{
  "description": "This is created/used by the RAPIDS project within TELUS.   May also be used in the Patient Chart",
  "_filename": "profile-questionnaire-response.StructureDefinition.json",
  "package_name": "ForgePatientChart.0830",
  "date": null,
  "derivation": "constraint",
  "publisher": null,
  "fhirVersion": "4.0.1",
  "name": "QuestionnaireResponse",
  "abstract": false,
  "type": "QuestionnaireResponse",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": null,
  "package_version": "0.1.0",
  "status": "draft",
  "id": "fc066bf7-3631-4659-ad94-5f3d0d353787",
  "kind": "resource",
  "url": "http://telus.com/fhir/patientChart/StructureDefinition/questionnaire-response",
  "version": null,
  "differential": {
    "element": [ {
      "id": "QuestionnaireResponse",
      "path": "QuestionnaireResponse",
      "comment": "Usage Note:  You cannot query against a Quesitonnnaire Response based on the answer.   Information from the questionnaire can be extracted into observations which is then searchable.   \r\n\r\nUsage Note:   For referrals, we are likely going to send a PDF.   For RAPIDs, this may be very useful.   For \r\n\r\nThe 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."
    }, {
      "id": "QuestionnaireResponse.id",
      "path": "QuestionnaireResponse.id",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.meta",
      "path": "QuestionnaireResponse.meta",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.meta.lastUpdated",
      "path": "QuestionnaireResponse.meta.lastUpdated",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.meta.source",
      "path": "QuestionnaireResponse.meta.source",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.meta.profile",
      "path": "QuestionnaireResponse.meta.profile",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.text",
      "min": 1,
      "path": "QuestionnaireResponse.text",
      "comment": "Usage Note:   This is used if a PDF image of the questionnaire response is included in the bundle, or if a text rendering if desired.\r\n\r\nContained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied).  This may be necessary for data from legacy systems where information is captured as a \"text blob\" or where text is additionally entered raw or narrated and encoded information is added later.",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.text.status",
      "path": "QuestionnaireResponse.text.status",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.text.div",
      "path": "QuestionnaireResponse.text.div",
      "comment": "Usage Note:   Used to reference the PDF, Image , XHTML - Image Tag - \"display this thing here\" - URL would be hash123, if 123 if the id of the contained resouce.   This is a local reference to the contained binary resource.\r\n\r\nUsage Note:   If there is no PDF, this can also be used to convey the XHTML\r\n\r\nhe contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard,  elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.contained",
      "path": "QuestionnaireResponse.contained",
      "comment": "Usage Note:  This would be a binary, PDF\r\n\r\nThis should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.identifier",
      "path": "QuestionnaireResponse.identifier",
      "comment": "Usage Note:   This could be a transaction id or this type of concept in the EMR.   If it exists in the EMR this should be populated.",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.identifier.system",
      "path": "QuestionnaireResponse.identifier.system",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.identifier.value",
      "path": "QuestionnaireResponse.identifier.value",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.questionnaire",
      "path": "QuestionnaireResponse.questionnaire",
      "comment": "Usage Note:  This may be necessary if order or further context to the questions included in the Questionnaire Response are necessary.   \r\nInternal Templates (specific to EMR), and universal templates (eg PHQ-9).   As a general rule, universal templates are known and theefore the questionnaire is not typically required.    For internal templates, the questionnnaire should be included, so the recipient clearly understands what was in the original form.  \r\n\r\nUsage Note:   The questionnaire (canonical URL) identifies the particular questionnnaire.   The contents of the questionnaire will tell recipients the default values, questions that were not answered, etc.     eg please identify relevant comorbilities; knowing that there was a limited choice set (eg 4 answers) becomes very relevant.   \r\n\r\nUsage Note:  The name questionnaire implies questions, but this could just be a tag, rather than an actual question.   \r\n\r\nIf 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.).",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.status",
      "path": "QuestionnaireResponse.status",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.subject",
      "min": 1,
      "path": "QuestionnaireResponse.subject",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.subject.reference",
      "path": "QuestionnaireResponse.subject.reference",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.subject.display",
      "path": "QuestionnaireResponse.subject.display",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item",
      "path": "QuestionnaireResponse.item",
      "comment": "Usage note:   **** Confirm that we will use this for Progress Notes, and in this case there may not be any items. -- LL\r\nUsage Note:  This includes the \"total score\" and any other calculated answers and/or pre-populated answers\r\n\r\nUsage Note:   The same hierarchy and ordering is the same as the questionnaire; there will be some repetition in the response (eg for repeating group).   There may be some items in the questionnaire that are not in the response as they are not required.    If the receeiving system would like to understand what questions were not answered, the questionnaire is useful for this.  \r\n\r\nGroups 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).",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.linkId",
      "path": "QuestionnaireResponse.item.linkId",
      "comment": "Usage Note:   Where possible, this should be the LOINC code, eg for PHQ-9, each question has a LOINC code;.   For other custom questionnairs this can be structured in any logical way.   Example:   Custom Form Name + version + field identifier/field name.    \r\n\r\nTBD - we should publish the canonical URL for all standardized forms, for those in TELUS library and third partties such as OCEAN\r\n\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.definition",
      "path": "QuestionnaireResponse.item.definition",
      "comment": "Usage Note:  This is used to convey the LOINC code associated with this item., structured as http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].\n\n\r\nThe ElementDefinition must be in a [StructureDefinition](structuredefinition.html#), and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].\n\nThere is no need for this element if the item pointed to by the linkId has a definition listed.",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.text",
      "comment": "Usage Note:   thiis is the question text\r\n\r\nNote that FHIR strings SHALL NOT exceed 1MB in size",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer",
      "comment": "Usage Note:  For PHQ-9 and GAD-7 there will only be a single answer (1..1)\r\n\r\nThe value is nested because we cannot have a repeating structure that has variable type.",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.value[x]",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer.item",
      "path": "QuestionnaireResponse.item.answer.item",
      "mustSupport": true,
      "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item"
    }, {
      "id": "QuestionnaireResponse.item.answer.item.linkId",
      "path": "QuestionnaireResponse.item.answer.item.linkId",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer.item.text",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.item.text",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer.item.answer",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.item.answer",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer.item.answer.value[x]",
      "min": 1,
      "path": "QuestionnaireResponse.item.answer.item.answer.value[x]",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.answer.item.answer.item",
      "path": "QuestionnaireResponse.item.answer.item.answer.item",
      "mustSupport": true,
      "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item"
    }, {
      "id": "QuestionnaireResponse.item.answer.item.item",
      "path": "QuestionnaireResponse.item.answer.item.item",
      "mustSupport": true,
      "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item"
    }, {
      "id": "QuestionnaireResponse.item.item",
      "path": "QuestionnaireResponse.item.item",
      "mustSupport": true,
      "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item"
    }, {
      "id": "QuestionnaireResponse.item.item.text",
      "path": "QuestionnaireResponse.item.item.text",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.item.answer",
      "path": "QuestionnaireResponse.item.item.answer",
      "mustSupport": true
    }, {
      "id": "QuestionnaireResponse.item.item.item",
      "path": "QuestionnaireResponse.item.item.item",
      "contentReference": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse#QuestionnaireResponse.item"
    } ]
  },
  "baseDefinition": "http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"
}