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Source1

{
  "resourceType": "QuestionnaireResponse",
  "id": "chr-on-west-QuestionnaireResponse-4001-Complete",
  "meta": {
    "lastUpdated": "2024-12-08T14:30:00Z",
    "source": "urn:telus:emr:chr:on-west",
    "profile": [
      "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwQuestionnaireResponse"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "identifier": {
    "system": "urn:telus:emr:chr:on-west:questionnaireresponseid",
    "value": "4001"
  },
  "questionnaire": "Questionnaire/chr-on-west-Questionnaire-1001-AllTypes",
  "status": "completed",
  "subject": {
    "reference": "Patient/chr-on-west-Patient-5001",
    "type": "Patient",
    "display": "Jane Elizabeth Doe"
  },
  "encounter": {
    "reference": "Encounter/chr-on-west-Encounter-6001",
    "type": "Encounter"
  },
  "authored": "2024-12-08T14:30:00Z",
  "item": [
    {
      "linkId": "patient_name",
      "text": "Patient Full Name",
      "answer": [
        {
          "valueString": "Jane Elizabeth Doe"
        }
      ]
    },
    {
      "linkId": "medical_history",
      "text": "Please describe your medical history",
      "answer": [
        {
          "valueString": "History of hypertension diagnosed in 2015, managed with lisinopril 10mg daily. No history of diabetes, cancer, or heart disease. Previous appendectomy in 2008."
        }
      ]
    },
    {
      "linkId": "date_of_birth",
      "text": "Date of Birth",
      "answer": [
        {
          "valueDate": "1985-06-15"
        }
      ]
    },
    {
      "linkId": "appointment_time",
      "text": "Preferred appointment time",
      "answer": [
        {
          "valueTime": "14:30:00"
        }
      ]
    },
    {
      "linkId": "has_insurance",
      "text": "Do you have health insurance?",
      "answer": [
        {
          "valueBoolean": true
        }
      ]
    },
    {
      "linkId": "age_years",
      "text": "Age (years)",
      "answer": [
        {
          "valueInteger": 38
        }
      ]
    },
    {
      "linkId": "weight_kg",
      "text": "Weight (kg)",
      "answer": [
        {
          "valueDecimal": 68.5
        }
      ]
    },
    {
      "linkId": "gender",
      "text": "Gender",
      "answer": [
        {
          "valueString": "Female"
        }
      ]
    },
    {
      "linkId": "symptoms",
      "text": "Select all symptoms you are experiencing",
      "answer": [
        {
          "valueString": "Fever"
        },
        {
          "valueString": "Headache"
        },
        {
          "valueString": "Fatigue"
        }
      ]
    },
    {
      "linkId": "pain_scale",
      "text": "Rate your pain level (0 = no pain, 10 = worst pain)",
      "answer": [
        {
          "valueString": "3"
        }
      ]
    },
    {
      "linkId": "insurance_details",
      "text": "Please provide insurance details",
      "answer": [
        {
          "valueString": "Blue Cross Blue Shield - Policy #: BCBS987654321, Group #: GRP12345"
        }
      ]
    },
    {
      "linkId": "medications_table",
      "text": "Current Medications",
      "item": [
        {
          "linkId": "medications_table-row-0",
          "item": [
            {
              "linkId": "medication_name",
              "answer": [
                {
                  "valueString": "Lisinopril"
                }
              ]
            },
            {
              "linkId": "dosage",
              "answer": [
                {
                  "valueString": "10mg"
                }
              ]
            },
            {
              "linkId": "frequency",
              "answer": [
                {
                  "valueString": "Once daily"
                }
              ]
            }
          ]
        },
        {
          "linkId": "medications_table-row-1",
          "item": [
            {
              "linkId": "medication_name",
              "answer": [
                {
                  "valueString": "Metformin"
                }
              ]
            },
            {
              "linkId": "dosage",
              "answer": [
                {
                  "valueString": "500mg"
                }
              ]
            },
            {
              "linkId": "frequency",
              "answer": [
                {
                  "valueString": "Twice daily"
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "linkId": "patient_signature",
      "text": "Patient Signature",
      "answer": [
        {
          "valueAttachment": {
            "contentType": "image/png",
            "data": "iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+M9QDwADhgGAWjR9awAAAABJRU5ErkJggg==",
            "title": "Patient Signature"
          }
        }
      ]
    },
    {
      "linkId": "signature_date",
      "text": "Signature Date",
      "answer": [
        {
          "valueDate": "2024-12-08"
        }
      ]
    }
  ]
}