An example to illustrate a questionnaire regarding a fitness for work survey

Table View

Questionnaire.id[0]UKCore-Questionnaire-FitnessForWork-Example
Questionnaire.text[0].status[0]additional
Questionnaire.text[0].div[0]<div xmlns="http://www.w3.org/1999/xhtml">An example to illustrate a fitness for work form questions</div>
Questionnaire.url[0]https://example.com/base/Questionnaire/UKCore-Questionnaire-FitnessForWork-Example
Questionnaire.title[0]Statement of Fitness for Work (Mock up)
Questionnaire.status[0]draft
Questionnaire.experimental[0]True
Questionnaire.subjectType[0]Patient
Questionnaire.description[0]This is based on Med 3 from DWP purely for demonstration purposes
Questionnaire.code[0].system[0]http://snomed.info/sct
Questionnaire.code[0].code[0]18381000000107
Questionnaire.code[0].display[0]Sickness certificates
Questionnaire.item[0].linkId[0]Q1
Questionnaire.item[0].text[0]Assessment Date
Questionnaire.item[0].type[0]date
Questionnaire.item[0].required[0]True
Questionnaire.item[1].linkId[0]Q2
Questionnaire.item[1].text[0]Condition(s)
Questionnaire.item[1].type[0]group
Questionnaire.item[1].item[0].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].code[0]autocomplete
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].display[0]Auto-complete
Questionnaire.item[1].item[0].linkId[0]Q2g
Questionnaire.item[1].item[0].text[0]Condition (Coded)
Questionnaire.item[1].item[0].type[0]choice
Questionnaire.item[1].item[0].repeats[0]True
Questionnaire.item[1].item[0].answerValueSet[0]https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode
Questionnaire.item[2].linkId[0]Q3
Questionnaire.item[2].code[0].system[0]http://snomed.info/sct
Questionnaire.item[2].code[0].code[0]365524007
Questionnaire.item[2].code[0].display[0]Fitness for work - finding
Questionnaire.item[2].text[0]I find you
Questionnaire.item[2].type[0]choice
Questionnaire.item[2].required[0]True
Questionnaire.item[2].answerOption[0].value[0].system[0]http://snomed.info/sct
Questionnaire.item[2].answerOption[0].value[0].code[0]160910001
Questionnaire.item[2].answerOption[0].value[0].display[0]Unfit for work
Questionnaire.item[2].answerOption[1].value[0].system[0]http://snomed.info/sct
Questionnaire.item[2].answerOption[1].value[0].code[0]225891002
Questionnaire.item[2].answerOption[1].value[0].display[0]Fit for work with restrictions

XML View

<Questionnaire xmlns="http://hl7.org/fhir">
<id value="UKCore-Questionnaire-FitnessForWork-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-FitnessForWork-Example" />
<title value="Statement of Fitness for Work (Mock up)" />
<status value="draft" />
<experimental value="true" />
<subjectType value="Patient" />
<description value="This is based on Med 3 from DWP purely for demonstration purposes" />
<system value="http://snomed.info/sct" />
<code value="18381000000107" />
<display value="Sickness certificates" />
</code>
<linkId value="Q1" />
<text value="Assessment Date" />
<type value="date" />
<required value="true" />
</item>
<linkId value="Q2" />
<text value="Condition(s)" />
<type value="group" />
<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="Q2g" />
<text value="Condition (Coded)" />
<type value="choice" />
<repeats value="true" />
<answerValueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode" />
</item>
</item>
<linkId value="Q3" />
<system value="http://snomed.info/sct" />
<code value="365524007" />
<display value="Fitness for work - finding" />
</code>
<text value="I find you" />
<type value="choice" />
<required value="true" />
<system value="http://snomed.info/sct" />
<code value="160910001" />
<display value="Unfit for work" />
</valueCoding>
</answerOption>
<system value="http://snomed.info/sct" />
<code value="225891002" />
<display value="Fit for work with restrictions" />
</valueCoding>
</answerOption>
</item>
</Questionnaire>

JSON View

{
"resourceType": "Questionnaire",
"id": "UKCore-Questionnaire-FitnessForWork-Example",
"text": {
"status": "additional",
--- We have skipped the narrative for better readability of the resource ---
},
"url": "https://example.com/base/Questionnaire/UKCore-Questionnaire-FitnessForWork-Example",
"title": "Statement of Fitness for Work (Mock up)",
"status": "draft",
"experimental": true,
"Patient"
],
"description": "This is based on Med 3 from DWP purely for demonstration purposes",
"code": [
{
"system": "http://snomed.info/sct",
"code": "18381000000107",
"display": "Sickness certificates"
}
],
"item": [
{
"linkId": "Q1",
"text": "Assessment Date",
"type": "date",
"required": true
},
{
"linkId": "Q2",
"text": "Condition(s)",
"type": "group",
"item": [
{
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "autocomplete",
"display": "Auto-complete"
}
]
}
}
],
"linkId": "Q2g",
"text": "Condition (Coded)",
"type": "choice",
"repeats": true,
"answerValueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode"
}
]
},
{
"linkId": "Q3",
"code": [
{
"system": "http://snomed.info/sct",
"code": "365524007",
"display": "Fitness for work - finding"
}
],
"text": "I find you",
"type": "choice",
"required": true,
{
"system": "http://snomed.info/sct",
"code": "160910001",
"display": "Unfit for work"
}
},
{
"system": "http://snomed.info/sct",
"code": "225891002",
"display": "Fit for work with restrictions"
}
}
]
}
]
}