An example to illustrate a questionnaire regarding an end of life plan

Table View

Questionnaire.id[0]UKCore-Questionnaire-EOLPlan-Example
Questionnaire.text[0].status[0]additional
Questionnaire.text[0].div[0]<div xmlns="http://www.w3.org/1999/xhtml">An example to illustrate an end of life plan questionnaire</div>
Questionnaire.url[0]https://example.com/base/Questionnaire/UKCore-Questionnaire-EOLPlan-Example
Questionnaire.title[0]End of Life Care Plan (Mock up)
Questionnaire.status[0]draft
Questionnaire.experimental[0]True
Questionnaire.subjectType[0]Patient
Questionnaire.date[0]2023-11-13T13:32:13+00:00
Questionnaire.description[0]This is an End of Life plan, purely for demonstration purposes
Questionnaire.code[0].system[0]http://snomed.info/sct
Questionnaire.code[0].code[0]861411000000103
Questionnaire.code[0].display[0]End of Life Care Document
Questionnaire.item[0].linkId[0]Q1
Questionnaire.item[0].text[0]Advanced Treatment Preferences
Questionnaire.item[0].type[0]group
Questionnaire.item[0].enableBehavior[0]any
Questionnaire.item[0].item[0].linkId[0]Q1.1
Questionnaire.item[0].item[0].text[0]Clinical Problems and Advised Interventions
Questionnaire.item[0].item[0].type[0]group
Questionnaire.item[0].item[0].enableBehavior[0]any
Questionnaire.item[0].item[0].repeats[0]True
Questionnaire.item[0].item[0].item[0].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[0].item[0].item[0].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[0].item[0].item[0].extension[0].value[0].coding[0].code[0]autocomplete
Questionnaire.item[0].item[0].item[0].extension[0].value[0].coding[0].display[0]Auto-complete
Questionnaire.item[0].item[0].item[0].linkId[0]Q1.1g
Questionnaire.item[0].item[0].item[0].text[0]ATP Problems
Questionnaire.item[0].item[0].item[0].type[0]choice
Questionnaire.item[0].item[0].item[0].enableBehavior[0]any
Questionnaire.item[0].item[0].item[0].required[0]True
Questionnaire.item[0].item[0].item[0].answerValueSet[0]https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode
Questionnaire.item[0].item[1].linkId[0]Q1.2
Questionnaire.item[0].item[1].text[0]Anticipatory medicines/just in case box issued
Questionnaire.item[0].item[1].type[0]string
Questionnaire.item[0].item[1].enableBehavior[0]any
Questionnaire.item[0].item[1].required[0]True
Questionnaire.item[0].item[2].linkId[0]Q1.3
Questionnaire.item[0].item[2].text[0]Advance Decision to Refuse Treatment
Questionnaire.item[0].item[2].type[0]string
Questionnaire.item[0].item[2].enableBehavior[0]any
Questionnaire.item[0].item[2].required[0]True
Questionnaire.item[1].linkId[0]Q2
Questionnaire.item[1].text[0]Consent
Questionnaire.item[1].type[0]group
Questionnaire.item[1].enableBehavior[0]any
Questionnaire.item[1].item[0].linkId[0]Q2g
Questionnaire.item[1].item[0].code[0].system[0]http://snomed.info/sct
Questionnaire.item[1].item[0].code[0].code[0]887031000000108
Questionnaire.item[1].item[0].code[0].display[0]Consent for information sharing
Questionnaire.item[1].item[0].text[0]Consent for Information Sharing
Questionnaire.item[1].item[0].type[0]date
Questionnaire.item[2].linkId[0]Q3
Questionnaire.item[2].text[0]EOL Register
Questionnaire.item[2].type[0]group
Questionnaire.item[2].enableBehavior[0]any
Questionnaire.item[2].repeats[0]False
Questionnaire.item[2].item[0].linkId[0]Q3g
Questionnaire.item[2].item[0].code[0].system[0]http://snomed.info/sct
Questionnaire.item[2].item[0].code[0].code[0]526631000000108
Questionnaire.item[2].item[0].code[0].display[0]On end of life care register
Questionnaire.item[2].item[0].text[0]On End Of Life Register
Questionnaire.item[2].item[0].type[0]dateTime

