PackagesCanonicalsLogsProblems
    Packages
    NHSD.Assets.STU3@1.0.0
    https://fhir.nhs.uk/STU3/StructureDefinition/DCH-ExaminationFindings-QuestionnaireResponse-1
{
  "description": "This Questionnaire Response resource is constrained to represent the s constrained to represent the responses given to an Examination Findings questionnaire, to support the Digital Child Health project.",
  "_filename": "DCH-ExaminationFindings-QuestionnaireResponse-1.json",
  "package_name": "NHSD.Assets.STU3",
  "date": "2018-01-30T12:02:36.823+00:00",
  "derivation": "constraint",
  "meta": {
    "lastUpdated": "2018-04-12T14:35:55.068+01:00"
  },
  "publisher": "NHS Digital",
  "fhirVersion": "3.0.1",
  "name": "DCH-ExaminationFindings-QuestionnaireResponse-1",
  "abstract": false,
  "copyright": "Copyright © 2018 NHS Digital",
  "type": "QuestionnaireResponse",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "1.0.0",
  "snapshot": {
    "element": [ {
      "constraint": [ {
        "key": "dom-2",
        "human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
        "xpath": "not(parent::f:contained and f:contained)",
        "severity": "error",
        "expression": "contained.contained.empty()"
      }, {
        "key": "dom-1",
        "human": "If the resource is contained in another resource, it SHALL NOT contain any narrative",
        "xpath": "not(parent::f:contained and f:text)",
        "severity": "error",
        "expression": "contained.text.empty()"
      }, {
        "key": "dom-4",
        "human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
        "xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
        "severity": "error",
        "expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"
      }, {
        "key": "dom-3",
        "human": "If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource",
        "xpath": "not(exists(for $id in f:contained/*/@id return $id[not(ancestor::f:contained/parent::*/descendant::f:reference/@value=concat('#', $id))]))",
        "severity": "error",
        "expression": "contained.where(('#'+id in %resource.descendants().reference).not()).empty()"
      } ],
      "path": "QuestionnaireResponse",
      "min": 0,
      "definition": "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.",
      "short": "A structured set of questions and their answers",
      "mapping": [ {
        "map": "Entity. Role, or Act",
        "identity": "rim"
      }, {
        "map": "Observation[moodCode=EVN]",
        "identity": "rim"
      }, {
        "map": "infrastructure.information",
        "identity": "w5"
      } ],
      "alias": [ "Form", "QuestionnaireAnswers" ],
      "max": "*",
      "id": "QuestionnaireResponse",
      "comment": "The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on.  I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Resource"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.id",
      "min": 0,
      "definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
      "short": "Logical id of this artifact",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "id"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.id",
      "condition": [ "ele-1" ],
      "comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.id"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.meta",
      "min": 0,
      "definition": "The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.",
      "short": "Metadata about the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Meta"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.meta",
      "condition": [ "ele-1" ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.meta"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.implicitRules",
      "min": 0,
      "definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content.",
      "isModifier": true,
      "short": "A set of rules under which this content was created",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.implicitRules",
      "condition": [ "ele-1" ],
      "comment": "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. \n\nThis element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.implicitRules"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.language",
      "min": 0,
      "definition": "The base language in which the resource is written.",
      "short": "Language of the resource content",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
          "valueReference": {
            "reference": "http://hl7.org/fhir/ValueSet/all-languages"
          }
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "Language"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A human language.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/languages"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.language",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Resource.language"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.text",
      "min": 0,
      "definition": "A human-readable narrative that contains a summary of the resource, and may 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.",
      "short": "Text summary of the resource, for human interpretation",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      }, {
        "map": "Act.text?",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Narrative"
      } ],
      "alias": [ "narrative", "html", "xhtml", "display" ],
      "max": "1",
      "id": "QuestionnaireResponse.text",
      "condition": [ "ele-1", "dom-1" ],
      "comment": "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 in formation is added later.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "DomainResource.text"
      }
    }, {
      "path": "QuestionnaireResponse.contained",
      "min": 0,
      "definition": "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.",
      "short": "Contained, inline Resources",
      "mapping": [ {
        "map": "Entity. Role, or Act",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Resource"
      } ],
      "alias": [ "inline resources", "anonymous resources", "contained resources" ],
      "max": "*",
      "id": "QuestionnaireResponse.contained",
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.contained"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the resource. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.modifierExtension",
      "min": 0,
      "definition": "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. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "DomainResource.modifierExtension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier",
      "requirements": "Used for tracking, registration and other business purposes.",
      "min": 0,
      "definition": "A business identifier assigned to a particular completed (or partially completed) questionnaire.",
      "short": "Unique id for this set of answers",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".id",
        "identity": "rim"
      }, {
        "map": "id",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier",
      "condition": [ "ele-1" ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.identifier.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.identifier.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.use",
      "requirements": "Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.",
      "min": 0,
      "definition": "The purpose of this identifier.",
      "isModifier": true,
      "short": "usual | official | temp | secondary (If known)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierUse"
        } ],
        "description": "Identifies the purpose for this identifier, if known .",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/identifier-use"
        }
      },
      "max": "0",
      "id": "QuestionnaireResponse.identifier.use",
      "condition": [ "ele-1" ],
      "comment": "This is labeled as \"Is Modifier\" because applications should not mistake a temporary id for a permanent one. Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.use"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type",
      "requirements": "Allows users to make use of identifiers when the identifier system is not known.",
      "min": 0,
      "definition": "A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.",
      "short": "Description of identifier",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CE/CNE/CWE",
        "identity": "v2"
      }, {
        "map": "CD",
        "identity": "rim"
      }, {
        "map": "fhir:CodeableConcept rdfs:subClassOf dt:CD",
        "identity": "orim"
      }, {
        "map": "CX.5",
        "identity": "v2"
      }, {
        "map": "Role.code or implied by context",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "extensible",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "IdentifierType"
        }, {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
          "valueBoolean": true
        } ],
        "description": "A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/identifier-type"
        }
      },
      "max": "0",
      "id": "QuestionnaireResponse.identifier.type",
      "condition": [ "ele-1" ],
      "comment": "This element deals only with general categories of identifiers.  It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. \n\nWhere the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.type"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.identifier.type.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.identifier.type.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding",
      "requirements": "Allows for translations and alternate encodings within a code system.  Also supports communication of the same instance to systems requiring different encodings.",
      "min": 0,
      "definition": "A reference to a code defined by a terminology system.",
      "short": "Code defined by a terminology system",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CE/CNE/CWE subset one of the sets of component 1-3 or 4-6",
        "identity": "v2"
      }, {
        "map": "CV",
        "identity": "rim"
      }, {
        "map": "fhir:Coding rdfs:subClassOf dt:CDCoding",
        "identity": "orim"
      }, {
        "map": "C*E.1-8, C*E.10-22",
        "identity": "v2"
      }, {
        "map": "union(., ./translation)",
        "identity": "rim"
      }, {
        "map": "fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "Coding"
      } ],
      "max": "*",
      "id": "QuestionnaireResponse.identifier.type.coding",
      "condition": [ "ele-1" ],
      "comment": "Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.  Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "CodeableConcept.coding"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.coding.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.identifier.type.coding.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.system",
      "requirements": "Need to be unambiguous about the source of the definition of the symbol.",
      "min": 0,
