| Package | hl7.fhir.uv.sdc |
| Resource Type | Questionnaire |
| Id | questionnaire-sdc-profile-example-form-behavior |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/sdc/https://build.fhir.org/ig/HL7/sdc/Questionnaire-questionnaire-sdc-profile-example-form-behavior.html |
| URL | http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior |
| Version | 4.0.0-ballot |
| Status | active |
| Date | 2025-08-07T06:58:13+00:00 |
| Name | SDCAdvancedRenderingExample |
| Realm | uv |
| Authority | hl7 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire questionnaire-sdc-profile-example-form-behavior
Profile: Advanced Behavior Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  SDCAdvancedRenderingExample | Questionnaire | http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior#4.0.0-ballot | |||
  1 | Value constraints | 0..1 | group | ||
  1.1 | First Name | 0..1 | string | Max Length: 50 | |
| 1.2 | Last Name | 0..1 | string | ||
| 1.3 | Postal Code (A1A 1A1) | 0..1 | string | ||
 1.4 | Enter your weight in kg | 0..1 | decimal | ||
 1.5 | Body Weight | 0..1 | quantity | ||
  1.6 | Attach Proof of Citizenship | 0..1 | attachment | ||
| 2 | Value constraints | 0..1 | group | ||
 2.1 | (I/We) worried whether (my/our) food would run out before (I/we) got money to buy more. | 0..1 | choice | Options: 4 options | |
| 2.3 | Activity Level | 0..1 | choice | Value Set: http://loinc.org/vs/LL4882-8 | |
| 2.5 | Applicable health conditions | 0..* | choice | Value Set: Questionnaire Form Behavior Conditions | |
| 2.6 | Email* | 1..1 | string | ||
 2.7 | Current Date: | 0..1 | date |  | |
 2.7.1 | null | 0..1 | display | ||
| 2.8 | Heart History (check all that applies) | 0..* | open-choice | Options: 5 options | |
| 2.9 | Heart History (check at least 2): | 1..* | choice | Options: 5 options | |
| 2.10 | Heart History (check no more than 3): | 1..* | choice | Options: 5 options | |
| 2.11 | What treatments do you now have for heart disease? (select all that applies) | 0..* | choice | Options: 6 options | |
| 2.12 | Dosage | 0..1 | quantity | ||
| 2.13 | Specify age: | 0..1 | quantity | ||
 2.14 | Select your preferred practitioner: | 0..1 | reference | ||
| 3 | Calculation | 0..1 | group | ||
| 3.1 | Deadline for submission (7 days from now) | 0..1 | date | | |
| 3.2 | null | 0..1 | group | ||
| 3.2.1 | Last Name: | 0..1 | string | | |
| 3.2.2 | First Name: | 0..1 | string | | |
| 3.2.3 | Gender: | 0..1 | string | | |
| 3.3 | Calculated Expression | 0..1 | group | ||
| 3.3.1 | Weight (kg) | 0..1 | decimal | ||
| 3.3.2 | Body Height (inches) | 0..1 | decimal | ||
| 3.3.3 | Your Body Mass Index (BMI) | 0..1 | decimal | | |
| 3.4 | CQF-related Example | 0..1 | group | ||
| 3.4.1 | Enter weight in kg | 0..1 | decimal | ||
| 3.4.2 | Enter email address | 0..1 | string | ||
| 3.5 | null | 0..1 | display | ||
| 4 | Other Controls | 0..1 | group | ||
 4.1 | Marital Status | 0..1 | choice | Value Set: MaritalStatus Initial Value: Coding = MaritalStatus#D "Divorced" | |
| 4.2 | null | 0..1 | group | ||
| 4.2.1 | Choose Gender | 0..1 | choice | Value Set: AdministrativeGender | |
| 4.2.2 | Are you pregnant? (enableWhen = gender is Female, disableDisplay=protected) | 0..1 | choice | Enable When: 4.2.1 = Value Set: Yes/No/Don't Know | |
| 4.2.3 | Are you diabetic? (enableWhen = gender is Female, disableDisplay=hidden) | 0..1 | choice | Enable When: 4.2.1 = Value Set: Yes/No/Don't Know | |
| 4.2.4 | Have you been diagnosed with Gestational Diabetes? (enableBehavior = only when pregnant and diabetic, disableDisplay=protected) | 0..1 | choice | Enable When: Value Set: Yes/No/Don't Know | |
| 4.2.5 | Enter your birthdate (MM/DD/YYYY) | 0..1 | date | Value Set: AdministrativeGender | |
