Einwilligungsmanagement

Questionnaire Response

Auf Basis einer generierten Einwilligungsvorlage Consent Management Questionnaire Composed kann der Patient mittels Consent Management QuestionnaireResponse seine Einwilligung zu einem Forschungsprojekt geben. Diese wird pseudonymisiert zusammen mit etwaigen Unterschriften und Einwilligungsscans maschinenlesbar gespeichert.

Das patientenbezogen ausgefüllte Formular stellt gleichzeitig die menschenlesbare Repräsentation der Einwilligung dar.

QuestionnaireResponse			QuestionnaireResponse	There are no (further) constraints on this element Element Id QuestionnaireResponse Short description A structured set of questions and their answers Alternate names Form, QuestionnaireAnswers Definition A structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to. Comments The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse. Data Type QuestionnaireResponse Constraints dom-2:If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4:If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3:If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6:A resource should have narrative for robust management text.`div`.exists() dom-5:If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim:Entity. Role, or Act workflow:Event rim:Observation[moodCode=EVN]
language	S	0..1	codeBinding	There are no (further) constraints on this element Element Id QuestionnaireResponse.language Short description Language of the resource content Definition The base language in which the resource is written. Comments Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). Data Type code Binding CommonLanguages (preferred) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id QuestionnaireResponse.identifier Short description Unique id for this set of answers Definition A business identifier assigned to a particular completed (or partially completed) questionnaire. Requirements Used for tracking, registration and other business purposes. Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier workflow:Event.identifier w5:FiveWs.identifier rim:.id
basedOn	Σ	0..*	Reference(CarePlan\| ServiceRequest)	There are no (further) constraints on this element Element Id QuestionnaireResponse.basedOn Short description Request fulfilled by this QuestionnaireResponse Alternate names order Definition The order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression. Requirements Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data Type Reference(CarePlan\| ServiceRequest) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.basedOn rim:.outboundRelationship[typeCode=FLFS].target
partOf	Σ	0..*	Reference(Observation\| Procedure)	There are no (further) constraints on this element Element Id QuestionnaireResponse.partOf Short description Part of this action Definition A procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of. Comments Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn. Data Type Reference(Observation\| Procedure) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.partOf rim:.inboundRelationship[typeCode=COMP].source[moodCode=EVN]
questionnaire	S Σ	1..1	canonical	There are no (further) constraints on this element Element Id QuestionnaireResponse.questionnaire Short description Form being answered Alternate names Form Definition The Questionnaire that defines and organizes the questions for which answers are being provided. Requirements Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form. Comments If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.). Data Type canonical Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.instantiates rim:./outboundRelationship[typeCode=INST]/target[classCode=OBS, moodCode=DEFN]
status	S Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element Id QuestionnaireResponse.status Short description in-progress \| completed \| amended \| entered-in-error \| stopped Definition The position of the questionnaire response within its overall lifecycle. Requirements The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data Type code Binding QuestionnaireResponseStatus (required) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.status w5:FiveWs.status rim:.statusCode (also whether there's a revisionControlAct - and possibly mood to distinguish "in-progress" from "published)
subject	S Σ	1..1	Reference(Consent Management: Patient)	Element Id QuestionnaireResponse.subject Short description Der Patient, für den die Einwilligung gilt Alternate names Patient, Focus Definition The subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information. Requirements Allows linking the answers to the individual the answers describe. May also affect access control. Comments If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types. Data Type Reference(Consent Management: Patient) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.subject w5:FiveWs.subject[x] rim:.participation[typeCode=SBJ].role w5:FiveWs.subject
reference	Σ	0..1	string	There are no (further) constraints on this element Element Id QuestionnaireResponse.subject.reference Short description Literal reference, Relative, internal or absolute URL Definition A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Comments Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element Id QuestionnaireResponse.subject.type Short description Type the reference refers to (e.g. "Patient") Definition The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources). Comments This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data Type uri Binding ResourceType (extensible) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element Id QuestionnaireResponse.subject.identifier Short description Logical reference, when literal reference is not known Definition An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. Comments When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation\|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any). Data Type Identifier Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a v2:CX / EI (occasionally, more often EI maps to a resource id or a URL) rim:II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd:Identifier rim:.identifier
display	Σ	0..1	string	There are no (further) constraints on this element Element Id QuestionnaireResponse.subject.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:N/A
encounter	Σ	0..1	Reference(Encounter)	There are no (further) constraints on this element Element Id QuestionnaireResponse.encounter Short description Encounter created as part of Definition The Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated. Requirements Provides context for the information that was captured. May also affect access control. Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter. Data Type Reference(Encounter) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.encounter w5:FiveWs.context rim:.inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
