| Package | hl7.eu.fhir.gh |
| Resource Type | Questionnaire |
| Id | Questionnaire-example |
| FHIR Version | R5 |
| Source | http://hl7.eu/fhir/ig/gravitate-health/https://build.fhir.org/ig/hl7-eu/gravitate-health/Questionnaire-Questionnaire-example.html |
| URL | https://myserver.org/Questionnaire/196f47ee-45c1-470e-888c-742cb0098b72 |
| Version | 0.1.0 |
| Status | active |
| Date | 2025-07-25T07:27:16+00:00 |
| Realm | eu |
| Authority | hl7 |
| Description | An questionnaire to gather personal info regarding mental stability |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire Questionnaire-example
Structure| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | An questionnaire to gather personal info regarding mental stability | Questionnaire | https://myserver.org/Questionnaire/196f47ee-45c1-470e-888c-742cb0098b72#0.1.0 | |
  age | 1. What's your age? | 0..1 | quantity | |
 social-sup | 2. How's your Social Support? | 0..1 | coding | Options: 4 options |
| sex | 3. Please state you gender. | 0..1 | coding | Options: 4 options |
| workLife | 4. How's your work Life ? | 0..1 | coding | Options: 3 options |
| smoking | 5. How many cigaretes do you smoke per day? | 0..1 | coding | Options: 4 options |
| physical | 6. How is your physical activity? | 0..1 | coding | Options: 4 options |
| organized | 7. How organized are you? | 0..1 | coding | Options: 3 options |
| extrovert | 8. How Extrovert do you feel? | 0..1 | coding | Options: 3 options |
| emotional | 9. How emotional do you feel? | 0..1 | coding | Options: 3 options |
| nrdiagnoses | 10. Nr of Diagnoses that you have? | 0..1 | coding | Options: 4 options |
 chronic | 11. Do you have a chronic afliction? | 0..1 | boolean | |
| nrmedicine | 12. Nr of medicines that you have? | 0..1 | coding | Options: 4 options |
| healthadvice | 13. Did you receive any health advice? | 0..1 | coding | Options: 4 options |
| concern | 14. Did you have any concern domains? | 0..1 | coding | Options: 4 options |
| shareinfo | 15. How willing are you to share information? | 0..1 | coding | Options: 3 options |
| mood | 16. How's your mood level? | 0..1 | coding | Options: 3 options |
| autonomy | 17. How's your Autonomy? | 0..1 | coding | Options: 3 options |
| healthliteracy | 18. How's your level of health literacy? | 0..1 | coding | Options: 3 options |
| digitalliteracy | 19. How's your level of digital literacy? | 0..1 | coding | Options: 3 options |
 toolsupport | 20. How's your level of tool support interest? | 0..1 | coding | Options: 3 options |
| Documentation for this format | ||||
Options Sets
Answer options for social-sup
Answer options for sex
Answer options for workLife
Answer options for smoking
Answer options for physical
Answer options for organized
Answer options for extrovert
Answer options for emotional
Answer options for nrdiagnoses
Answer options for nrmedicine
Answer options for healthadvice
Answer options for concern
Answer options for shareinfo
Answer options for mood
Answer options for autonomy
Answer options for healthliteracy
Answer options for digitalliteracy
Answer options for toolsupport
FHIR{
"resourceType": "Questionnaire",
"id": "Questionnaire-example",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"url": "https://myserver.org/Questionnaire/196f47ee-45c1-470e-888c-742cb0098b72",
"version": "0.1.0",
"status": "active",
"date": "2025-07-25T07:27:16+00:00",
"publisher": "Gravitate Health Project",
"contact": [
{
"name": "Gravitate Health Project",
"telecom": [
{
"system": "url",
"value": "https://www.gravitatehealth.eu/"
}
]
},
{
"name": "Gravitate Health Project",
"telecom": [
{
"system": "url",
"value": "https://www.gravitatehealth.eu/"
}
]
}
],
"description": "An questionnaire to gather personal info regarding mental stability",
"item": [
{
"linkId": "age",
"prefix": "1",
"text": "What's your age?",
"type": "quantity"
},
{
"linkId": "social-sup",
"prefix": "2",
"text": "How's your Social Support?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "None",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "sex",
"prefix": "3",
"text": "Please state you gender.",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "F",
"display": "Female"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "M",
"display": "Male"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "O",
"display": "Other Gender"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "ND",
"display": "Non-Disclosed Gender"
}
}
]
},
{
"linkId": "workLife",
"prefix": "4",
"text": "How's your work Life ?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "U",
"display": "Unemployed/Retired"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "EM",
"display": "Employed Manual"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "ENM",
"display": "Employed non Manual"
}
}
]
},
{
"linkId": "smoking",
"prefix": "5",
"text": "How many cigaretes do you smoke per day?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "0",
"display": "Non Smoker"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "1",
"display": "1-5"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "2",
"display": "6-20"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "3",
"display": ">20"
}
}
]
},
{
"linkId": "physical",
"prefix": "6",
"text": "How is your physical activity?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "None",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "organized",
"prefix": "7",
"text": "How organized are you?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "extrovert",
"prefix": "8",
"text": "How Extrovert do you feel?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "emotional",
"prefix": "9",
"text": "How emotional do you feel?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "nrdiagnoses",
"prefix": "10",
"text": "Nr of Diagnoses that you have?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "None",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SINGLE",
"display": "single"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SOME23",
"display": "Some (2-3)"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "MANY",
"display": "Many"
}
}
]
},
{
"linkId": "chronic",
"prefix": "11",
"text": "Do you have a chronic afliction?",
"type": "boolean"
},
{
"linkId": "nrmedicine",
"prefix": "12",
"text": "Nr of medicines that you have?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "None",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SINGLE",
"display": "single"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SOME23",
"display": "Some (2-3)"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "MANY",
"display": "Many"
}
}
]
},
{
"linkId": "healthadvice",
"prefix": "13",
"text": "Did you receive any health advice?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "None",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SINGLE",
"display": "single"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SOME",
"display": "some"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "MANY",
"display": "Many"
}
}
]
},
{
"linkId": "concern",
"prefix": "14",
"text": "Did you have any concern domains?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "None",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SINGLE",
"display": "single"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "SOME",
"display": "some"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "MANY",
"display": "Many"
}
}
]
},
{
"linkId": "shareinfo",
"prefix": "15",
"text": "How willing are you to share information?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "mood",
"prefix": "16",
"text": "How's your mood level?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "autonomy",
"prefix": "17",
"text": "How's your Autonomy?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "healthliteracy",
"prefix": "18",
"text": "How's your level of health literacy?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "digitalliteracy",
"prefix": "19",
"text": "How's your level of digital literacy?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
},
{
"linkId": "toolsupport",
"prefix": "20",
"text": "How's your level of tool support interest?",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Low",
"display": "Low"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "Medium",
"display": "Medium"
}
},
{
"valueCoding": {
"system": "http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/questi-dimens-cs",
"code": "High",
"display": "High"
}
}
]
}
]
}