      "definition": "The identification of the code system that defines the meaning of the symbol in the code.",
      "short": "Identity of the terminology system",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "C*E.3",
        "identity": "v2"
      }, {
        "map": "./codeSystem",
        "identity": "rim"
      }, {
        "map": "fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.coding.system",
      "condition": [ "ele-1" ],
      "comment": "The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...).  OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Coding.system"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.version",
      "min": 0,
      "definition": "The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured. and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.",
      "short": "Version of the system - if relevant",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "C*E.7",
        "identity": "v2"
      }, {
        "map": "./codeSystemVersion",
        "identity": "rim"
      }, {
        "map": "fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.coding.version",
      "condition": [ "ele-1" ],
      "comment": "Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Coding.version"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.code",
      "requirements": "Need to refer to a particular code in the system.",
      "min": 0,
      "definition": "A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).",
      "short": "Symbol in syntax defined by the system",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "C*E.1",
        "identity": "v2"
      }, {
        "map": "./code",
        "identity": "rim"
      }, {
        "map": "fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.coding.code",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Coding.code"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.display",
      "requirements": "Need to be able to carry a human-readable meaning of the code for readers that do not know  the system.",
      "min": 0,
      "definition": "A representation of the meaning of the code in the system, following the rules of the system.",
      "short": "Representation defined by the system",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "C*E.2 - but note this is not well followed",
        "identity": "v2"
      }, {
        "map": "CV.displayName",
        "identity": "rim"
      }, {
        "map": "fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.coding.display",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Coding.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.coding.userSelected",
      "requirements": "This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.",
      "min": 0,
      "definition": "Indicates that this coding was chosen by a user directly - i.e. off a pick list of available items (codes or displays).",
      "short": "If this coding was chosen directly by the user",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "Sometimes implied by being first",
        "identity": "v2"
      }, {
        "map": "CD.codingRationale",
        "identity": "rim"
      }, {
        "map": "fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map;   fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\\#true a [     fhir:source \"true\";     fhir:target dt:CDCoding.codingRationale\\#O   ]",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "boolean"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.coding.userSelected",
      "condition": [ "ele-1" ],
      "comment": "Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Coding.userSelected"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.type.text",
      "requirements": "The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.",
      "min": 0,
      "definition": "A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.",
      "short": "Plain text representation of the concept",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "C*E.9. But note many systems use C*E.2 for this",
        "identity": "v2"
      }, {
        "map": "./originalText[mediaType/code=\"text/plain\"]/data",
        "identity": "rim"
      }, {
        "map": "fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText",
        "identity": "orim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.type.text",
      "condition": [ "ele-1" ],
      "comment": "Very often the text is the same as a displayName of one of the codings.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "CodeableConcept.text"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.system",
      "requirements": "There are many sets  of identifiers.  To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.",
      "min": 0,
      "definition": "Establishes the namespace for the value - that is, a URL that describes a set values that are unique.",
      "short": "The namespace for the identifier value",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX.4 / EI-2-4",
        "identity": "v2"
      }, {
        "map": "II.root or Role.id.root",
        "identity": "rim"
      }, {
        "map": "./IdentifierType",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.system",
      "condition": [ "ele-1" ],
      "comment": "see http://en.wikipedia.org/wiki/Uniform_resource_identifier",
      "example": [ {
        "label": "General",
        "valueUri": "http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.system"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.value",
      "min": 1,
      "definition": "The portion of the identifier typically relevant to the user and which is unique within the context of the system.",
      "short": "The value that is unique",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX.1 / EI.1",
        "identity": "v2"
      }, {
        "map": "II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)",
        "identity": "rim"
      }, {
        "map": "./Value",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.value",
      "condition": [ "ele-1" ],
      "comment": "If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986.  The value's primary purpose is computational mapping.  As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.)  A value formatted for human display can be conveyed using the [Rendered Value extension](extension-rendered-value.html).",
      "example": [ {
        "label": "General",
        "valueString": "123456"
      } ],
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.value"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "per-1",
        "human": "If present, start SHALL have a lower value than end",
        "xpath": "not(exists(f:start)) or not(exists(f:end)) or (f:start/@value <= f:end/@value)",
        "severity": "error",
        "expression": "start.empty() or end.empty() or (start <= end)"
      } ],
      "path": "QuestionnaireResponse.identifier.period",
      "min": 0,
      "definition": "Time period during which identifier is/was valid for use.",
      "short": "Time period when id is/was valid for use",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "DR",
        "identity": "v2"
      }, {
        "map": "IVL[lowClosed=\"true\" and highClosed=\"true\"] or URG[lowClosed=\"true\" and highClosed=\"true\"]",
        "identity": "rim"
      }, {
        "map": "CX.7 + CX.8",
        "identity": "v2"
      }, {
        "map": "Role.effectiveTime or implied by context",
        "identity": "rim"
      }, {
        "map": "./StartDate and ./EndDate",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Period"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.identifier.period",
      "condition": [ "ele-1" ],
      "comment": "This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. \"the patient was an inpatient of the hospital for this time range\") or one value from the range applies (e.g. \"give to the patient between these two times\"). If duration is required, specify the type as Interval|Duration.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.period"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.period.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.period.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.identifier.period.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.identifier.period.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.period.start",
      "min": 0,
      "definition": "The start of the period. The boundary is inclusive.",
      "short": "Starting time with inclusive boundary",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "DR.1",
        "identity": "v2"
      }, {
        "map": "./low",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "dateTime"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.period.start",
      "condition": [ "ele-1", "per-1" ],
      "comment": "If the low element is missing, the meaning is that the low boundary is not known.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Period.start"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.period.end",
      "min": 0,
      "definition": "The end of the period. If the end of the period is missing, it means that the period is ongoing. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.",
      "short": "End time with inclusive boundary, if not ongoing",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "DR.2",
        "identity": "v2"
      }, {
        "map": "./high",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "dateTime"
      } ],
      "meaningWhenMissing": "If the end of the period is missing, it means that the period is ongoing",
      "max": "1",
      "id": "QuestionnaireResponse.identifier.period.end",
      "condition": [ "ele-1", "per-1" ],
      "comment": "The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has a end value of 2012-02-03.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Period.end"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.identifier.assigner",
      "min": 0,
      "definition": "Organization that issued/manages the identifier.",
      "short": "Organization that issued id (may be just text)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": "CX.4 / (CX.4,CX.9,CX.10)",
        "identity": "v2"
      }, {
        "map": "II.assigningAuthorityName but note that this is an improper use by the definition of the field.  Also Role.scoper",
        "identity": "rim"
      }, {
        "map": "./IdentifierIssuingAuthority",
        "identity": "servd"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Organization"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.identifier.assigner",
      "condition": [ "ele-1" ],
      "comment": "The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Identifier.assigner"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.assigner.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.assigner.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.identifier.assigner.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.identifier.assigner.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.assigner.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.assigner.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.assigner.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.assigner.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.identifier.assigner.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.identifier.assigner.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.basedOn",