XML View

<Questionnaire xmlns="http://hl7.org/fhir">
<id value="UKCore-Questionnaire-EOLPlan-Example" />
<status value="additional" />
--- We have skipped the narrative for better readability of the resource ---
</text>
<url value="https://example.com/base/Questionnaire/UKCore-Questionnaire-EOLPlan-Example" />
<title value="End of Life Care Plan (Mock up)" />
<status value="draft" />
<experimental value="true" />
<subjectType value="Patient" />
<date value="2023-11-13T13:32:13+00:00" />
<description value="This is an End of Life plan, purely for demonstration purposes" />
<system value="http://snomed.info/sct" />
<code value="861411000000103" />
<display value="End of Life Care Document" />
</code>
<linkId value="Q1" />
<text value="Advanced Treatment Preferences" />
<type value="group" />
<enableBehavior value="any" />
<linkId value="Q1.1" />
<text value="Clinical Problems and Advised Interventions" />
<type value="group" />
<enableBehavior value="any" />
<repeats value="true" />
<extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<system value="http://hl7.org/fhir/questionnaire-item-control" />
<code value="autocomplete" />
<display value="Auto-complete" />
</coding>
</valueCodeableConcept>
</extension>
<linkId value="Q1.1g" />
<text value="ATP Problems" />
<type value="choice" />
<enableBehavior value="any" />
<required value="true" />
<answerValueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode" />
</item>
</item>
<linkId value="Q1.2" />
<text value="Anticipatory medicines/just in case box issued" />
<type value="string" />
<enableBehavior value="any" />
<required value="true" />
</item>
<linkId value="Q1.3" />
<text value="Advance Decision to Refuse Treatment" />
<type value="string" />
<enableBehavior value="any" />
<required value="true" />
</item>
</item>
<linkId value="Q2" />
<text value="Consent" />
<type value="group" />
<enableBehavior value="any" />
<linkId value="Q2g" />
<system value="http://snomed.info/sct" />
<code value="887031000000108" />
<display value="Consent for information sharing" />
</code>
<text value="Consent for Information Sharing" />
<type value="date" />
</item>
</item>
<linkId value="Q3" />
<text value="EOL Register" />
<type value="group" />
<enableBehavior value="any" />
<repeats value="false" />
<linkId value="Q3g" />
<system value="http://snomed.info/sct" />
<code value="526631000000108" />
<display value="On end of life care register" />
</code>
<text value="On End Of Life Register" />
<type value="dateTime" />
</item>
</item>
</Questionnaire>

JSON View

{
"resourceType": "Questionnaire",
"id": "UKCore-Questionnaire-EOLPlan-Example",
"text": {
"status": "additional",
--- We have skipped the narrative for better readability of the resource ---
},
"url": "https://example.com/base/Questionnaire/UKCore-Questionnaire-EOLPlan-Example",
"title": "End of Life Care Plan (Mock up)",
"status": "draft",
"experimental": true,
"Patient"
],
"date": "2023-11-13T13:32:13+00:00",
"description": "This is an End of Life plan, purely for demonstration purposes",
"code": [
{
"system": "http://snomed.info/sct",
"code": "861411000000103",
"display": "End of Life Care Document"
}
],
"item": [
{
"linkId": "Q1",
"text": "Advanced Treatment Preferences",
"type": "group",
"enableBehavior": "any",
"item": [
{
"linkId": "Q1.1",
"text": "Clinical Problems and Advised Interventions",
"type": "group",
"enableBehavior": "any",
"repeats": true,
"item": [
{
"linkId": "Q1.1g",
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "autocomplete",
"display": "Auto-complete"
}
]
}
}
],
"text": "ATP Problems",
"type": "choice",
"enableBehavior": "any",
"required": true,
"answerValueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode"
}
]
},
{
"linkId": "Q1.2",
"text": "Anticipatory medicines/just in case box issued",
"type": "string",
"enableBehavior": "any",
"required": true
},
{
"linkId": "Q1.3",
"text": "Advance Decision to Refuse Treatment",
"type": "string",
"enableBehavior": "any",
"required": true
}
]
},
{
"linkId": "Q2",
"text": "Consent",
"type": "group",
"enableBehavior": "any",
"item": [
{
"linkId": "Q2g",
"code": [
{
"system": "http://snomed.info/sct",
"code": "887031000000108",
"display": "Consent for information sharing"
}
],
"text": "Consent for Information Sharing",
"type": "date"
}
]
},
{
"linkId": "Q3",
"text": "EOL Register",
"type": "group",
"enableBehavior": "any",
"repeats": false,
"item": [
{
"linkId": "Q3g",
"code": [
{
"system": "http://snomed.info/sct",
"code": "526631000000108",
"display": "On end of life care register"
}
],
"text": "On End Of Life Register",
"type": "dateTime"
}
]
}
]
}