{
"description": null,
"_filename": "example/Questionnaire-questionnaire-sdc-profile-example-render.json",
"package_name": "hl7.fhir.uv.sdc",
"date": "2024-12-17T01:55:34+00:00",
"meta": {
"profile": [ "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-render" ]
},
"publisher": "HL7 International / FHIR Infrastructure",
"jurisdiction": [ {
"coding": [ {
"code": "001",
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"display": "World"
} ]
} ],
"name": "SDCAdvancedRenderingExample",
"item": [ {
"item": [ {
"text": "Enter your First Name",
"type": "string",
"_text": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "color:green;"
} ]
},
"linkId": "1.1"
}, {
"text": "Please answer Yes or No to each of the following questions:",
"type": "display",
"_text": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "Please answer Yes or No to each of the following questions:"
} ]
},
"linkId": "1.2"
}, {
"text": "ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.",
"type": "display",
"linkId": "1.3",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory",
"valueCodeableConcept": {
"text": "The text provides guidance on how the information will be handled from a security perspective.",
"coding": [ {
"code": "security",
"system": "http://hl7.org/fhir/questionnaire-display-category",
"display": "Security"
} ]
}
} ]
}, {
"item": [ {
"text": "Form ID",
"type": "string",
"linkId": "1.4.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
} ]
}, {
"text": "Event ID",
"type": "string",
"linkId": "1.4.2"
} ],
"type": "group",
"linkId": "1.4"
} ],
"text": "Text Appearance",
"type": "group",
"linkId": "1"
}, {
"item": [ {
"text": "If you have any other medical problems or serious injuries, please describe them here:",
"type": "text",
"linkId": "2.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where a user can type in their answer freely.",
"coding": [ {
"code": "text-box",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Text Box"
} ]
}
} ]
}, {
"text": "Gender:",
"type": "choice",
"linkId": "2.2",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others.",
"coding": [ {
"code": "radio-button",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Radio Button"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "female",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Female"
},
"initialSelected": true
}, {
"valueCoding": {
"code": "male",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Male"
}
}, {
"valueCoding": {
"code": "other",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Other"
}
}, {
"valueCoding": {
"code": "unknown",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Unknown"
}
} ]
}, {
"item": [ {
"text": "Completely dissatisfied",
"type": "display",
"linkId": "2.3.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [ {
"code": "lower",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Lower-bound"
} ]
}
} ]
}, {
"text": "Completely satisfied",
"type": "display",
"linkId": "2.3.2",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [ {
"code": "upper",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Upper-bound"
} ]
}
} ]
} ],
"text": "Rate your doctor:",
"type": "integer",
"linkId": "2.3",
"initial": [ {
"valueInteger": 50
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where an axis is displayed between the high and low values and the control can be visually manipulated to select a value anywhere on the axis.",
"coding": [ {
"code": "slider",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Slider"
} ]
}
}, {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-sliderStepValue",
"valueInteger": 10
}, {
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
}, {
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 100
} ]
}, {
"item": [ {
"text": "Diabetes",
"type": "choice",
"linkId": "2.4.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible.",
"coding": [ {
"code": "check-box",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Check-box"
} ]
}
}, {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-width",
"valueQuantity": {
"code": "%",
"value": 65,
"system": "http://unitsofmeasure.org"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "diabetes-type1",
"system": "http://example.org/CodeSystem/conditions",
"display": "Type 1"
}
}, {
"valueCoding": {
"code": "diabetes-type2",
"system": "http://example.org/CodeSystem/conditions",
"display": "Type 2"
}
} ]
}, {
"text": "Other Information",
"type": "choice",
"linkId": "2.4.2",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible.",
"coding": [ {
"code": "check-box",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Check-box"
} ]
}
}, {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-width",
"valueQuantity": {
"code": "%",
"value": 35,
"system": "http://unitsofmeasure.org"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "diabetes-type1",
"system": "http://example.org/CodeSystem/conditions",
"display": "Type 1"
}
}, {
"valueCoding": {
"code": "diabetes-type2",
"system": "http://example.org/CodeSystem/conditions",
"display": "Type 2"
}
}, {
"valueCoding": {
"code": "otherinformation-hypertension",
"system": "http://example.org/CodeSystem/conditions",
"display": "Hypertension"
}
}, {
"valueCoding": {