      "requirements": "Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.",
      "min": 0,
      "definition": "The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse.  For example, a ProcedureRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.",
      "short": "Request fulfilled by this QuestionnaireResponse",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=FLFS].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/ReferralRequest"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/CarePlan"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/ProcedureRequest"
      } ],
      "alias": [ "order" ],
      "max": "0",
      "id": "QuestionnaireResponse.basedOn",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.basedOn"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.basedOn.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.basedOn.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.basedOn.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.basedOn.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.basedOn.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.basedOn.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.basedOn.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.basedOn.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.basedOn.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.basedOn.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.parent",
      "min": 0,
      "definition": "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.",
      "short": "Part of this action",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".inboundRelationship[typeCode=COMP].source[moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Observation"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Procedure"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.parent",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.parent"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.parent.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.parent.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.parent.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.parent.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.parent.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.parent.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.parent.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.parent.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.parent.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.parent.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.questionnaire",
      "requirements": "Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.",
      "min": 0,
      "definition": "The Questionnaire that defines and organizes the questions for which answers are being provided.",
      "short": "Form being answered",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": "./outboundRelationship[typeCode=INST]/target[classCode=OBS, moodCode=DEFN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Questionnaire"
      } ],
      "alias": [ "Form" ],
      "max": "0",
      "id": "QuestionnaireResponse.questionnaire",
      "condition": [ "ele-1" ],
      "comment": "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.).",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.questionnaire"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.questionnaire.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.questionnaire.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.questionnaire.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.questionnaire.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.questionnaire.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.questionnaire.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.questionnaire.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.questionnaire.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.questionnaire.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.questionnaire.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.status",
      "requirements": "The information on Questionnaire resources  may possibly be gathered during multiple sessions and altered after considered being finished.",
      "min": 1,
      "definition": "The position of the questionnaire response within its overall lifecycle.",
      "isModifier": true,
      "short": "in-progress | completed | amended | entered-in-error | stopped",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".statusCode (also whether there's a revisionControlAct - and possibly mood to distinguish \"in-progress\" from \"published)",
        "identity": "rim"
      }, {
        "map": "status",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "code"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireResponseStatus"
        } ],
        "description": "Lifecycle status of the questionnaire response.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/questionnaire-answers-status"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.status",
      "condition": [ "ele-1" ],
      "comment": "This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.status"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.subject",
      "requirements": "Allows linking the answers to the individual the answers describe.  May also affect access control.",
      "min": 1,
      "definition": "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.",
      "short": "The subject of the questions",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role",
        "identity": "rim"
      }, {
        "map": "who.focus",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-DCH-Patient-1"
      } ],
      "alias": [ "Patient", "Focus" ],
      "max": "1",
      "id": "QuestionnaireResponse.subject",
      "condition": [ "ele-1" ],
      "comment": "If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.subject"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.subject.reference",
      "min": 1,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.context",
      "requirements": "Provides context for the information that was captured.  May also affect access control.",
      "min": 1,
      "definition": "The encounter or episode of care with primary association to the questionnaire response.",
      "short": "Encounter or Episode during which questionnaire was completed",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]",
        "identity": "rim"
      }, {
        "map": "context",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-DCH-Encounter-1"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.context",
      "condition": [ "ele-1" ],
      "comment": "A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.context"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.context.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.context.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.context.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.context.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.context.reference",
      "min": 1,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.context.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.context.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.context.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.context.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.context.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.authored",
      "requirements": "Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.",
      "min": 0,
      "definition": "The date and/or time that this set of answers were last changed.",
      "short": "Date the answers were gathered",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=AUT].time",
        "identity": "rim"
      }, {
        "map": "when.recorded",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "dateTime"
      } ],
      "alias": [ "Date Created", "Date published", "Date Issued", "Date updated" ],
      "max": "1",
      "id": "QuestionnaireResponse.authored",
      "condition": [ "ele-1" ],
      "comment": "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.\n\nThis element is optional to allow for systems that may not know the value, however it SHOULD be populated if possible.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.authored"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.author",
      "requirements": "Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.",
      "min": 1,
      "definition": "Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.",
      "short": "Person who received and recorded the answers",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=AUT].role",
        "identity": "rim"
      }, {
        "map": "who.author",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-DCH-Practitioner-1"
      } ],
      "alias": [ "Laboratory", "Service", "Practitioner", "Department", "Company", "Performer" ],
      "max": "1",
      "id": "QuestionnaireResponse.author",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.author"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.author.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.author.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.author.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.author.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.author.reference",
      "min": 1,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.author.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.author.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.author.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.author.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.author.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.source",
      "requirements": "When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.",
      "min": 0,
      "definition": "The person who answered the questions about the subject.",
      "short": "The person who answered the questions",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=INF].role",
        "identity": "rim"
      }, {
        "map": "who.source",
        "identity": "w5"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Patient"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Practitioner"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/RelatedPerson"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.source",
      "condition": [ "ele-1" ],
