Patient":{
"_id":"patsub",
"identifier":[
{
"system":{
"value":"http://cancer.questionnaire.org/systems/id/patientnr"
},
"key":{
"value":"A34442332"
}
},
{
"label":{
"value":"Dutch BSN"
},
"system":{
"value":"urn:oid:2.16.840.1.113883.2.4.6.3"
},
"key":{
"value":"188912345"
}
}
],
"gender":{
"coding":[
{
"system":{
"value":"http://hl7.org/fhir/v3/AdministrativeGender"
},
"code":{
"value":"M"
}
}
]
},
"birthDate":{
"value":"1972-11-30"
}
}
},
{
"Practitioner":{
"_id":"questauth",
"identifier":[
{
"label":{
"value":"AUMC, Den Helder"
},
"system":{
"value":"http://cancer.questionnaire.org/systems/id/org"
},
"key":{
"value":"AUMC"
}
}
]
}
},
{
"Observation":{
"_id":"obs.pt-category",
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/questions"
},
"code":{
"value":"53786006"
},
"display":{
"value":"pT1 category"
}
}
]
},
"status":{
"value":"final"
},
"reliability":{
"value":"unknown"
}
}
}
],
"status":{
"value":"final"
},
"authored":{
"value":"2013-02-19T14:15:00"
},
"subject":{
"type":{
"value":"Patient"
},
"reference":{
"value":"#patsub"
}
},
"author":{
"type":{
"value":"Practitioner"
},
"reference":{
"value":"#questauth"
}
},
"name":{
"text":{
"value":"Cancer Quality Forum Questionnaire 2012"
}
},
"group":[
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/sections"
},
"code":{
"value":"COMORBIDITY"
}
}
]
},
"question":[
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/questions"
},
"code":{
"value":"COMORB"
}
}
]
},
"choice":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/yesno"
},
"code":{
"value":"1"
},
"display":{
"value":"Yes"
}
}
]
}
],
"group":[
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/sections"
},
"code":{
"value":"CARDIAL"
}
}
]
},
"question":[
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/questions"
},
"code":{
"value":"COMORBCAR"
}
}
]
},
"choice":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/yesno"
},
"code":{
"value":"1"
}
}
]
},
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/questions"
},
"code":{
"value":"COMCAR00"
},
"display":{
"value":"Angina Pectoris"
}
},
{
"system":{
"value":"http://snomed.info/sct"
},
"code":{
"value":"194828000"
},
"display":{
"value":"Angina (disorder)"
}
}
]
},
"choice":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/yesno"
},
"code":{
"value":"1"
}
}
]
},
{
"name":{
"coding":[
{
"system":{
"value":"http://snomed.info/sct"
},
"code":{
"value":"22298006"
},
"display":{
"value":"Myocardial infarction (disorder)"
}
}
]
},
"choice":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/yesno"
},
"code":{
"value":"0"
}
}
]
}
]
},
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/sections"
},
"code":{
"value":"VASCULAR"
}
}
]
}
}
]
},
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/sections"
},
"code":{
"value":"HISTOPATHOLOGY"
}
}
]
},
"group":[
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/sections"
},
"code":{
"value":"ABDOMINAL"
}
}
]
},
"question":[
{
"name":{
"coding":[
{
"system":{
"value":"http://cancer.questionnaire.org/system/code/questions"
},
"code":{
"value":"STADPT"
},
"display":{
"value":"pT category"
}
}
]
},
"dataResource":{
"type":{
"value":"Observation"
},
"reference":{
"value":"#obs.pt-category"
}
}
}
]
}
]
}
]
}
}