| 4.2.6 | Have you had mammogram before?(enableWhenExpression = only when gender is female and age > 40, disableDisplay=protected) | 0..1 | choice | Value Set: Yes/No/Don't Know | |
| 4.4 | Signature of Patient | 1..1 | attachment | ||
| 4.5 | All the practitioners below can speak the patient's language. Choose all preferred practioners: | 0..* | reference | ||
| 4.6 | null | 0..1 | group | ||
| 4.6.1 | Home Address | 0..1 | display | ||
| 4.6.2 | Address | 0..1 | string | Definition: Patient.address.line | |
| 4.6.3 | City | 0..1 | string | Definition: Patient.address.city | |
| 4.6.4 | Province | 0..1 | choice | Definition: Patient.address.state Options: 10 options | |
| 4.6.5 | Postal Code | 0..1 | string | Definition: Patient.address.postalCode | |
| Documentation for this format | |||||
Options Sets
Answer options for 2.1
Answer options for 2.8
Answer options for 2.9
Answer options for 2.10
Answer options for 2.11
Answer options for 4.6.4
FHIR{
"resourceType": "Questionnaire",
"id": "questionnaire-sdc-profile-example-form-behavior",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-behave"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm[x]",
"valueCoding": {
"system": "http://hl7.org/fhir/version-algorithm",
"code": "semver"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "weight",
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='3.3.1').item.answer.value"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "height",
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='3.3.2').item.answer.value*0.0254"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-library",
"valueCanonical": "http://example.org/Library/MeasurementLimits"
},
{
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "patient",
"display": "Patient"
}
},
{
"url": "type",
"valueCode": "Patient"
},
{
"url": "description",
"valueString": "The patient that is to be used to pre-populate the form"
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-endpoint",
"valueUri": "http://example.org/QuestionnaireResponse/create"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
"valueCode": "sequential"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-assembleDefinitionRoot",
"valueUri": "http://example.org/StructureDefinition/myElementLibrary"
}
],
"modifierExtension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-rendering-criticalExtension",
"valueCanonical": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-rendering-criticalExtension",
"valueCanonical": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerOptionsToggleExpression"
}
],
"url": "http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-form-behavior",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.40.17.35.9"
}
],
"version": "4.0.0-ballot",
"name": "SDCAdvancedRenderingExample",
"status": "active",
"date": "2025-08-07T06:58:13+00:00",
"publisher": "HL7 International / FHIR Infrastructure",
"contact": [
{
"name": "HL7 International / FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
},
{
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"item": [
{
"linkId": "1",
"text": "Value constraints",
"type": "group",
"item": [
{
"linkId": "1.1",
"text": "First Name",
"type": "string",
"maxLength": 50
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minLength",
"valueInteger": 2
}
],
"linkId": "1.2",
"text": "Last Name",
"type": "string"
},
{
"extension": [
{
"extension": [
{
"url": "key",
"valueId": "contraint-regex1"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='1.3').answer.all(value.matches('[A-Z][0-9][A-Z] [0-9][A-Z][0-9]'))"
}
},
{
"url": "human",
"valueString": "Postal code must match syntax A1A 1A1."