      "comment": "If not specified, no inference can be made about who provided the data.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.source"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.source.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.source.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.source.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.source.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.source.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.source.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.source.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.source.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.source.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.source.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "A group or question item from the original questionnaire for which answers are provided.",
      "short": "Groups and questions",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "closed",
        "ordered": true,
        "discriminator": [ {
          "path": "text",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "*",
      "id": "QuestionnaireResponse.item",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 0,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 0,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "*",
      "id": "QuestionnaireResponse.item.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 0,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "boolean"
      }, {
        "code": "decimal"
      }, {
        "code": "integer"
      }, {
        "code": "date"
      }, {
        "code": "dateTime"
      }, {
        "code": "time"
      }, {
        "code": "string"
      }, {
        "code": "uri"
      }, {
        "code": "Attachment"
      }, {
        "code": "Coding"
      }, {
        "code": "Quantity"
      }, {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the response provided for a question.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/questionnaire-answers"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "*",
      "id": "QuestionnaireResponse.item.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "*",
      "id": "QuestionnaireResponse.item.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of colour. The record of a clinician’s ‘first impression’ assessment including general clinical examination finding, e.g., clubbing, anaemia, jaundice, obese/malnourished etc.",
      "short": "Physical examination of colour",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "generalAppearanceColour",
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "generalAppearanceColour",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "General Appearance Colour",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:generalAppearanceColour.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "The record of essential physiological measurements, e.g., heart rate, blood pressure, temperature, pulse, respiratory rate, level of consciousness.",
      "short": "The record of essential physiological measurements",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "vitalSigns",
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:vitalSigns.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:vitalSigns.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "vitalSigns",
      "id": "QuestionnaireResponse.item:vitalSigns.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:vitalSigns.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Vital signs",
      "id": "QuestionnaireResponse.item:vitalSigns.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:vitalSigns.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:vitalSigns.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:vitalSigns.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:vitalSigns.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.valueString",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "sliceName": "valueString",
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the response provided for a question.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/questionnaire-answers"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:vitalSigns.answer.valueString:valueString",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:vitalSigns.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:vitalSigns.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Formal mental state examination or general description, e.g.. depression, anxiety, confusion, delirium",
      "short": "Formal mental state examination",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "mentalState",
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:mentalState.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:mentalState.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "mentalState",
      "id": "QuestionnaireResponse.item:mentalState.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:mentalState.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Mental state",
      "id": "QuestionnaireResponse.item:mentalState.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:mentalState.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:mentalState.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:mentalState.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:mentalState.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.valueString",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "sliceName": "valueString",
      "binding": {
        "strength": "example",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the response provided for a question.",
        "valueSetReference": {
          "reference": "http://hl7.org/fhir/ValueSet/questionnaire-answers"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:mentalState.answer.valueString:valueString",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:mentalState.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:mentalState.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Head and Skull (Features, hair, moulding, fontanelles, sutures, caput, cephalhaematoma, trauma)",
      "short": "Physical examination of Head and Skull",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "headAndSkull",
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:headAndSkull.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:headAndSkull.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "headAndSkull",
      "id": "QuestionnaireResponse.item:headAndSkull.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:headAndSkull.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Head and Skull",
      "id": "QuestionnaireResponse.item:headAndSkull.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:headAndSkull.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:headAndSkull.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:headAndSkull.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:headAndSkull.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:headAndSkull.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:headAndSkull.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:headAndSkull.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Face (Appearance, haemangioma, asymmetry)",
      "short": "Physical examination of Face",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "face",
      "max": "1",
      "id": "QuestionnaireResponse.item:face",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:face.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:face.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "face",
      "id": "QuestionnaireResponse.item:face.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:face.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Face",
      "id": "QuestionnaireResponse.item:face.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:face.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:face.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:face.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:face.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:face.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "time"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:face.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:face.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:face.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Ears (Dimples, position, appearance)",
      "short": "Physical examination of Ears",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "ears",
      "max": "1",
      "id": "QuestionnaireResponse.item:ears",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:ears.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:ears.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "ears",
      "id": "QuestionnaireResponse.item:ears.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:ears.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Ears",
      "id": "QuestionnaireResponse.item:ears.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:ears.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:ears.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:ears.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:ears.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:ears.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:ears.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:ears.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Neck and Clavicles (Clavicles fracture, mobility, sternoma)",
      "short": "Physical examination of Neck and Clavicles",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "neckAndClavicle",
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:neckAndClavicle.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:neckAndClavicle.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "neckAndClavicle",
      "id": "QuestionnaireResponse.item:neckAndClavicle.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:neckAndClavicle.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Neck and Clavicles",
      "id": "QuestionnaireResponse.item:neckAndClavicle.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:neckAndClavicle.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Mouth and Palate (Palate  (visualise and palpate), teeth)",
      "short": "Physical examination of Mouth and Palate",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "oralExaminationMouthAndPalate",
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "oralExaminationMouthAndPalate",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Oral examination: Mouth and Palate",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Chest (Shape, nipples, auscultate breath sounds)",
      "short": "Physical examination of Cardiovascular System",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "cardiovascularSystem",
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "cardiovascularSystem",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Cardiovascular System",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:cardiovascularSystem.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Chest (Shape, nipples, auscultate breath sounds)",
