FHIR IG analytics| Package | hl7.fhir.us.sirb |
| Resource Type | QuestionnaireResponse |
| Id | QuestionnaireResponse-determination-populate-exampleQR.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
| LinkId | Text | Definition | Answer |
|---|---|---|---|
  determination-populate-exampleQR | QuestionnaireResponse | ||
  dl1 | Research Study | ||
  dl1.1 | Study Title | Study of Drug A for arthritis | |
 dl1.2 | IRB Protocol Number | PRO098765 | |
| dl2 | Reliance Determination | ||
| dl2.1 | sIRB (Reviewing Institution) | ||
| dl2.1.1 | Institution | ||
 dl2.1.1.1 | sIRB (Reviewing Institution) Name | X Pharmaceutical Research IRB | |
| dl2.1.1.2 | Federal Wide Assurance (FWA) | 12345 | |
| dl2.2 | Determination Decision | Temporary Codes AR: Accepts Review | |
| dl5 | Lead Principal Investigator Responsible for Overall Study | ||
| dl5.1 | First Name | Jane | |
| dl5.2 | Last Name | Doe | |
| dl5.5 | Degree(s) | MD | |
| dl5.3 | drjanedoe@sampleuniversity.edu | ||
| dl11 | Lead Principal Investigator Institution | ||
| dl11.1 | Lead Principal Investigator Institution Name | Sample University Medical Center | |
| dl7 | Relying IRB | ||
| dl7.5 | Relying institution and Relying Site Principal Investigator for this Determination Letter | ||
| ExternalDataFor_dl7.5.1 | External Data For linkId dl7.5.1 | ||
| dl7.5.1 | Select the relying site in order to pre-populate the relying institution and relying site principal investigator details below. | [not stated] : Test Example University | | Xi-Yang Lee, Jr., MD, PhD | Example, MA | |
| dl7.1 | Relying Institution | ||
| dl7.1.1 | Name | Test Example University | |
| dl7.1.2 | Federal Wide Assurance (FWA) | 34567 | |
| dl7.2 | Relying Site Principal Investigator | ||
| dl7.2.1 | First Name | Xi-Yang | |
| dl7.2.2 | Last Name | Lee | |
| dl7.2.4 | Suffix | Jr. | |
| dl7.2.5 | Professional Degree(s) | MD, PhD | |
| dl7.2.3 | XiYangLee@teu.med.edu | ||
| dl9 | Point of Contact for Study Participants | ||
| dl9.1 | First Name | Xi-Yang | |
| dl9.2 | Last Name | Lee | |
| dl9.4 | Suffix | Jr. | |
| dl9.5 | Professional Degree(s) | MD, PhD | |
| dl9.3 | XiYangLee@teu.med.edu | ||
| ADMIN00 | Administrative Use Only | ||
| ADMIN01 | Link ID prefix | dl | |
| ADMIN02 | Questionnaire Response ID for the parent Questionnaire Response (such as the Initiate a Study Questionnaire Response), if any | initiate-study-populate-exampleQR | |
| ADMIN03 | ID of the Research Study FHIR Resource associated with the study Questionnaire Responses, if any | ResearchStudyExample-sIRB | |
| Documentation for this format | |||
FHIR
FHIRsmith{
"resourceType": "QuestionnaireResponse",
"id": "determination-populate-exampleQR",
"meta": {
"versionId": "1",
"lastUpdated": "2022-03-11T00:28:29.124+00:00"
},
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/workflow-researchStudy",
"valueReference": {
"reference": "ResearchStudy/ResearchStudyExample-sIRB",
"display": "ResearchStudyExample-sIRB"
}
}
],
"questionnaire": "http://hl7.org/fhir/us/sirb/Questionnaire/sirb-determination-letter-questionnaire-populate",
"status": "completed",
"authored": "2022-03-11T00:28:27.661Z",
"item": [
{
"linkId": "dl1",
"text": "Research Study",
"item": [
{
"linkId": "dl1.1",
"text": "Study Title",
"answer": [
{
"valueString": "Study of Drug A for arthritis"
}
]
},
{
"linkId": "dl1.2",
"text": "IRB Protocol Number",
"answer": [
{
"valueString": "PRO098765"
}
]
}
]
},
{
"linkId": "dl2",
"text": "Reliance Determination",
"item": [
{
"linkId": "dl2.1",
"text": "sIRB (Reviewing Institution)",
"item": [
{
"linkId": "dl2.1.1",
"text": "Institution",
"item": [
{
"linkId": "dl2.1.1.1",
"text": "sIRB (Reviewing Institution) Name",
"answer": [
{
"valueString": "X Pharmaceutical Research IRB"
}
]
},
{
"linkId": "dl2.1.1.2",