}
],
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint"
}
],
"linkId": "1.3",
"text": "Postal Code (A1A 1A1)",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueDecimal": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueDecimal": 100
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxDecimalPlaces",
"valueInteger": 2
}
],
"linkId": "1.4",
"text": "Enter your weight in kg",
"type": "decimal"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/ucum-bodyweight"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-minQuantity",
"valueQuantity": {
"value": 10,
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-maxQuantity",
"valueQuantity": {
"value": 100,
"system": "http://unitsofmeasure.org",
"code": "kg"
}
}
],
"linkId": "1.5",
"text": "Body Weight",
"type": "quantity"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/jpeg"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/pdf"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal": 1048576
}
],
"linkId": "1.6",
"text": "Attach Proof of Citizenship",
"type": "attachment"
}
]
},
{
"linkId": "2",
"text": "Value constraints",
"type": "group",
"item": [
{
"linkId": "2.1",
"text": "(I/We) worried whether (my/our) food would run out before (I/we) got money to buy more.",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA28397-0",
"display": "Often true"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA6729-3",
"display": "Sometimes true"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA28398-8",
"display": "Never true"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA15775-2",
"display": "Don't know/refused"
}
}
]
},
{
"linkId": "2.3",
"text": "Activity Level",
"type": "choice",
"answerValueSet": "http://loinc.org/vs/LL4882-8"
},
{
"extension": [
{
"extension": [
{
"url": "option",
"valueCoding": {
"system": "http://example.org/CodeSystem/conditions",
"code": "3"
}
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%patient.gender!='male'"
}
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerOptionsToggleExpression"
},
{
"extension": [
{
"url": "option",
"valueCoding": {
"system": "http://example.org/CodeSystem/conditions",
"code": "4"
}
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%patient.gender!='female'"
}
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerOptionsToggleExpression"
}
],
"linkId": "2.5",
"text": "Applicable health conditions",
"type": "choice",
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/sdc/ValueSet/formBehaviorConditions"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-keyboard",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/keyboardType",
"code": "email",
"display": "email"
}
}
],
"linkId": "2.6",
"text": "Email*",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "current date",
"language": "text/fhirpath",
"expression": "today()"
}
}
],
"linkId": "2.7",
"text": "Current Date:",
"type": "date",
"readOnly": true
},
{
"linkId": "2.7.1",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"description": "Substitute in current date",
"language": "text/fhirpath",
"expression": "'Please only enter data that has been validated as of ' + today()"
}
}
]
},
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-openLabel",
"valueString": "Other event (specify)"
}
],
"linkId": "2.8",
"text": "Heart History (check all that applies)",
"type": "open-choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U1",
"display": "Heart attack"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U2",
"display": "Heart surgery"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U3",
"display": "Cardiac catheterization"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U4",
"display": "Coronary angioplasty (PTCA)"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U5",
"display": "Cardiac pacemaker"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-minOccurs",
"valueInteger": 2
}
],
"linkId": "2.9",
"text": "Heart History (check at least 2):",
"type": "choice",
"required": true,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U1",
"display": "Heart attack"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U2",
"display": "Heart surgery"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U3",
"display": "Cardiac catheterization"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U4",
"display": "Coronary angioplasty (PTCA)"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U5",
"display": "Cardiac pacemaker"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxOccurs",
"valueInteger": 3
}
],
"linkId": "2.10",
"text": "Heart History (check no more than 3):",
"type": "choice",
"required": true,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U1",
"display": "Heart attack"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U2",
"display": "Heart surgery"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U3",
"display": "Cardiac catheterization"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U4",
"display": "Coronary angioplasty (PTCA)"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/procedures",
"code": "U5",
"display": "Cardiac pacemaker"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check-box"
}
]
}
}
],
"linkId": "2.11",
"text": "What treatments do you now have for heart disease? (select all that applies)",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://example.org/CodeSystem/treatments",
"code": "noTreatment",
"display": "NoTreatment"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/treatments",
"code": "aspirin",
"display": "Aspirin"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/treatments",
"code": "otherMeds",
"display": "Other medicines, tablets, or pills"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/treatments",
