This page is part of the Argonaut Questionnaire Implementation Guide (v1.0.0: Release) based on FHIR R3. This is the current published version. For a full list of available versions, see the Directory of published versions
XML Format: QuestionnaireResponse-questionnaireresponse-example-phq9
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<QuestionnaireResponse xmlns="http://hl7.org/fhir"> <id value="questionnaireresponse-example-phq9"/> <meta> <profile value="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/argo-questionnaireresponse"/> </meta> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <h3>Response Summary</h3> <strong>Questionnaire URL:</strong> http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-phq9<br /> <strong>Date Completed:</strong> 2019-02-13T00:36:41.051113Z<br /> <hr /> <br /><strong>Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “X” to indicate your answer)</strong><br /><br /> <strong>Question:</strong> (linkID=g1.q1) Little interest or pleasure in doing things,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q2) Feeling down, depressed, or hopeless,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q3) Trouble falling or staying asleep, or sleeping too much<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q4) Feeling tired or having little energy,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q5) Poor appetite or overeating,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q6) Feeling bad about yourself - or that you are a failure or have let yourself or your family down,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q7) Trouble concentrating on things, such as reading the newspaper or watching television,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q8) Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual,<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /> <strong>Question:</strong> (linkID=g1.q9) Thoughts that you would be better off dead, or of hurting yourself<br /><strong>Response:</strong> Not at all ( code = LA6568-5, codesystem = http://loinc.org)<br /><br /><strong>Scoring: Add up all checked boxes on PHQ-9. For every: Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3 Interpretation of Total Score Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression (this is hidden text/should not be displayed to the user)</strong><br /><br /> <strong>Question:</strong> (linkID=g2.q1) If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people,<br /><strong>Response:</strong> Not difficult at all ( code = LA6572-7, codesystem = http://loinc.org)<br /> <br /><br /> </div> </text> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-responsePeriod"> <valuePeriod> <start value="2019-02-13T00:36:07.985403Z"/> <end value="2019-02-13T00:36:41.051113Z"/> </valuePeriod> </extension> <identifier> <value value="questionnaireresponse-example-phq9"/> </identifier> <questionnaire> <reference value="http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-phq9"/> </questionnaire> <status value="completed"/> <subject> <reference value="Patient/subject1"/> </subject> <context> <reference value="Encounter/encounter1"/> </context> <authored value="2019-02-13T00:36:41.051113Z"/> <author> <reference value="Practitioner/prov-admin1"/> </author> <source> <reference value="Patient/subject1"/> </source> <item> <linkId value="g1"/> <item> <linkId value="g1.d"/> <text value="Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “X” to indicate your answer)"/> </item> <item> <linkId value="g1.q1"/> <text value="Little interest or pleasure in doing things,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q2"/> <text value="Feeling down, depressed, or hopeless,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q3"/> <text value="Trouble falling or staying asleep, or sleeping too much"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q4"/> <text value="Feeling tired or having little energy,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q5"/> <text value="Poor appetite or overeating,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q6"/> <text value="Feeling bad about yourself - or that you are a failure or have let yourself or your family down,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q7"/> <text value="Trouble concentrating on things, such as reading the newspaper or watching television,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q8"/> <text value="Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.q9"/> <text value="Thoughts that you would be better off dead, or of hurting yourself"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6568-5"/> <display value="Not at all"/> </valueCoding> </answer> </item> <item> <linkId value="g1.s"/> <text value="Scoring: Add up all checked boxes on PHQ-9. For every: Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3 Interpretation of Total Score Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression"/> </item> </item> <item> <linkId value="g2"/> <item> <linkId value="g2.q1"/> <text value="If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people,"/> <answer> <valueCoding> <system value="http://loinc.org"/> <code value="LA6572-7"/> <display value="Not difficult at all"/> </valueCoding> </answer> </item> </item> </QuestionnaireResponse>