      "short": "Physical examination of Chest",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "chest",
      "max": "1",
      "id": "QuestionnaireResponse.item:chest",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:chest.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:chest.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "chest",
      "id": "QuestionnaireResponse.item:chest.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:chest.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Cardiovascular system: Chest",
      "id": "QuestionnaireResponse.item:chest.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:chest.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:chest.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:chest.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:chest.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:chest.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:chest.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:chest.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Respiratory (Distress, cry)",
      "short": "Physical examination of Respiratory",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "respiratorySystem",
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:respiratorySystem.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:respiratorySystem.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "respiratorySystem",
      "id": "QuestionnaireResponse.item:respiratorySystem.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:respiratorySystem.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Respiratory system",
      "id": "QuestionnaireResponse.item:respiratorySystem.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:respiratorySystem.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:respiratorySystem.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:respiratorySystem.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Abdomen (Liver, spleen, masses, tone)",
      "short": "Physical examination of Abdomen",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "abdomen",
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomen.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomen.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "abdomen",
      "id": "QuestionnaireResponse.item:abdomen.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomen.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Abdomen",
      "id": "QuestionnaireResponse.item:abdomen.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomen.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomen.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomen.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomen.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomen.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomen.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomen.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Umbilicus (Smell, discharge, hernia)",
      "short": "Physical examination of Umbilicus",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "abdomenUmbilicus",
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "abdomenUmbilicus",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Abdomen Umbilicus",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Genitalia (Female, Male not Testes)",
      "short": "Physical examination of Genitalia",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "genitourinaryGenitalia",
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "genitourinaryGenitalia",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Genitourinary: Genitalia",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Anus (position, patency)",
      "short": "Physical examination of Anus",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "genitourinaryAnus",
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "genitourinaryAnus",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Genitourinary: Anus",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:genitourinaryAnus.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Reflexes (Grasp, Moro, rooting, stepping)",
      "short": "Physical examination of Reflexes",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "nervousSystemReflexes",
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "nervousSystemReflexes",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Nervous system: Reflexes",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Examination of manipulation",
      "short": "Examination of manipulation",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "musculoskeletalManipulation",
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "musculoskeletalManipulation",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Musculoskeletal: Manipulation",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Upper Limbs (Length, digits, palmar creases, syn/poly-dactyly, tone, movement, oedema)",
      "short": "Physical examination of Upper Limbs",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "musculoskeletalUpperLimbs",
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "musculoskeletalUpperLimbs",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Musculoskeletal: Upper Limbs",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Lower Limbs, feet (Length digits, syn/poly-dactyly, tone, movement, talipes, oedema)",
      "short": "Physical examination of Lower Limbs, feet",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "musculoskeletalLowerLimbsFeet",
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "musculoskeletalLowerLimbsFeet",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Musculoskeletal: Lower Limbs, feet",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Back and Spine (Dimples, hair tufts, naevus, abnormal skin patches)",
      "short": "Physical examination of Back and Spine",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "musculoskeletalBackAndSpine",
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "musculoskeletalBackAndSpine",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Musculoskeletal: Back and Spine",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 1,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "1",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Skin (Hyperpigmented macule, birthmarks, dry abrasions, bruises)",
      "short": "Physical examination of Skin",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "skin",
      "max": "1",
      "id": "QuestionnaireResponse.item:skin",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:skin.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:skin.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "skin",
      "id": "QuestionnaireResponse.item:skin.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:skin.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Skin",
      "id": "QuestionnaireResponse.item:skin.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:skin.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:skin.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:skin.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:skin.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:skin.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:skin.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:skin.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Stills, startles, risk factors as recorded for example at 6-8 week GP Led Review or School Entry Review",
      "short": "Stills, startles, risk factors",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "developmentalAssessmentHearing",
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "developmentalAssessmentHearing",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Developmental Assessment: Hearing",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Tone, head control as recorded for example at 6-8 week GP Led Review",
      "short": "Tone, head control",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "developmentalAssessmentLocomotion",
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "developmentalAssessmentLocomotion",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Developmental Assessment: Locomotion",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Social smile as recorded for example at 6-8 week GP Led Review",
      "short": "Social smile",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "developmentalAssessmentSpeechLanguage",
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "developmentalAssessmentSpeechLanguage",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Developmental Assessment: Speech and Language",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Parental concerns, sleep, feeding as recorded for example at 6-8 week GP Led Review",
      "short": "Parental concerns, sleep, feeding",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "developmentalAssessmentBehaviour",
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "developmentalAssessmentBehaviour",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Developmental Assessment: Behaviour",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Posture and Behaviour as recorded for example at 6-8 week GP Led Review",
      "short": "Physical examination of Posture and Behaviour",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "developmentalAssessmentPostureAndBehaviour",
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "developmentalAssessmentPostureAndBehaviour",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Developmental Assessment: Posture and Behaviour",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 1,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "1",
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Vision check as recorded for example at School Entry Review",
      "short": "Vision check",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "examinationVision",
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationVision.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationVision.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "examinationVision",
      "id": "QuestionnaireResponse.item:examinationVision.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationVision.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Examination: Vision",
      "id": "QuestionnaireResponse.item:examinationVision.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationVision.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationVision.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationVision.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationVision.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "dateTime"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationVision.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationVision.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationVision.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Bowels",
      "short": "Physical examination of Bowels",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "examinationBowels",