"code": "diet",
"display": "Diet"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/treatments",
"code": "exercise",
"display": "Exercise"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionExclusive",
"valueBoolean": true
}
],
"valueCoding": {
"system": "http://example.org/CodeSystem/treatments",
"code": "none",
"display": "None of the above"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "mL",
"display": "mL"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "L",
"display": "L"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "g",
"display": "g"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "mg",
"display": "mg"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-unitOpen",
"valueCode": "optionsOrType"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-unitSupplementalSystem",
"valueCanonical": "http://example.org/SomeUnitCodeSystem"
}
],
"linkId": "2.12",
"text": "Dosage",
"type": "quantity"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/age-units"
}
],
"linkId": "2.13",
"text": "Specify age:",
"type": "quantity"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource",
"valueCode": "Practitioner"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
"valueCanonical": "http://example.org/fhir/StructureDefinition/my-practitioner"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-lookupQuestionnaire",
"valueCanonical": "http://example.org/Questionnaire/1234"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"description": "all active practitioners",
"language": "application/x-fhir-query",
"expression": "Practitioner?active=true&_sort=family,given"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name.where(use='official').family + ', ' + name.where(use='official').given.first()"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "2.14",
"text": "Select your preferred practitioner:",
"type": "reference"
}
]
},
{
"linkId": "3",
"text": "Calculation",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "deadline for submission",
"language": "text/fhirpath",
"expression": "today() + 7 days"
}
}
],
"linkId": "3.1",
"text": "Deadline for submission (7 days from now)",
"type": "date",
"readOnly": true
},
{
"linkId": "3.2",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "patient's last name",
"language": "text/fhirpath",
"expression": "%patient.name.where(use='official').given.first()"
}
}
],
"linkId": "3.2.1",
"text": "Last Name:",
"type": "string",
"readOnly": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "patient's first name",
"language": "text/fhirpath",
"expression": "%patient.name.where(use='official').family"
}
}
],
"linkId": "3.2.2",
"text": "First Name:",
"type": "string",
"readOnly": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "patient's gender",
"language": "text/fhirpath",
"expression": "%patient.gender"
}
}
],
"linkId": "3.2.3",
"text": "Gender:",
"type": "string",
"readOnly": true
}
]
},
{
"linkId": "3.3",
"text": "Calculated Expression",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "kg"
}
}
],
"linkId": "3.3.1",
"text": "Weight (kg)",
"type": "decimal"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "[in_i]"
}
}
],
"linkId": "3.3.2",
"text": "Body Height (inches)",
"type": "decimal"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
"valueExpression": {
"description": "BMI Calculation",
"language": "text/fhirpath",
"expression": "(%weight/(%height.power(2))).round(1)"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-assembleDefinitionRoot",
"valueBoolean": false
}
],
"linkId": "3.3.3",
"text": "Your Body Mass Index (BMI)",
"type": "decimal",
"readOnly": true
}
]
},
{
"linkId": "3.4",
"text": "CQF-related Example",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueDecimal": 1,
"_valueDecimal": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "min_weight"
}
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueDecimal": 100,
"_valueDecimal": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "max_weight"
}
}
]
}
}
],
"linkId": "3.4.1",
"text": "Enter weight in kg",
"type": "decimal"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-keyboard",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/keyboardType",
"code": "email",
"display": "email"
}
}
],
"linkId": "3.4.2",
"text": "Enter email address",
"type": "string",
"required": false,
"_required": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"description": "current date",
"language": "text/fhirpath",
"expression": "%patient.active"
}
}
]
}
}
]
},
{
"linkId": "3.5",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"description": "last immunization date",
"language": "text/fhirpath",
"expression": "'Your last immunization was on '+ %Immunization.occurrenceDateTime.substring(0,10) + '.'"
}
}
]
},
"type": "display"
}
]
},
{
"linkId": "4",
"text": "Other Controls",
"type": "group",
"item": [
{
"linkId": "4.1",
"text": "Marital Status",
"type": "choice",
"answerValueSet": "http://hl7.org/fhir/ValueSet/marital-status",
"initial": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "D",
"display": "Divorced"
}
}
]
},
{
"linkId": "4.2",
"type": "group",
"item": [
{
"linkId": "4.2.1",
"text": "Choose Gender",
"type": "choice",
"answerValueSet": "http://hl7.org/fhir/ValueSet/administrative-gender"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.item.disabledDisplay",
"valueCode": "protected"
}
],
"linkId": "4.2.2",
"text": "Are you pregnant? (enableWhen = gender is Female, disableDisplay=protected)",
"type": "choice",
"enableWhen": [
{
"question": "4.2.1",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female"
}
}
],
"answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.item.disabledDisplay",
