QuestionnaireResponse

A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to. Read related on US Core QuestionnaireResponse profile.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier	Unique id for this set of answers Details A business identifier assigned to a particular completed (or partially completed) questionnaire.
basedOn		Reference<CarePlan | ServiceRequest>[]	Request fulfilled by this QuestionnaireResponse Details The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.
partOf		Reference<Observation | Procedure>[]	Part of this action Details A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of. Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.
questionnaire		canonical	Form being answered Details The Questionnaire that defines and organizes the questions for which answers are being provided. If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).
status	✓	code	in-progress | completed | amended | entered-in-error | stopped Details The position of the questionnaire response within its overall lifecycle. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
subject		Reference<Resource>	The subject of the questions Details The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information. If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.
encounter		Reference<Encounter>	Encounter created as part of Details The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.
authored		dateTime	Date the answers were gathered Details The date and/or time that this set of answers were last changed. May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured. This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.
author		Reference< Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization >	Person who received and recorded the answers Details Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system. Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.
source		Reference< Patient | Practitioner | PractitionerRole | RelatedPerson >	The person who answered the questions Details The person who answered the questions about the subject. If not specified, no inference can be made about who provided the data.
item		QuestionnaireResponseItem[]	Groups and questions Details A group or question item from the original questionnaire for which answers are provided. Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
linkId	✓	string	Pointer to specific item from Questionnaire Details The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
definition		uri	ElementDefinition - details for the item Details A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item. The ElementDefinition must be in a [StructureDefinition](structuredefinition.html#), and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. There is no need for this element if the item pointed to by the linkId has a definition listed.
text		string	Name for group or question text Details Text that is displayed above the contents of the group or as the text of the question being answered.
answer		QuestionnaireResponseItemAnswer[]	The response(s) to the question Details The respondent's answer(s) to the question. The value is nested because we cannot have a repeating structure that has variable type.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
value[x]		boolean, decimal, integer, date, dateTime, time, string, uri, Attachment, Coding, Quantity, Reference<Resource>	Single-valued answer to the question Details The answer (or one of the answers) provided by the respondent to the question. More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.
item		[]	Nested groups and questions Details Nested groups and/or questions found within this particular answer.
item		[]	Nested questionnaire response items Details Questions or sub-groups nested beneath a question or group.

Search Parameters

Name	Type	Description	Expression
author	reference	The author of the questionnaire response	QuestionnaireResponse.author
authored	date	When the questionnaire response was last changed	QuestionnaireResponse.authored
based-on	reference	Plan/proposal/order fulfilled by this questionnaire response	QuestionnaireResponse.basedOn
encounter	reference	Encounter associated with the questionnaire response	QuestionnaireResponse.encounter
identifier	token	The unique identifier for the questionnaire response	QuestionnaireResponse.identifier
part-of	reference	Procedure or observation this questionnaire response was performed as a part of	QuestionnaireResponse.partOf
patient	reference	The patient that is the subject of the questionnaire response	QuestionnaireResponse.subject.where(resolve() is Patient)
questionnaire	reference	The questionnaire the answers are provided for	QuestionnaireResponse.questionnaire
source	reference	The individual providing the information reflected in the questionnaire respose	QuestionnaireResponse.source
status	token	The status of the questionnaire response	QuestionnaireResponse.status
subject	reference	The subject of the questionnaire response	QuestionnaireResponse.subject

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored Details May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Usage

QuestionnaireResponse provides a complete or partial list of answers to a set of questions filled when responding to a questionnaire. The questions may be included directly or by reference to a Questionnaire resource that defines the questions as well as the constraints on the allowed answers. In some cases, both formal rules for editing the questionnaire (via link to Questionnaire) as well as sufficient local information to allow rendering of the questionnaire may be provided.

Each time a questionnaire is completed for a different subject or at a different time, a distinct QuestionnaireResponse is generated, though it may be possible for a previously entered set of answers to be edited or updated.

Questionnaire responses cover the need to communicate data originating from forms used in medical history examinations, research questionnaires and sometimes full clinical specialty records. In many systems this data is collected using user-defined screens and forms. Questionnaire responses record specifics about data capture - exactly what questions were asked, in what order, what answers were given, etc. Each of these questions is part of the Questionnaire, and as such the Questionnaire is a separately identifiable Resource, whereas the individual questions are not.

Examples of Questionnaires include:

• Past medical history (PMH)
• Family diseases
• Social history
• Research questionnaires and Case report forms (CRFs)
• Quality and evaluation forms
• Patient intake form (e.g. clipboard)
• Insurance claim form

QuestionnaireResponse resources can be validated against their corresponding Questionnaire to verify that required groups and questions are answered and that answers fit constraints in terms of cardinality, data type, etc.

Relationships

The QuestionnaireResponse resource captures the responses to a questionnaire, while Questionnaire represents the definition of the questionnaire form, including what questions are asked, how they're organized and the constraints on the allowed answers.

While Observation, with its nested relatedObservation structure, can create complex hierarchies of questions and answers, the focus is different. First, Observation is used primarily for capturing data elements that are "true" observations - lab measurements, vital signs, social assessments, etc., while QuestionnaireResponse can be used to capture any types of data, including data that would typically map to other resources (Procedure, Patient, MedicationStatement, etc.). Second, the focus of QuestionnaireResponse includes the specific phrasing and organization of the questions. All data must be explicitly captured as a question. With Observation, the focus is only on the meaning of the answer, not what question was asked (assuming a question was even asked at all). Additional information such as normal ranges, interpretation, date, etc., may also be captured.

Referenced By

• ClinicalImpression
• Consent
• Contract
• DeviceUseStatement
• FamilyMemberHistory
• Observation