---
type: "example"
title: "QuestionnaireResponse Example: questionnaireresponse-example-f201-lifelines"
resource: "QuestionnaireResponse"
example: "questionnaireresponse-example-f201-lifelines"
---
# QuestionnaireResponse Example: questionnaireresponse-example-f201-lifelines

## Example XML



```xml
<?xml version="1.0" encoding="UTF-8"?>
<QuestionnaireResponse xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/questionnaireresponse.xsd">
 <id value="f201"/>
   <questionnaire>
    <extension url="http://hl7.org/fhir/StructureDefinition/display">
      <valueString value="Lifelines"/>
    </extension>
   </questionnaire>
   <status value="completed"/>
  <!--Fictive, only the below answers are non-fictive-->
  <subject>
    <reference value="Patient/f201"/>
    <display value="Roel"/>
  </subject>
  <authored value="2013-06-18T00:00:00+01:00"/>
  <author>
    <reference value="Practitioner/f201"/>
  </author>
  <source>
    <reference value="Practitioner/f201"/>
  </source>
  <item>
    <linkId value="1"/>
    <text value="Do you have allergies?"/>
    <answer>
      <valueBoolean value="true"/>
    </answer>
  </item>
  <item>
    <!--Answers to general questions-->
    <linkId value="2"/>
    <text value="General questions"/>
    <item>
      <linkId value="2.1"/>
      <text value="What is your gender?"/>
      <answer>
        <valueString value="Male"/>
      </answer>
    </item>
    <item>
      <linkId value="2.2"/>
      <text value="What is your date of birth?"/>
      <answer>
        <valueDate value="1960-03-13"/>
      </answer>
    </item>
    <item>
      <linkId value="2.3"/>
      <text value="What is your country of birth?"/>
      <answer>
        <valueString value="The Netherlands"/>
      </answer>
    </item>
    <item>
      <linkId value="2.4"/>
      <text value="What is your marital status?"/>
      <answer>
        <valueString value="married"/>
      </answer>
    </item>
  </item>
  <item>
    <!--Answers to intoxications-->
    <linkId value="3"/>
    <text value="Intoxications"/>
    <item>
      <linkId value="3.1"/>
      <text value="Do you smoke?"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
    <item>
      <linkId value="3.2"/>
      <text value="Do you drink alchohol?"/>
      <answer>
        <valueBoolean value="false"/>
      </answer>
    </item>
  </item>
</QuestionnaireResponse>
```