With regard to your proposed metadata extension, much of this has been discussed and the view was that many of the items were already carried in the archetype metadata definition and did not have to be explicitly recorded in the patient record. FHIR Questionnaires are in essence, design-time artefacts i.e not actually part of a patient record. If we need to carry some of these items it would probably be as extra
tags in the other_details section of the archety[e and not as an actual CLUSTER which intended for data that will end up in the patient record
But definitely worth reviewing, in terms of any extra information that we should include as routine.