"valueCode": "hidden"
}
],
"linkId": "4.2.3",
"text": "Are you diabetic? (enableWhen = gender is Female, disableDisplay=hidden)",
"type": "choice",
"enableWhen": [
{
"question": "4.2.1",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female"
}
}
],
"answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.item.disabledDisplay",
"valueCode": "protected"
}
],
"linkId": "4.2.4",
"text": "Have you been diagnosed with Gestational Diabetes? (enableBehavior = only when pregnant and diabetic, disableDisplay=protected)",
"type": "choice",
"enableWhen": [
{
"question": "4.2.2",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "Y"
}
},
{
"question": "4.2.3",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "Y"
}
}
],
"enableBehavior": "all",
"answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "MM/DD/YYYY"
}
],
"linkId": "4.2.5",
"text": "Enter your birthdate (MM/DD/YYYY)",
"type": "date",
"answerValueSet": "http://hl7.org/fhir/ValueSet/administrative-gender"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.item.disabledDisplay",
"valueCode": "protected"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"description": "if last 2 questions were answered",
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='4.2.b.1').answer.value.code ='female' and today().toString().substring(0, 4).toInteger() - %resource.repeat(item).where(linkId='4.2.b.5').answer.value.toString().substring(0, 4).toInteger() >= 40"
}
}
],
"linkId": "4.2.6",
"text": "Have you had mammogram before?(enableWhenExpression = only when gender is female and age > 40, disableDisplay=protected)",
"type": "choice",
"answerValueSet": "http://hl7.org/fhir/ValueSet/yesnodontknow"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired",
"valueCodeableConcept": {
"coding": [
{
"system": "urn:iso-astm:E1762-95:2013",
"code": "1.2.840.10065.1.12.1.8",
"display": "Signature Witness Signature"
}
],
"text": "the signature of a witness to any other signature."
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-usageMode",
"valueCode": "capture"
}
],
"linkId": "4.4",
"text": "Signature of Patient",
"type": "attachment",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-candidateExpression",
"valueExpression": {
"description": "active practitioners that speak at least one of the patient's language",
"language": "application/x-fhir-query",
"expression": "Practitioner?communication=&active=true"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name.first().family"
},
{
"url": "label",
"valueString": "LAST NAME"
},
{
"url": "width",
"valueQuantity": {
"value": 40,
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
},
{
"extension": [
{
"url": "path",
"valueString": "name.first().given.first()"
},
{
"url": "label",
"valueString": "FIRST NAME"
},
{
"url": "width",
"valueQuantity": {
"value": 40,
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
},
{
"extension": [
{
"url": "path",
"valueString": "gender"
},
{
"url": "label",
"valueString": "GENDER"
},
{
"url": "width",
"valueQuantity": {
"value": 20,
"system": "http://unitsofmeasure.org",
"code": "%"
}
},
{
"url": "forDisplay",
"valueBoolean": false
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "4.5",
"text": "All the practitioners below can speak the patient's language. Choose all preferred practioners:",
"type": "reference",
"repeats": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-itemPopulationContext",
"valueExpression": {
"description": "Home address of the patient",
"name": "homeAddress",
"language": "text/fhirpath",
"expression": "%patient.address.where(use='home').first()"
}
}
],
"linkId": "4.6",
"type": "group",
"item": [
{
"linkId": "4.6.1",
"text": "Home Address",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "Address Line 1",
"language": "text/fhirpath",
"expression": "%homeAddress.line.first()"
}
}
],
"linkId": "4.6.2",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.line",
"text": "Address",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "City",
"language": "text/fhirpath",
"expression": "%homeAddress.city"
}
}
],
"linkId": "4.6.3",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.city",
"text": "City",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "State",
"language": "text/fhirpath",
"expression": "%homeAddress.state"
}
}
],
"linkId": "4.6.4",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.state",
"text": "Province",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "Alberta",
"display": "Alberta"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "BritishColumbia",
"display": "British Columbia"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "Manitoba",
"display": "Manitoba"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "NewBrunswick",
"display": "New Brunswick"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "NewfoundlandAndLabrador",
"display": "Newfoundland and Labrador"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "NovaScotia",
"display": "Nova Scotia"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "Ontario",
"display": "Ontario"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "PrinceEdwardIsland",
"display": "Prince Edward Island"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "Quebec",
"display": "Quebec"
}
},
{
"valueCoding": {
"system": "http://example.org/CodeSystem/provinces",
"code": "Saskatchewan",
"display": "Saskatchewan"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "Postal Code",
"language": "text/fhirpath",
"expression": "%homeAddress.postalCode"
}
}
],
"linkId": "4.6.5",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.postalCode",
"text": "Postal Code",
"type": "string"
}
]
}
]
}
]
}