| Package | hl7.fhir.uv.ichom-breast-cancer |
| Resource Type | Questionnaire |
| Id | ClinicalResponseSixMonths |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/ichom-breast-cancer/https://build.fhir.org/ig/HL7/fhir-ichom-breast-cancer-ig/Questionnaire-ClinicalResponseSixMonths.html |
| URL | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseSixMonths |
| Version | 1.0.0 |
| Status | draft |
| Date | 2023-08-21T16:37:24+00:00 |
| Name | ClinicalResponseSixMonths |
| Title | Clinical response at 6 months post-treatment follow-up |
| Realm | uv |
| Authority | hl7 |
| Description | Clinical response questionnaire at 6 months post-treatment follow-up |
No resources found
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Note: links and images are rebased to the (stated) source
| LinkId | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  ClinicalResponseSixMonths | Clinical response questionnaire at 6 months post-treatment follow-up | Questionnaire | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseSixMonths#1.0.0 | |
  General-Information-Clinical | General information | 1..1 | group | |
  NA-Clinical | What is the patient's medical record number? | 1..1 | string | |
 LastName-Clinical | What is the patient's last name? | 1..1 | string | |
| Tumor-Factors | Tumor factors | 1..1 | group | |
 received_surgery | Has the patient received surgery? | 1..1 | boolean | |
 TNMPT_BREAST | Indicate the pathological tumor stage (per AJCC 8th Ed.) | 1..1 | choice | Enable When: received_surgery = true Value Set: TNM Primary Tumor ValueSet |
| TNMPN_BREAST | Indicate the pathological nodal stage (per AJCC 8th Ed.) | 1..1 | choice | Enable When: received_surgery = true Value Set: TNM Regional Nodes ValueSet |
| TNMPM_BREAST | Indicate the pathological distant metastasis (per AJCC 8th Ed.) | 1..1 | choice | Enable When: received_surgery = true Value Set: TNM Distant Metastases ValueSet |
 SIZEINV | Indicate size of invasive component of tumor (in mm) | 1..1 | integer | Enable When: received_surgery = true |
| NumLymphNodesResect | Indicate the number of lymph nodes resected | 1..1 | integer | Enable When: received_surgery = true |
| LYMPHINV_BREAST | Indicate the number of lymph nodes involved according to the TNM stage AJCC 8th Ed. | 1..1 | integer | Enable When: received_surgery = true |
| Treatment-Variables | Treatment Variables | 1..1 | group | |
| TREATMENT_BREAST | Indicate whether the patient received one of the following treatment during the last year (select all that apply) | 1..* | choice | Value Set: Type of treatments ValueSet |
| SURGERY_BREAST | Indicate whether the patient received surgery during the last year | 1..1 | choice | Enable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003) Value Set: Types of breast surgery ValueSet |
| SurgeryDateKnown | Is the date of surgery known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003) |
 SurgeryDate | Please provide the date of surgery | 1..1 | date | Enable When: SurgeryDateKnown = true |
| SURGERYAX | Indicate whether the patient received surgery to the axilla | 1..1 | choice | Enable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008) Value Set: Axilla surgery ValueSet |
| SURGERYAXDATE-Known | Is the date of surgery to the axilla known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008) |
| SURGERYAXDATE | Please provide the date of surgery to the axilla | 1..1 | date | Enable When: SURGERYAXDATE-Known = true |
| SURGERYAX2 | Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year | 1..1 | choice | Enable When:
Value Set: Yes, No and Unknown Valueset |
| SURGERYAX2DATE-Known | Is the date of axillary clearance known? | 1..1 | boolean | Enable When: SURGERYAX2 = Yes (expandedYes-NoIndicator#Y) |
| SURGERYAX2DATE | Please provide the date of axillary clearance | 1..1 | date | Enable When: SURGERYAX2DATE-Known = true |
| RECONSTRUCTION_DELAY | Indicate whether the patient received a delayed reconstruction | 1..1 | choice | Enable When: SURGERY_BREAST = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Yes, No and Unknown Valueset |
| SURGERY_RECONSTRUCTION | Indicate what type of reconstruction the patient received | 1..1 | choice | Enable When:
