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Source1

{
  "resourceType": "QuestionnaireResponse",
  "id": "QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example",
  "questionnaire": "https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-ConsulteeDeclarationForm-Example",
  "status": "completed",
  "basedOn": [
    {
      "reference": "ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example"
    }
  ],
  "subject": {
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/nhs-number",
      "value": "9449307539"
    },
    "display": "A Patient"
  },
  "authored": "2024-01-25",
  "author": {
    "type": "PractitionerRole",
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
      "value": "999999999999"
    }
  },
  "source": {
    "type": "PractitionerRole",
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
      "value": "999999999999"
    }
  },
  "item": [
    {
      "linkId": "patientDetails",
      "text": "Patient Details",
      "item": [
        {
          "linkId": "givenName",
          "text": "First Name",
          "answer": [
            {
              "valueString": "Phoebe"
            }
          ]
        },
        {
          "linkId": "familyName",
          "text": "Last Name",
          "answer": [
            {
              "valueString": "Smitham"
            }
          ]
        },
        {
          "linkId": "nhs_Number",
          "text": "NHS number (or postcode if not not known)",
          "answer": [
            {
              "valueString": "9449307539"
            }
          ]
        },
        {
          "linkId": "birthDate",
          "text": "Date of Birth",
          "answer": [
            {
              "valueDate": "2013-09-27"
            }
          ]
        }
      ]
    },
    {
      "linkId": "confirmationOfDecision",
      "text": "Confirmation of decision",
      "item": [
        {
          "linkId": "confirmation",
          "text": "I confirm that I have read and had the opportunity to discuss information about acting as a consultee for the person lacking capacity. My research choices are indicated below.",
          "item": [
            {
              "linkId": "choiceConfirmation1",
              "text": "I have been consulted about this person’s participation in the National Genomic Research Library",
              "answer": [
                {
                  "valueBoolean": true
                }
              ]
            },
            {
              "linkId": "choiceConfirmation2",
              "text": "I am willing to accept the role of consultee for this person",
              "answer": [
                {
                  "valueBoolean": true
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "linkId": "isRemoteConsentTrue",
      "text": "Consent obtained remotely, no consultee signature",
      "answer": [
        {
          "valueBoolean": false
        }
      ]
    },
    {
      "linkId": "consulteeValidation",
      "text": "Consultee Validation",
      "item": [
        {
          "linkId": "consulteeNamecombined",
          "text": "Your Name(i.e, the Consultee)",
          "answer": [
            {
              "valueString": "James Goldsmith"
            }
          ]
        },
        {
          "linkId": "dateConsulteeCompletedForm",
          "text": "Date",
          "answer": [
            {
              "valueDateTime": "2023-09-15"
            }
          ]
        },
        {
          "linkId": "consulteeSignature",
          "text": "Signature",
          "answer": [
            {
              "valueString": "JamesG"
            }
          ]
        }
      ]
    },
    {
      "linkId": "healthcareProfessionalValidation",
      "text": "Healthcare professional use only",
      "item": [
        {
          "linkId": "healthcareProfessional",
          "text": "To be completed by the healthcare professional recording the consultee’s choices.",
          "item": [
            {
              "linkId": "healthcareProfessionalName",
              "text": "Healthcare professional name",
              "answer": [
                {
                  "valueString": "Mathew Arnold"
                }
              ]
            },
            {
              "linkId": "healthcareProfessionalSignature",
              "text": "Signature",
              "answer": [
                {
                  "valueString": "MathewA"
                }
              ]
            },
            {
              "linkId": "datehealthcareProfessionalCompletedForm",
              "text": "Date",
              "answer": [
                {
                  "valueDateTime": "2023-09-15"
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}