authored	S Σ	0..1	dateTime	There are no (further) constraints on this element Element Id QuestionnaireResponse.authored Short description Date the answers were gathered Alternate names Date Created, Date published, Date Issued, Date updated Definition The date and/or time that this set of answers were last changed. Requirements Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers. Comments May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured. This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible. Data Type dateTime Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a workflow:Event.occurrence[x] w5:FiveWs.recorded rim:.participation[typeCode=AUT].time
author	S Σ	0..1	Reference(Practitioner\| PractitionerRole\| Patient\| RelatedPerson)	Element Id QuestionnaireResponse.author Short description Die Person, welche die Einwilligungsangaben erfasst/dokumentiert Alternate names Laboratory, Service, Practitioner, Department, Company, Performer Definition Person who received the answers to the questions in the QuestionnaireResponse and recorded them in the system. Requirements Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers. Comments Füllt der betroffene Patient selbst den Fragebogen aus, so ist dieser hier erneut zu referenzieren (author = subject). Data Type Reference(Practitioner\| PractitionerRole\| Patient\| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow:Event.performer w5:FiveWs.author rim:.participation[typeCode=AUT].role
source	S Σ	0..1	Reference(Patient\| Practitioner\| PractitionerRole\| RelatedPerson)	Element Id QuestionnaireResponse.source Short description Die Person, von der die Einwilligungsangaben stammen Definition The person who answered the questions about the subject. Requirements When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions. Comments Stammen die Antworten auf die Fragen vom betroffenen Patienten selbst, so ist dieser hier erneut zu referenzieren (source = subject). Data Type Reference(Patient\| Practitioner\| PractitionerRole\| RelatedPerson) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1:SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim:n/a rim:The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5:FiveWs.source rim:.participation[typeCode=INF].role
item	S	1..*	BackboneElement	There are no (further) constraints on this element Element Id QuestionnaireResponse.item Short description Groups and questions Definition A group or question item from the original questionnaire for which answers are provided. Comments Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer). Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qrs-1:Nested item can't be beneath both item and answer `(answer.exists() and item.exists()).not()` Mappings rim:n/a rim:.outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]
linkId	S	1..1	string	There are no (further) constraints on this element Element Id QuestionnaireResponse.item.linkId Short description Pointer to specific item from Questionnaire Definition The item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource. Requirements Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id
definition		0..1	uri	There are no (further) constraints on this element Element Id QuestionnaireResponse.item.definition Short description ElementDefinition - details for the item Definition A reference to an ElementDefinition that provides the details for the item. Requirements A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition. Comments The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. There is no need for this element if the item pointed to by the linkId has a definition listed. Data Type uri Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code
text		0..1	string	There are no (further) constraints on this element Element Id QuestionnaireResponse.item.text Short description Name for group or question text Definition Text that is displayed above the contents of the group or as the text of the question being answered. Requirements Allows the questionnaire response to be read without access to the questionnaire. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data Type string Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.text
answer	S	0..*	BackboneElement	There are no (further) constraints on this element Element Id QuestionnaireResponse.item.answer Short description The response(s) to the question Definition The respondent's answer(s) to the question. Comments The value is nested because we cannot have a repeating structure that has variable type. Data Type BackboneElement Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.value[type=LIST_ANY]
value[x]	S	0..1		There are no (further) constraints on this element Element Id QuestionnaireResponse.item.answer.value[x] Short description Single-valued answer to the question Definition The answer (or one of the answers) provided by the respondent to the question. Requirements Ability to retain a single-valued answer to a question. Comments More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire. Binding QuestionnaireAnswerCodes (example) Constraints ele-1:All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim:n/a rim:.item
valueBoolean			boolean	There are no (further) constraints on this element Data Type boolean
valueDecimal			decimal	There are no (further) constraints on this element Data Type decimal
valueInteger			integer	There are no (further) constraints on this element Data Type integer
valueDate			date	There are no (further) constraints on this element Data Type date
valueDateTime			dateTime	There are no (further) constraints on this element Data Type dateTime
valueTime			time	There are no (further) constraints on this element Data Type time
valueString			string	There are no (further) constraints on this element Data Type string
valueUri			uri	There are no (further) constraints on this element Data Type uri
valueAttachment			Attachment	There are no (further) constraints on this element Data Type Attachment
valueCoding			Coding	There are no (further) constraints on this element Data Type Coding
valueQuantity			Quantity	There are no (further) constraints on this element Data Type Quantity
valueReference			Reference(Resource)	There are no (further) constraints on this element Data Type Reference(Resource)
item	S	0..*	see (item)	There are no (further) constraints on this element Element Id QuestionnaireResponse.item.answer.item Short description Nested groups and questions Definition Nested groups and/or questions found within this particular answer. Requirements It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details. Mappings rim:.outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]
item	S	0..*	see (item)	There are no (further) constraints on this element Element Id QuestionnaireResponse.item.item Short description Nested questionnaire response items Definition Questions or sub-groups nested beneath a question or group. Requirements Reports can consist of complex nested groups. Mappings rim:.outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]