"code": "otherinformation-smoker",
"system": "http://example.org/CodeSystem/conditions",
"display": "Smoker"
}
} ]
} ],
"text": "Medical History",
"type": "group",
"linkId": "2.4",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions.",
"coding": [ {
"code": "htable",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Horizontal Answer Table"
} ]
}
} ]
}, {
"item": [ {
"text": "Relationship to patient",
"type": "choice",
"linkId": "2.5.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "FTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Father"
}
}, {
"valueCoding": {
"code": "MTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Mother"
}
}, {
"valueCoding": {
"code": "SIB",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Sibling"
}
} ]
}, {
"text": "Name",
"type": "string",
"linkId": "2.5.2"
}, {
"text": "Gender",
"type": "choice",
"linkId": "2.5.3",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [ {
"code": "radio-button",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Radio Button"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "female",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Female"
},
"initialSelected": true
}, {
"valueCoding": {
"code": "male",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Male"
}
}, {
"valueCoding": {
"code": "other",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Other"
}
}, {
"valueCoding": {
"code": "unknown",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Unknown"
}
} ]
} ],
"type": "group",
"linkId": "2.5",
"extension": [ {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-collapsible",
"valueCode": "default-closed"
} ]
}, {
"item": [ {
"text": "Exercise Habits",
"type": "choice",
"linkId": "2.6.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible.",
"coding": [ {
"code": "check-box",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Check-box"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "daily",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Daily"
}
}, {
"valueCoding": {
"code": "weekly",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Weekly"
}
}, {
"valueCoding": {
"code": "monthly",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Monthly"
}
}, {
"valueCoding": {
"code": "never",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Never"
}
} ]
}, {
"text": "Smoking Frequency",
"type": "choice",
"linkId": "2.6.2",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible.",
"coding": [ {
"code": "check-box",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Check-box"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "daily",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Daily"
}
}, {
"valueCoding": {
"code": "weekly",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Weekly"
}
}, {
"valueCoding": {
"code": "monthly",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Monthly"
}
}, {
"valueCoding": {
"code": "never",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Never"
}
} ]
}, {
"text": "Alcohol Consumption",
"type": "choice",
"linkId": "2.6.3",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a box beside them. The box can be toggled to select or de-select a given choice. Multiple selections may be possible.",
"coding": [ {
"code": "check-box",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Check-box"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "daily",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Daily"
}
}, {
"valueCoding": {
"code": "weekly",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Weekly"
}
}, {
"valueCoding": {
"code": "monthly",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Monthly"
}
}, {
"valueCoding": {
"code": "never",
"system": "http://example.org/CodeSystem/lifestyle",
"display": "Never"
}
} ]
} ],
"text": "Lifestyle Factors",
"type": "group",
"linkId": "2.6",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Questions within the group are columns in the table with possible answers as rows. Used for 'choice' questions.",
"coding": [ {
"code": "htable",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Horizontal Answer Table"
} ]
}
} ]
} ],
"text": "Control Appearance",
"type": "group",
"linkId": "2"
}, {
"item": [ {
"text": "Have you traveled outside the country within the last 14 days?",
"type": "choice",
"linkId": "3.1",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-supportLink",
"valueUri": "http://hl7.org/fhir/StructureDefinition/questionnaire-supportLink"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others.",
"coding": [ {
"code": "radio-button",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Radio Button"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "Y",
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "N",
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"display": "No"
}
} ]
}, {
"text": "Select Platelet:",
"type": "choice",
"linkId": "3.2",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
}, {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn",
"extension": [ {
"url": "path",
"valueString": "code"
}, {
"url": "label",
"valueString": "CODE"
}, {
"url": "width",
"valueQuantity": {
"code": "%",
"value": 25,
"system": "http://unitsofmeasure.org"
}
}, {
"url": "forDisplay",
"valueBoolean": false
