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

## Narrative

Comorbidity? YES
              Cardial Comorbidity? YES
                Angina? YES
                MI? NO
              Vascular Comorbidity?
                (no answers)
              ...
            Histopathology
              Abdominal
                pT category: 1a
              ...

## 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="3141"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <pre>
            Comorbidity? YES
              Cardial Comorbidity? YES
                Angina? YES
                MI? NO
              Vascular Comorbidity?
                (no answers)
              ...
            Histopathology
              Abdominal
                pT category: 1a
              ...
          </pre>
    </div>
  </text>
  <contained>
    <Patient>
      <id value="patsub"/>
      <identifier>
        <system value="http://cancer.questionnaire.org/systems/id/patientnr"/>
        <value value="A34442332"/>
      </identifier>
      <identifier>
        <type>
          <text value="Dutch BSN"/>
        </type>
        <system value="urn:oid:2.16.840.1.113883.2.4.6.3"/>
        <value value="188912345"/>
      </identifier>
      <gender value="male"/>
      <birthDate value="1972-11-30"/>
    </Patient>
  </contained>
  <contained>
    <ServiceRequest>
      <id value="order"/>
      <status value="unknown"/>
      <intent value="order"/>
      <subject>
        <reference value="#patsub"/>
      </subject>
      <requester>
          <reference value="Practitioner/example"/>
      </requester>
    </ServiceRequest>
  </contained>
  <contained>
    <Practitioner>
      <id value="questauth"/>
      <identifier>
        <type>
          <text value="AUMC, Den Helder"/>
        </type>
        <system value="http://cancer.questionnaire.org/systems/id/org"/>
        <value value="AUMC"/>
      </identifier>
    </Practitioner>
  </contained>
  <!--   TODO: decide how to do this
  <contained>

    <Observation>
      <id value="obs.pt-category"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="53786006"/>
          <display value="pT1 category"/>
        </coding>
      </code>
      <subject>
        <reference value="#patsub"/>
      </subject>
      <performer>
        <reference value="#questauth"/>
      </performer>
      <valueCodeableConcept>
        <coding>
          <system value="http://snomed.info/sct"/>
          <code value="443357004"/>
          <display value="pT1a category"/>
        </coding>
      </valueCodeableConcept>
    </Observation>
  </contained> -->
  <identifier>
    <system value="http://example.org/fhir/NamingSystem/questionnaire-ids"/>
    <value value="Q12349876"/>
  </identifier>
  <basedOn>
    <reference value="#order"/>
  </basedOn>
  <partOf>
    <reference value="Procedure/f201"/>
  </partOf>
  <questionnaire value="urn:uuid:95eaedf7-8a24-478a-8300-39acc44c746b"/>
  <status value="completed"/>
  <subject>
    <reference value="#patsub"/>
  </subject>
  <encounter>
    <reference value="Encounter/example"/>
  </encounter>
  <authored value="2013-02-19T14:15:00-05:00"/>
  <author>
    <reference value="#questauth"/>
  </author>
  <item>
    <!--   COMORBIDITY   -->
    <!--   First main section of the form, questions about comorbidity   -->
    <!--   section contains one question: whether there is comorbidity   -->
    <linkId value="1"/>
    <item>
      <linkId value="1.1"/>
      <answer>
        <valueCoding>
          <system value="http://cancer.questionnaire.org/system/code/yesno"/>
          <code value="1"/>
          <display value="Yes"/>
        </valueCoding>
        <item>
          <!--   COMORBIDITY/CARDIAL   -->
          <!--   Subsection about specific comorbidity: cardial   -->
          <linkId value="1.1.1"/>
          <item>
            <linkId value="1.1.1.1"/>
            <answer>
              <valueCoding>
                <system value="http://cancer.questionnaire.org/system/code/yesno"/>
                <code value="1"/>
              </valueCoding>
            </answer>
          </item>
          <item>
            <!--   This answer carries both the questionnaire-specific name and an equivalent SNOMED CT code   -->
            <linkId value="1.1.1.2"/>
            <answer>
              <valueCoding>
                <system value="http://cancer.questionnaire.org/system/code/yesno"/>
                <code value="1"/>
              </valueCoding>
            </answer>
          </item>
          <item>
            <linkId value="1.1.1.3"/>
            <answer>
              <valueCoding>
                <system value="http://cancer.questionnaire.org/system/code/yesno"/>
                <code value="0"/>
              </valueCoding>
            </answer>
          </item>
        </item>
      </answer>
    </item>
  </item>
  <!--   HISTOPATHOLOGY   -->
  <!--   TODO: decide how to do this
  <item>

    <item>
      <item>
       <dataResource>
          <reference value="#obs.pt-category"/>
        </dataResource>
      </item>
    </item>
  </item>   -->
</QuestionnaireResponse>
```