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationBowels.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationBowels.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "examinationBowels",
      "id": "QuestionnaireResponse.item:examinationBowels.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationBowels.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Examination: Bowels",
      "id": "QuestionnaireResponse.item:examinationBowels.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationBowels.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationBowels.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationBowels.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationBowels.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/ValueSet-DCH-BowelExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationBowels.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationBowels.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationBowels.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "qrs-1",
        "human": "Nested item can't be beneath both item and answer",
        "xpath": "not(exists(f:answer) and exists(f:item))",
        "severity": "error",
        "expression": "(answer.exists() and item.exists()).not()"
      } ],
      "path": "QuestionnaireResponse.item",
      "min": 0,
      "definition": "Physical examination of Urine",
      "short": "Physical examination of Urine",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "sliceName": "examinationUrine",
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine",
      "condition": [ "ele-1" ],
      "comment": "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).",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationUrine.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationUrine.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.linkId",
      "requirements": "Items can repeat in the answers, so a direct 1..1 correspondence by position may not exist - requiring correspondence by identifier.",
      "min": 1,
      "definition": "The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.",
      "short": "Pointer to specific item from Questionnaire",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "examinationUrine",
      "id": "QuestionnaireResponse.item:examinationUrine.linkId",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 1,
        "path": "QuestionnaireResponse.item.linkId"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.definition",
      "requirements": "A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.",
      "min": 0,
      "definition": "A reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.",
      "short": "ElementDefinition - details for the item",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "uri"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationUrine.definition",
      "condition": [ "ele-1" ],
      "comment": "The ElementDefinition must be in a [StructureDefinition](structuredefinition.html) or a [DataElement](dataelement.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].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.definition"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.text",
      "requirements": "Allows the questionnaire response to be read without access to the questionnaire.",
      "min": 1,
      "definition": "Text that is displayed above the contents of the group or as the text of the question being answered.",
      "short": "Name for group or question text",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".text",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "fixedString": "Examination: Urine",
      "id": "QuestionnaireResponse.item:examinationUrine.text",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.text"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ref-1",
        "human": "SHALL have a contained resource if a local reference is provided",
        "xpath": "not(starts-with(f:reference/@value, '#')) or exists(ancestor::*[self::f:entry or self::f:parameter]/f:resource/f:*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')]|/*/f:contained/f:*[f:id/@value=substring-after(current()/f:reference/@value, '#')])",
        "severity": "error",
        "expression": "reference.startsWith('#').not() or (reference.substring(1).trace('url') in %resource.contained.id.trace('ids'))"
      } ],
      "path": "QuestionnaireResponse.item.subject",
      "requirements": "Sometimes a group of answers is about a specific participant, artifact or piece of information in the patient's care or record, e.g. a specific Problem, RelatedPerson, Allergy etc.",
      "min": 0,
      "definition": "More specific subject this section's answers are about, details the subject given in QuestionnaireResponse.",
      "short": "The subject this group's answers are about",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "The target of a resource reference is a RIM entry point (Act, Role, or Entity)",
        "identity": "rim"
      }, {
        "map": ".participation[typeCode=SBJ].role or .outboundRelationship[typeCode=SUBJ].target",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Reference",
        "targetProfile": "http://hl7.org/fhir/StructureDefinition/Resource"
      } ],
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationUrine.subject",
      "condition": [ "ele-1" ],
      "comment": "References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.subject"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.subject.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.subject.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationUrine.subject.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.reference",
      "min": 0,
      "definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
      "short": "Literal reference, Relative, internal or absolute URL",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.subject.reference",
      "condition": [ "ele-1", "ref-1" ],
      "comment": "Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries.   Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure \"/[type]/[id]\" then it should be assumed that the reference is to a FHIR RESTful server.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.reference"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.identifier",
      "min": 0,
      "definition": "An identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
      "short": "Logical reference, when literal reference is not known",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "CX / EI (occasionally, more often EI maps to a resource id or a URL)",
        "identity": "v2"
      }, {
        "map": "II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs.  Also maps to Role[classCode=IDENT]",
        "identity": "rim"
      }, {
        "map": "Identifier",
        "identity": "servd"
      }, {
        "map": ".identifier",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Identifier"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.subject.identifier",
      "condition": [ "ele-1" ],
      "comment": "When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. \n\nWhen both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.identifier"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.subject.display",
      "min": 0,
      "definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
      "short": "Text alternative for the resource",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
        "valueBoolean": true
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.subject.display",
      "condition": [ "ele-1" ],
      "comment": "This is generally not the same as the Resource.text of the referenced resource.  The purpose is to identify what's being referenced, not to fully describe it.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Reference.display"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer",
      "min": 1,
      "definition": "The respondent's answer(s) to the question.",
      "short": "The response(s) to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".value[type=LIST_ANY]",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "BackboneElement"
      } ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.answer",
      "condition": [ "ele-1" ],
      "comment": "The value is nested because we cannot have a repeating structure that has variable type.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.id",
      "min": 0,
      "definition": "unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
      "short": "xml:id (or equivalent in JSON)",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      } ],
      "representation": [ "xmlAttr" ],
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.answer.id",
      "condition": [ "ele-1" ],
      "comment": "Note that FHIR strings may not exceed 1MB in size",
      "base": {
        "max": "1",
        "min": 0,
        "path": "Element.id"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.extension",
      "min": 0,
      "definition": "May be used to represent additional information that is not part of the basic definition of the element. In order 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.",
      "short": "Additional Content defined by implementations",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "slicing": {
        "rules": "open",
        "description": "Extensions are always sliced by (at least) url",
        "discriminator": [ {
          "path": "url",
          "type": "value"
        } ]
      },
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationUrine.answer.extension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "Element.extension"
      }
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      }, {
        "key": "ext-1",
        "human": "Must have either extensions or value[x], not both",
        "xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])",
        "severity": "error",
        "expression": "extension.exists() != value.exists()"
      } ],
      "path": "QuestionnaireResponse.item.answer.modifierExtension",
      "min": 0,
      "definition": "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 that contains it. Usually modifier elements provide negation or qualification. In order 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.",
      "isModifier": true,
      "short": "Extensions that cannot be ignored",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": "N/A",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "Extension"
      } ],
      "alias": [ "extensions", "user content", "modifiers" ],
      "max": "*",
      "id": "QuestionnaireResponse.item:examinationUrine.answer.modifierExtension",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "*",
        "min": 0,
        "path": "BackboneElement.modifierExtension"
      },
      "isSummary": true
    }, {
      "constraint": [ {
        "key": "ele-1",
        "human": "All FHIR elements must have a @value or children",