} ]
}, {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn",
"extension": [ {
"url": "path",
"valueString": "display"
}, {
"url": "label",
"valueString": "DESCRIPTION"
}, {
"url": "width",
"valueQuantity": {
"code": "%",
"value": 75,
"system": "http://unitsofmeasure.org"
}
}, {
"url": "forDisplay",
"valueBoolean": true
} ]
} ],
"answerValueSet": "http://loinc.org/vs/LL715-4"
}, {
"text": "Gender:",
"type": "choice",
"linkId": "3.3",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others.",
"coding": [ {
"code": "radio-button",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Radio Button"
} ]
}
} ],
"answerOption": [ {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "(a)"
} ],
"valueCoding": {
"code": "female",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Female"
},
"initialSelected": true
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "(b)"
} ],
"valueCoding": {
"code": "male",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Male"
}
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "(c)"
} ],
"valueCoding": {
"code": "other",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Other"
}
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "(d)"
} ],
"valueCoding": {
"code": "unknown",
"system": "http://hl7.org/fhir/administrative-gender",
"display": "Unknown"
}
} ]
}, {
"text": "Enter timing of harm assessment:",
"type": "choice",
"linkId": "3.4",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "vertical"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "A control where choices are listed with a button beside them. The button can be toggled to select or de-select a given choice. Selecting one item deselects all others.",
"coding": [ {
"code": "radio-button",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Radio Button"
} ]
}
} ],
"answerValueSet": "#LL2821-8"
}, {
"text": "Birth Date",
"type": "date",
"linkId": "3.5",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "mm-dd-yyyy"
} ]
}, {
"text": "IMPORTANT: Please complete questionnaire.",
"type": "display",
"_text": {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "color:red;"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "IMPORTANT: Please complete questionnaire."
} ]
},
"linkId": "3.6",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/rendering-styleSensitive",
"valueBoolean": true
} ]
}, {
"text": "Enter your Middle Name",
"type": "string",
"linkId": "3.7",
"extension": [ {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-optionalDisplay",
"valueBoolean": true
} ]
}, {
"text": "During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.",
"type": "decimal",
"linkId": "3.8",
"extension": [ {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-shortText",
"valueString": "Annual family income"
} ]
}, {
"text": "Which of the following time-slots are you available for?",
"type": "string",
"linkId": "3.9",
"extension": [ {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-columnCount",
"valuePositiveInt": 3
} ],
"answerOption": [ {
"valueString": "9-10am"
}, {
"valueString": "10-11am"
}, {
"valueString": "11am-12pm"
}, {
"valueString": "1-2pm"
}, {
"valueString": "2-3pm"
}, {
"valueString": "3-4pm"
} ]
} ],
"text": "Additional Display Content",
"type": "group",
"linkId": "3"
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": null,
"package_version": "4.0.0-ballot",
"extension": [ {
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm[x]",
"valueCoding": {
"code": "semver",
"system": "http://hl7.org/fhir/version-algorithm"
}
} ],
"contained": [ {
"description": "The answer list for timing of harm assessment",
"compose": {
"include": [ {
"system": "http://loinc.org",
"concept": [ {
"code": "LA20752-4",
"display": "Within 24 hours",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/valueset-label",
"valueString": "A."
} ]
}, {
"code": "LA20753-2",
"display": "After 24 hours but before 3 days",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/valueset-label",
"valueString": "B."
} ]
}, {
"code": "LA20754-0",
"display": "Three days or later",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/valueset-label",
"valueString": "C."
} ]
}, {
"code": "LA4489-6",
"display": "Unknown",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/valueset-label",
"valueString": "D."
} ]
} ]
} ]
},
"name": "TimingOfHarmAssessmentValueSet",
"copyright": "This content from LOINC® is copyright © 1995 Regenstrief Institute, Inc. and the LOINC Committee, and available at no cost under the license at http://loinc.org/terms-of-use",
"resourceType": "ValueSet",
"title": "Timing of harm assessment [AHRQ]",
"status": "active",
"id": "LL2821-8",
"url": "http://example.org/ValueSet/LL2821-8"
} ],
"status": "active",
"id": "0fc6ddd5-df6d-44e9-85bc-ef78df6ca4d3",
"kind": null,
"url": "http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render",
"identifier": [ {
"value": "urn:oid:2.16.840.1.113883.4.642.40.17.35.16",
"system": "urn:ietf:rfc:3986"
} ],
"version": "4.0.0-ballot",
"contact": [ {
"name": "HL7 International / FHIR Infrastructure",
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/fiwg",
"system": "url"
} ]
}, {
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/fiwg",
"system": "url"
} ]
} ]
}