FHIRsmith: Questionnaire/Questionnaire-HIEQuestionnaire-example.json

FHIR IG analytics

Package	hie-fhir-ig-profile
Resource Type	Questionnaire
Id	Questionnaire-HIEQuestionnaire-example.json
FHIR Version	R4B
Source	https://build.fhir.org/ig/savannahghi/hie-fhir-ig-profile/Questionnaire-HIEQuestionnaire-example.html
URL	http://example.org/Questionnaire/q-example
Version	0.1.0
Status	active
Date	2025-11-20
Name	HIE_Q_Demo_Symptoms_Visit
Title	HIE Intake Questionnaire
Description	Intake questionnaire capturing demographics, core symptoms, and visit intent for HIE workflows.

Resources that use this resource

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Resources that this resource uses

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Narrative

Note: links and images are rebased to the (stated) source

Questionnaire Summary

This form captures demographics, symptom screening, and appointment intent. Items are grouped for usability, typed for consistent capture, and use enableWhen for conditional logic.

Status: active
Versioned URL: http://example.org/Questionnaire/q-example
Root groups: Demographics, Symptoms, Visit

Key Behaviors

Unique linkIds across all items
Group items carry no answers or initial values
Non-group items define answer options or value sets when appropriate
Conditional item appears only when gender = female

Source1

{
  "resourceType": "Questionnaire",
  "id": "HIEQuestionnaire-example",
  "meta": {
    "profile": [
      "https://nshr.dha.go.ke/fhir/StructureDefinition/questionnaire"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "url": "http://example.org/Questionnaire/q-example",
  "identifier": [
    {
      "use": "official",
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "ACSN",
            "display": "Accession ID"
          }
        ]
      },
      "system": "http://example.org/questionnaires",
      "value": "Q-INTAKE-001"
    }
  ],
  "version": "0.1.0",
  "name": "HIE_Q_Demo_Symptoms_Visit",
  "title": "HIE Intake Questionnaire",
  "status": "active",
  "subjectType": [
    "Patient"
  ],
  "date": "2025-11-20",
  "publisher": "Kathurima Kimathi",
  "contact": [
    {
      "name": "Kathurima Kimathi",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.linkedin.com/in/kathurima-kimathi/"
        },
        {
          "system": "email",
          "value": "kathurima@savannahinformatics.com"
        }
      ]
    }
  ],
  "description": "Intake questionnaire capturing demographics, core symptoms, and visit intent for HIE workflows.",
  "item": [
    {
      "linkId": "grp-demographics",
      "text": "Demographics",
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "text-box",
                    "display": "Text box"
                  }
                ]
              }
            }
          ],
          "linkId": "given-name",
          "text": "Given name",
          "type": "string",
          "required": true
        },
        {
          "linkId": "family-name",
          "text": "Family name",
          "type": "string",
          "required": true
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept": {
                "coding": [
                  {
                    "system": "http://hl7.org/fhir/questionnaire-item-control",
                    "code": "drop-down",
                    "display": "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId": "gender",
          "text": "Gender",
          "type": "choice",
          "required": true,
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "female",
                "display": "Female"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "male",
                "display": "Male"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "other",
                "display": "Other"
              }
            },
            {
              "valueCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "unknown",
                "display": "Unknown"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId": "grp-symptoms",
      "text": "Symptoms",
      "type": "group",
      "item": [
        {
          "linkId": "has-headache",
          "text": "Headache present",
          "type": "boolean"
        },
        {
          "linkId": "headache-severity",
          "text": "Headache severity",
          "type": "choice",
          "enableWhen": [
            {
              "question": "has-headache",
              "operator": "=",
              "answerBoolean": true
            }
          ],
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://example.org/vs/severity",
                "code": "mild",
                "display": "Mild"
              }
            },
            {
              "valueCoding": {
                "system": "http://example.org/vs/severity",
                "code": "moderate",
                "display": "Moderate"
              }
            },
            {
              "valueCoding": {
                "system": "http://example.org/vs/severity",
                "code": "severe",
                "display": "Severe"
              }
            }
          ]
        },
        {
          "linkId": "pregnancy-status",
          "text": "Are you currently pregnant?",
          "type": "boolean",
          "enableWhen": [
            {
              "question": "gender",
              "operator": "=",
              "answerCoding": {
                "system": "http://hl7.org/fhir/administrative-gender",
                "code": "female",
                "display": "Female"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId": "grp-visit",
      "text": "Visit",
      "type": "group",
      "item": [
        {
          "linkId": "visit-intent",
          "text": "Reason for visit",
          "type": "choice",
          "required": true,
          "answerOption": [
            {
              "valueCoding": {
                "system": "http://example.org/vs/visit-intent",
                "code": "new-consult",
                "display": "New consultation"
              }
            },
            {
              "valueCoding": {
                "system": "http://example.org/vs/visit-intent",
                "code": "follow-up",
                "display": "Follow up"
              }
            },
            {
              "valueCoding": {
                "system": "http://example.org/vs/visit-intent",
                "code": "procedure",
                "display": "Procedure"
              }
            }
          ]
        },
        {
          "linkId": "requested-window",
          "text": "Preferred appointment window",
          "type": "choice"
        },
        {
          "linkId": "additional-notes",
          "text": "Additional notes",
          "type": "text"
        }
      ]
    }
  ]
}