        "xpath": "@value|f:*|h:div",
        "severity": "error",
        "expression": "hasValue() | (children().count() > id.count())"
      } ],
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "requirements": "Ability to retain a single-valued answer to a question.",
      "min": 1,
      "definition": "The answer (or one of the answers) provided by the respondent to the question.",
      "short": "Single-valued answer to the question",
      "mapping": [ {
        "map": "n/a",
        "identity": "rim"
      }, {
        "map": ".item",
        "identity": "rim"
      } ],
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/ValueSet-DCH-UrineExaminationFindingOutcome-1"
        }
      },
      "max": "1",
      "id": "QuestionnaireResponse.item:examinationUrine.answer.value[x]",
      "condition": [ "ele-1" ],
      "comment": "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.",
      "base": {
        "max": "1",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.value[x]"
      }
    }, {
      "path": "QuestionnaireResponse.item.answer.item",
      "requirements": "It is useful to have \"sub-questions\", questions which normally appear when certain answers are given and which collect additional details.",
      "min": 0,
      "definition": "Nested groups and/or questions found within this particular answer.",
      "short": "Nested groups and questions",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationUrine.answer.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.answer.item"
      }
    }, {
      "path": "QuestionnaireResponse.item.item",
      "requirements": "Reports can consist of complex nested groups.",
      "min": 0,
      "definition": "Questions or sub-groups nested beneath a question or group.",
      "short": "Nested questionnaire response items",
      "mapping": [ {
        "map": ".outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]",
        "identity": "rim"
      } ],
      "contentReference": "#QuestionnaireResponse.item",
      "max": "0",
      "id": "QuestionnaireResponse.item:examinationUrine.item",
      "base": {
        "max": "*",
        "min": 0,
        "path": "QuestionnaireResponse.item.item"
      }
    } ]
  },
  "status": "draft",
  "id": "86e81e1b-acdf-4588-96e0-1b263335352b",
  "kind": "resource",
  "url": "https://fhir.nhs.uk/STU3/StructureDefinition/DCH-ExaminationFindings-QuestionnaireResponse-1",
  "version": "1.0.0",
  "differential": {
    "element": [ {
      "id": "QuestionnaireResponse.identifier.use",
      "max": "0",
      "path": "QuestionnaireResponse.identifier.use"
    }, {
      "id": "QuestionnaireResponse.identifier.type",
      "max": "0",
      "path": "QuestionnaireResponse.identifier.type"
    }, {
      "id": "QuestionnaireResponse.identifier.value",
      "min": 1,
      "path": "QuestionnaireResponse.identifier.value"
    }, {
      "id": "QuestionnaireResponse.identifier.period",
      "max": "0",
      "path": "QuestionnaireResponse.identifier.period"
    }, {
      "id": "QuestionnaireResponse.identifier.assigner",
      "max": "0",
      "path": "QuestionnaireResponse.identifier.assigner"
    }, {
      "id": "QuestionnaireResponse.basedOn",
      "max": "0",
      "path": "QuestionnaireResponse.basedOn"
    }, {
      "id": "QuestionnaireResponse.parent",
      "max": "0",
      "path": "QuestionnaireResponse.parent"
    }, {
      "id": "QuestionnaireResponse.questionnaire",
      "max": "0",
      "path": "QuestionnaireResponse.questionnaire"
    }, {
      "id": "QuestionnaireResponse.subject",
      "min": 1,
      "path": "QuestionnaireResponse.subject",
      "type": [ {
        "code": "Reference",
        "targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-DCH-Patient-1"
      } ]
    }, {
      "id": "QuestionnaireResponse.subject.reference",
      "min": 1,
      "path": "QuestionnaireResponse.subject.reference"
    }, {
      "id": "QuestionnaireResponse.context",
      "min": 1,
      "path": "QuestionnaireResponse.context",
      "type": [ {
        "code": "Reference",
        "targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-DCH-Encounter-1"
      } ]
    }, {
      "id": "QuestionnaireResponse.context.reference",
      "min": 1,
      "path": "QuestionnaireResponse.context.reference"
    }, {
      "id": "QuestionnaireResponse.author",
      "min": 1,
      "path": "QuestionnaireResponse.author",
      "type": [ {
        "code": "Reference",
        "targetProfile": "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-DCH-Practitioner-1"
      } ]
    }, {
      "id": "QuestionnaireResponse.author.reference",
      "min": 1,
      "path": "QuestionnaireResponse.author.reference"
    }, {
      "id": "QuestionnaireResponse.source",
      "max": "0",
      "path": "QuestionnaireResponse.source"
    }, {
      "id": "QuestionnaireResponse.item",
      "path": "QuestionnaireResponse.item",
      "slicing": {
        "rules": "closed",
        "ordered": true,
        "discriminator": [ {
          "path": "text",
          "type": "value"
        } ]
      }
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of colour",
      "sliceName": "generalAppearanceColour",
      "definition": "Physical examination of colour. The record of a clinician’s ‘first impression’ assessment including general clinical examination finding, e.g., clubbing, anaemia, jaundice, obese/malnourished etc."
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "generalAppearanceColour"
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "General Appearance Colour"
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:generalAppearanceColour.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "The record of essential physiological measurements",
      "sliceName": "vitalSigns",
      "definition": "The record of essential physiological measurements, e.g., heart rate, blood pressure, temperature, pulse, respiratory rate, level of consciousness."
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "vitalSigns"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Vital signs"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.answer.valueString:valueString",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.valueString",
      "type": [ {
        "code": "string"
      } ],
      "sliceName": "valueString"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:vitalSigns.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:mentalState",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Formal mental state examination",
      "sliceName": "mentalState",
      "definition": "Formal mental state examination or general description, e.g.. depression, anxiety, confusion, delirium"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "mentalState"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Mental state"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.answer.valueString:valueString",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.valueString",
      "type": [ {
        "code": "string"
      } ],
      "sliceName": "valueString"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:mentalState.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Head and Skull",
      "sliceName": "headAndSkull",
      "definition": "Physical examination of Head and Skull (Features, hair, moulding, fontanelles, sutures, caput, cephalhaematoma, trauma)"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "headAndSkull"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Head and Skull"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:headAndSkull.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:face",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Face",
      "sliceName": "face",
      "definition": "Physical examination of Face (Appearance, haemangioma, asymmetry)"
    }, {
      "id": "QuestionnaireResponse.item:face.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "face"
    }, {
      "id": "QuestionnaireResponse.item:face.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:face.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Face"
    }, {
      "id": "QuestionnaireResponse.item:face.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:face.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:face.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "time"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:face.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:face.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:ears",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Ears",
      "sliceName": "ears",
      "definition": "Physical examination of Ears (Dimples, position, appearance)"
    }, {
      "id": "QuestionnaireResponse.item:ears.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "ears"
    }, {
      "id": "QuestionnaireResponse.item:ears.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:ears.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Ears"
    }, {
      "id": "QuestionnaireResponse.item:ears.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:ears.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:ears.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:ears.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:ears.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Neck and Clavicles",
      "sliceName": "neckAndClavicle",
      "definition": "Physical examination of Neck and Clavicles (Clavicles fracture, mobility, sternoma)"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "neckAndClavicle"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Neck and Clavicles"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:neckAndClavicle.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Mouth and Palate",
      "sliceName": "oralExaminationMouthAndPalate",
      "definition": "Physical examination of Mouth and Palate (Palate  (visualise and palpate), teeth)"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "oralExaminationMouthAndPalate"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Oral examination: Mouth and Palate"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:oralExaminationMouthAndPalate.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Cardiovascular System",
      "sliceName": "cardiovascularSystem",
      "definition": "Physical examination of Chest (Shape, nipples, auscultate breath sounds)"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "cardiovascularSystem"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Cardiovascular System"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:cardiovascularSystem.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:chest",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Chest",
      "sliceName": "chest",
      "definition": "Physical examination of Chest (Shape, nipples, auscultate breath sounds)"
    }, {
      "id": "QuestionnaireResponse.item:chest.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "chest"
    }, {
