Comment:

Make the "Questionnaire" Resource to be Mandatorily Associated with the "QuestionnaireResponse" Resource

Purpose: To associate a specific question item in the Questionnaire Resource with the associated response captured in the QuestionnaireResponse Resource.

Explanation: Since QuestionnaireResponse captures the responses to questions present in a Questionnaire, it would increase the efficiency of matching Question items to their associated QuestionnaireResponse values if it was mandatory to include the Questionnaire identifier with the QuestionnaireResponse.

Summary:

Suggested cardinality change