{
  "description": null,
  "_filename": "example/Questionnaire-phq-9-example.json",
  "package_name": "hl7.fhir.us.core.r4b",
  "subjectType": [ "Patient" ],
  "date": "2023-03-31",
  "meta": {
    "profile": [ "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire" ]
  },
  "publisher": "HL7 International / Cross-Group Projects",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166"
    } ]
  } ],
  "name": "PHQ9Example",
  "item": [ {
    "code": [ {
      "code": "44250-9",
      "system": "http://loinc.org",
      "display": "Little interest or pleasure in doing things in last 2 weeks"
    } ],
    "text": "Little interest or pleasure in doing things?",
    "type": "choice",
    "linkId": "/44250-9",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44255-8",
      "system": "http://loinc.org",
      "display": "Feeling down, depressed, or hopeless in last 2 weeks"
    } ],
    "text": "Feeling down, depressed, or hopeless?",
    "type": "choice",
    "linkId": "/44255-8",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44259-0",
      "system": "http://loinc.org",
      "display": "Trouble falling or staying asleep, or sleeping too much"
    } ],
    "text": "Trouble falling or staying asleep, or sleeping too much",
    "type": "choice",
    "linkId": "/44259-0",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44254-1",
      "system": "http://loinc.org",
      "display": "Feeling tired or having little energy"
    } ],
    "text": "Feeling tired or having little energy",
    "type": "choice",
    "linkId": "/44254-1",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44251-7",
      "system": "http://loinc.org",
      "display": "Poor appetite or overeating"
    } ],
    "text": "Poor appetite or overeating",
    "type": "choice",
    "linkId": "/44251-7",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44258-2",
      "system": "http://loinc.org",
      "display": "Feeling bad about yourself-or that you are a failure or have let yourself or your family down"
    } ],
    "text": "Feeling bad about yourself-or that you are a failure or have let yourself or your family down",
    "type": "choice",
    "linkId": "/44258-2",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44252-5",
      "system": "http://loinc.org",
      "display": "Trouble concentrating on things, such as reading the newspaper or watching television"
    } ],
    "text": "Trouble concentrating on things, such as reading the newspaper or watching television",
    "type": "choice",
    "linkId": "/44252-5",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44253-3",
      "system": "http://loinc.org",
      "display": "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"
    } ],
    "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",
    "linkId": "/44253-3",
    "required": true,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44260-8",
      "system": "http://loinc.org",
      "display": "Thoughts that you would be better off dead, or of hurting yourself in some way"
    } ],
    "text": "Thoughts that you would be better off dead, or of hurting yourself in some way",
    "type": "choice",
    "linkId": "/44260-8",
    "required": false,
    "answerOption": [ {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "0"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 0
      } ],
      "valueCoding": {
        "code": "LA6568-5",
        "system": "http://loinc.org",
        "display": "Not at all"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "1"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 1
      } ],
      "valueCoding": {
        "code": "LA6569-3",
        "system": "http://loinc.org",
        "display": "Several days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "2"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 2
      } ],
      "valueCoding": {
        "code": "LA6570-1",
        "system": "http://loinc.org",
        "display": "More than half the days"
      }
    }, {
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
        "valueString": "3"
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
        "valueDecimal": 3
      } ],
      "valueCoding": {
        "code": "LA6571-9",
        "system": "http://loinc.org",
        "display": "Nearly every day"
      }
    } ]
  }, {
    "code": [ {
      "code": "44261-6",
      "system": "http://loinc.org",
      "display": "Patient Health Questionnaire 9 item (PHQ-9) total score [Reported]"
    } ],
    "text": "Patient health questionnaire 9 item total score",
    "type": "decimal",
    "linkId": "/44261-6",
    "required": false
  }, {
    "code": [ {
      "code": "69722-7",
      "system": "http://loinc.org",
      "display": "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?"
    } ],
    "text": "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",
    "linkId": "/69722-7",
    "required": false,
    "answerOption": [ {
      "valueCoding": {
        "code": "LA6572-7",
        "system": "http://loinc.org",
        "display": "Not difficult at all"
      }
    }, {
      "valueCoding": {
        "code": "LA6573-5",
        "system": "http://loinc.org",
        "display": "Somewhat difficult"
      }
    }, {
      "valueCoding": {
        "code": "LA6575-0",
        "system": "http://loinc.org",
        "display": "Very difficult"
      }
    }, {
      "valueCoding": {
        "code": "LA6574-3",
        "system": "http://loinc.org",
        "display": "Extremely difficult"
      }
    } ]
  } ],
  "copyright": "Used by permission of HL7 International, all rights reserved Creative Commons License",
  "type": null,
  "experimental": "true",
  "resourceType": "Questionnaire",
  "title": "PHQ-9 Example",
  "package_version": "7.0.0-ballot",
  "extension": [ {
    "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode": "cgp"
  } ],
  "status": "active",
  "id": "04742431-8b57-46cb-bb74-baa23da82cc8",
  "kind": null,
  "url": "http://hl7.org/fhir/us/core/Questionnaire/phq-9-example",
  "code": [ {
    "code": "44249-1",
    "system": "http://loinc.org",
    "display": "PHQ-9 quick depression assessment panel [Reported.PHQ]"
  } ],
  "version": "7.0.0-ballot",
  "contact": [ {
    "name": "HL7 International / Cross-Group Projects",
    "telecom": [ {
      "value": "http://www.hl7.org/Special/committees/cgp",
      "system": "url"
    }, {
      "value": "cgp@lists.HL7.org",
      "system": "email"
    } ]
  } ]
}