      "id": "QuestionnaireResponse.item:chest.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:chest.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Cardiovascular system: Chest"
    }, {
      "id": "QuestionnaireResponse.item:chest.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:chest.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:chest.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:chest.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:chest.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Respiratory",
      "sliceName": "respiratorySystem",
      "definition": "Physical examination of Respiratory (Distress, cry)"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "respiratorySystem"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Respiratory system"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:respiratorySystem.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:abdomen",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Abdomen",
      "sliceName": "abdomen",
      "definition": "Physical examination of Abdomen (Liver, spleen, masses, tone)"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "abdomen"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Abdomen"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:abdomen.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:abdomen.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Umbilicus",
      "sliceName": "abdomenUmbilicus",
      "definition": "Physical examination of Umbilicus (Smell, discharge, hernia)"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "abdomenUmbilicus"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Abdomen Umbilicus"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:abdomenUmbilicus.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Genitalia",
      "sliceName": "genitourinaryGenitalia",
      "definition": "Physical examination of Genitalia (Female, Male not Testes)"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "genitourinaryGenitalia"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Genitourinary: Genitalia"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryGenitalia.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Anus",
      "sliceName": "genitourinaryAnus",
      "definition": "Physical examination of Anus (position, patency)"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "genitourinaryAnus"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Genitourinary: Anus"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:genitourinaryAnus.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Reflexes",
      "sliceName": "nervousSystemReflexes",
      "definition": "Physical examination of Reflexes (Grasp, Moro, rooting, stepping)"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "nervousSystemReflexes"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Nervous system: Reflexes"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
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      }
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:nervousSystemReflexes.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Examination of manipulation",
      "sliceName": "musculoskeletalManipulation",
      "definition": "Examination of manipulation"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "musculoskeletalManipulation"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Musculoskeletal: Manipulation"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalManipulation.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Upper Limbs",
      "sliceName": "musculoskeletalUpperLimbs",
      "definition": "Physical examination of Upper Limbs (Length, digits, palmar creases, syn/poly-dactyly, tone, movement, oedema)"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "musculoskeletalUpperLimbs"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Musculoskeletal: Upper Limbs"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalUpperLimbs.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Lower Limbs, feet",
      "sliceName": "musculoskeletalLowerLimbsFeet",
      "definition": "Physical examination of Lower Limbs, feet (Length digits, syn/poly-dactyly, tone, movement, talipes, oedema)"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "musculoskeletalLowerLimbsFeet"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Musculoskeletal: Lower Limbs, feet"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalLowerLimbsFeet.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Back and Spine",
      "sliceName": "musculoskeletalBackAndSpine",
      "definition": "Physical examination of Back and Spine (Dimples, hair tufts, naevus, abnormal skin patches)"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "musculoskeletalBackAndSpine"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Musculoskeletal: Back and Spine"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.answer.item",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:musculoskeletalBackAndSpine.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:skin",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Skin",
      "sliceName": "skin",
      "definition": "Physical examination of Skin (Hyperpigmented macule, birthmarks, dry abrasions, bruises)"
    }, {
      "id": "QuestionnaireResponse.item:skin.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "skin"
    }, {
      "id": "QuestionnaireResponse.item:skin.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:skin.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Skin"
    }, {
      "id": "QuestionnaireResponse.item:skin.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:skin.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:skin.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:skin.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:skin.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Stills, startles, risk factors",
      "sliceName": "developmentalAssessmentHearing",
      "definition": "Stills, startles, risk factors as recorded for example at 6-8 week GP Led Review or School Entry Review"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "developmentalAssessmentHearing"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Developmental Assessment: Hearing"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentHearing.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Tone, head control",
      "sliceName": "developmentalAssessmentLocomotion",
      "definition": "Tone, head control as recorded for example at 6-8 week GP Led Review"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "developmentalAssessmentLocomotion"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Developmental Assessment: Locomotion"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentLocomotion.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Social smile",
      "sliceName": "developmentalAssessmentSpeechLanguage",
      "definition": "Social smile as recorded for example at 6-8 week GP Led Review"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "developmentalAssessmentSpeechLanguage"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Developmental Assessment: Speech and Language"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentSpeechLanguage.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Parental concerns, sleep, feeding",
      "sliceName": "developmentalAssessmentBehaviour",
      "definition": "Parental concerns, sleep, feeding as recorded for example at 6-8 week GP Led Review"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "developmentalAssessmentBehaviour"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Developmental Assessment: Behaviour"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentBehaviour.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Posture and Behaviour",
      "sliceName": "developmentalAssessmentPostureAndBehaviour",
      "definition": "Physical examination of Posture and Behaviour as recorded for example at 6-8 week GP Led Review"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "developmentalAssessmentPostureAndBehaviour"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Developmental Assessment: Posture and Behaviour"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:developmentalAssessmentPostureAndBehaviour.item",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Vision check",
      "sliceName": "examinationVision",
      "definition": "Vision check as recorded for example at School Entry Review"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "examinationVision"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Examination: Vision"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "dateTime"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/DCH-ExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:examinationVision.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Bowels",
      "sliceName": "examinationBowels",
      "definition": "Physical examination of Bowels"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "examinationBowels"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Examination: Bowels"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/ValueSet-DCH-BowelExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:examinationBowels.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine",
      "max": "1",
      "path": "QuestionnaireResponse.item",
      "short": "Physical examination of Urine",
      "sliceName": "examinationUrine",
      "definition": "Physical examination of Urine"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "fixedString": "examinationUrine"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.definition",
      "max": "0",
      "path": "QuestionnaireResponse.item.definition"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "fixedString": "Examination: Urine"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.subject",
      "max": "0",
      "path": "QuestionnaireResponse.item.subject"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.answer",
      "max": "1",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "type": [ {
        "code": "string"
      }, {
        "code": "Coding"
      } ],
      "binding": {
        "strength": "required",
        "extension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
          "valueString": "QuestionnaireAnswer"
        } ],
        "description": "Code indicating the examination finding",
        "valueSetReference": {
          "reference": "https://fhir.nhs.uk/STU3/ValueSet/ValueSet-DCH-UrineExaminationFindingOutcome-1"
        }
      }
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.answer.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.answer.item"
    }, {
      "id": "QuestionnaireResponse.item:examinationUrine.item",
      "max": "0",
      "path": "QuestionnaireResponse.item.item"
    } ]
  },
  "contact": [ {
    "name": "Interoperability Team",
    "telecom": [ {
      "use": "work",
      "value": "interoperabilityteam@nhs.net",
      "system": "email"
    } ]
  } ],
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"
}