Beispiel

Erläuterungen

Item	Erläuterung
questionnaire	canonical URL des zugrunde liegenden Questionnaires (Profil QuestionnaireComposed)
status	Finalisierungsstatus, default="completed"
subject	Patient, für den die Einwilligungserklärung gilt
authored	Ausfülldatum der Einwilligung
author	ausfüllende Person (Reference)
source	Person, von der die Einwilligungsangaben stammen
item	1 - n Antworten, entweder als Coding (z.B. gemäß TFCU Konzept) oder als ValueString

Umsetzung

<QuestionnaireResponse xmlns="http://hl7.org/fhir">
    <id value="02eac854-6a2e-48f9-88d7-edd04faff81c" />
    <meta>
        <lastUpdated value="2020-12-11T09:39:07+00:00" />
        <profile value="http://fhir.de/ConsentManagement/StructureDefinition/QuestionnaireResponse" />
    </meta>
    <language value="de" />
    <!--  canonical URL des zugrunde liegenden Questionnaires (Profil QuestionnaireComposed)  -->
    <questionnaire value="https://beispiel.de/fhir/QuestionnaireComposedBeispiel1" />
    <!--  Finalisierungsstatus  -->
    <status value="completed" />
    <!--  Patient, für den die Einwilligungserklärung gilt  -->
    <subject>
        <reference value="Patient/9b4a702d-162c-428a-8c5d-8b98af21b693" />
        <display value="Studienpatient Nr. A38" />
    </subject>
    <!--  Ausfülldatum  -->
    <authored value="2020-09-08" />
    <!--  ausfüllende Person  -->
    <author>
        <reference value="RelatedPerson/5645464" />
    </author>
    <!--  Person, von der die Einwilligungsangaben stammen  -->
    <source>
        <reference value="Patient/9b4a702d-162c-428a-8c5d-8b98af21b693" />
    </source>
    <!--  Antworten  -->
    <item>
        <linkId value="1" />
        <answer>
            <valueCoding>
                <system value="urn:oid:2.16.840.1.113883.3.1937.777.24.5.2" />
                <code value="2.16.840.1.113883.3.1937.777.24.5.2.1" />
                <display value="g&#252;ltig" />
            </valueCoding>
        </answer>
    </item>
    <item>
        <linkId value="98" />
        <answer>
            <valueCoding>
                <system value="urn:oid:2.16.840.1.113883.3.1937.777.24.5.2" />
                <code value="2.16.840.1.113883.3.1937.777.24.5.2.1" />
                <display value="g&#252;ltig" />
            </valueCoding>
        </answer>
    </item>
    <item>
        <linkId value="555" />
        <answer>
            <valueString value="Dem habe ich nichts hinzuzuf&#252;gen." />
        </answer>
    </item>
</QuestionnaireResponse>