"text": "Federal Wide Assurance (FWA)",
"answer": [
{
"valueInteger": 12345
}
]
}
]
}
]
},
{
"linkId": "dl2.2",
"text": "Determination Decision",
"answer": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/us/sirb/CodeSystem/temporarycodes",
"code": "AR",
"display": "Accepts Review"
}
}
]
}
]
},
{
"linkId": "dl5",
"text": "Lead Principal Investigator Responsible for Overall Study",
"item": [
{
"linkId": "dl5.1",
"text": "First Name",
"answer": [
{
"valueString": "Jane"
}
]
},
{
"linkId": "dl5.2",
"text": "Last Name",
"answer": [
{
"valueString": "Doe"
}
]
},
{
"linkId": "dl5.5",
"text": "Degree(s)",
"answer": [
{
"valueString": "MD"
}
]
},
{
"linkId": "dl5.3",
"text": "Email",
"answer": [
{
"valueString": "drjanedoe@sampleuniversity.edu"
}
]
}
]
},
{
"linkId": "dl11",
"text": "Lead Principal Investigator Institution",
"item": [
{
"linkId": "dl11.1",
"text": "Lead Principal Investigator Institution Name",
"answer": [
{
"valueString": "Sample University Medical Center"
}
]
}
]
},
{
"linkId": "dl7",
"text": "Relying IRB",
"item": [
{
"linkId": "dl7.5",
"text": "Relying institution and Relying Site Principal Investigator for this Determination Letter",
"item": [
{
"linkId": "ExternalDataFor_dl7.5.1",
"text": "External Data For linkId dl7.5.1",
"answer": [
{
"valueString": "Sample University Medical Center | | Jane Doe, MD | Sample City, NC"
},
{
"valueString": "Test Example University | | Xi-Yang Lee, Jr., MD, PhD | Example, MA"
},
{
"valueString": "Central Campus Test University | | Maria Smith, PhD | Central, MI"
}
]
},
{
"linkId": "dl7.5.1",
"text": "Select the relying site in order to pre-populate the relying institution and relying site principal investigator details below.",
"answer": [
{
"valueCoding": {
"display": "Test Example University | | Xi-Yang Lee, Jr., MD, PhD | Example, MA"
}
}
]
}
]
},
{
"linkId": "dl7.1",
"text": "Relying Institution",
"item": [
{
"linkId": "dl7.1.1",
"text": "Name",
"answer": [
{
"valueString": "Test Example University"
}
]
},
{
"linkId": "dl7.1.2",
"text": "Federal Wide Assurance (FWA)",
"answer": [
{
"valueInteger": 34567
}
]
}
]
},
{
"linkId": "dl7.2",
"text": "Relying Site Principal Investigator",
"item": [
{
"linkId": "dl7.2.1",
"text": "First Name",
"answer": [
{
"valueString": "Xi-Yang"
}
]
},
{
"linkId": "dl7.2.2",
"text": "Last Name",
"answer": [
{
"valueString": "Lee"
}
]
},
{
"linkId": "dl7.2.4",
"text": "Suffix",
"answer": [
{
"valueString": "Jr."
}
]
},
{
"linkId": "dl7.2.5",
"text": "Professional Degree(s)",
"answer": [
{
"valueString": "MD, PhD"
}
]
},
{
"linkId": "dl7.2.3",
"text": "Email",
"answer": [
{
"valueString": "XiYangLee@teu.med.edu"
}
]
}
]
}
]
},
{
"linkId": "dl9",
"text": "Point of Contact for Study Participants",
"item": [
{
"linkId": "dl9.1",
"text": "First Name",
"answer": [
{
"valueString": "Xi-Yang"
}
]
},
{
"linkId": "dl9.2",
"text": "Last Name",
"answer": [
{
"valueString": "Lee"
}
]
},
{
"linkId": "dl9.4",
"text": "Suffix",
"answer": [
{
"valueString": "Jr."
}
]
},
{
"linkId": "dl9.5",
"text": "Professional Degree(s)",
"answer": [
{
"valueString": "MD, PhD"
}
]
},
{
"linkId": "dl9.3",
"text": "Email",
"answer": [
{
"valueString": "XiYangLee@teu.med.edu"
}
]
}
]
},
{
"linkId": "ADMIN00",
"text": "Administrative Use Only",
"item": [
{
"linkId": "ADMIN01",
"text": "Link ID prefix",
"answer": [
{
"valueString": "dl"
}
]
},
{
"linkId": "ADMIN02",
"text": "Questionnaire Response ID for the parent Questionnaire Response (such as the Initiate a Study Questionnaire Response), if any",
"answer": [
{
"valueString": "initiate-study-populate-exampleQR"
}
]
},
{
"linkId": "ADMIN03",
"text": "ID of the Research Study FHIR Resource associated with the study Questionnaire Responses, if any",
"answer": [
{
"valueString": "ResearchStudyExample-sIRB"
}
]
}
]
}
]
}