Value Set: Type of reconstruction surgery ValueSet |
| ImplantReconstruction | Indicate the location of the implant | 1..1 | choice | Enable When:
Value Set: Location of the implant ValueSet |
| RECONSTRUCTDATE-Known | Is the date of the delayed reconstruction known? | 1..1 | boolean | Enable When: RECONSTRUCTION_DELAY = Yes (expandedYes-NoIndicator#Y) |
| RECONSTRUCTDATE | Please provide the date of delayed reconstruction | 1..1 | date | Enable When: RECONSTRUCTDATE-Known = true |
| RADIOTX_BREAST | What was the intent of radiotherapy | 1..* | choice | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) Value Set: Intent of therapy ValueSet |
| RADIOTXTYPE_BREAST | Indicate location/type of radiotherapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) Value Set: The location of radiotherapy ValueSet |
| RadioTxStartDate-Known | Is the start date of radiotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) |
| RadioTxStartDate | Please provide the start date of radiotherapy | 1..1 | date | Enable When: RadioTxStartDate-Known = true |
| RadioTxStopDate-Known | Is the stop date of radiotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) |
| RadioTxStopDate | Please provide the stop date of radiotherapy | 1..1 | date | Enable When: RadioTxStopDate-Known = true |
| CHEMOTXINTENT | Indicate the intent of chemotherapy | 1..1 | choice | Enable When:
Value Set: Intent of therapy ValueSet |
| CHEMOTXTYPE_BREAST | Indicate the type of chemotherapy (select all that apply) | 1..* | choice | Enable When:
Value Set: Type of chemotherapy ValueSet |
| ChemoTxStartDate-Known | Is the start date of chemotherapy known? | 1..1 | boolean | Enable When:
|
| ChemoTxStartDate | Please provide the start date of chemotherapy | 1..1 | date | Enable When: ChemoTxStartDate-Known = true |
| ChemoTxStopdate-Known | Is the stop date of chemotherapy known? | 1..1 | boolean | Enable When:
|
| ChemoTxStopdate | Please provide the stop date of chemotherapy | 1..1 | date | Enable When: ChemoTxStopdate-Known = true |
| HORMONTX_BREAST | Indicate the intent of hormonal therapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) Value Set: Intent of therapy ValueSet |
| HORMONTXTYPE | Indicate the type of hormonal therapy (select all that apply) | 1..* | choice | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) Value Set: Type of hormonal therapy ValueSet |
| HORMONTXSTARTDATE-Known | Is the start date of hormonal therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) |
| HORMONTXSTARTDATE | Please provide the start date of hormonal therapy | 1..1 | date | Enable When: HORMONTXSTARTDATE-Known = true |
| HORMONTXSTOPDATE-Known | Is the stop date of hormonal therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) |
| HORMONTXSTOPDATE | Please provide the stop date of hormonal therapy, if applicable | 1..1 | date | Enable When: HORMONTXSTOPDATE-Known = true |
| TARGETTX_BREAST | Indicate the type of targeted therapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) Value Set: Type of targeted therapy ValueSet |
| TargetTxStartDate-Known | Is the start date of targeted therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) |
| TargetTxStartDate | Please provide the start date of targeted therapy | 1..1 | date | Enable When: TargetTxStartDate-Known = true |
| TargetTxStopDate-Known | Is the stop date of targeted therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) |
| TargetTxStopDate | Please provide the stop date of targeted therapy | 1..1 | date | Enable When: TargetTxStopDate-Known = true |
| SURGERYPATIENT | Indicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply) | 1..* | choice | Value Set: Type of re-operation |
| SURGERYDATEPATIENT-Known | Is the date of the reoperation known? | 1..1 | boolean | Enable When:
|
| SURGERYDATEPATIENT | Please provide the date of the reoperation | 1..1 | date | Enable When: SURGERYDATEPATIENT-Known = true |
| DisutilityofCare | Disutility of care | 1..1 | group | |
 REOP_BREAST | Indicate if the patient has undergone a reoperation due to involved margins after primary surgery | 1..1 | choice | Enable When: SURGERY_BREAST != unknown (NullFlavor#UNK) Value Set: Re-operation due to involved margins ValueSet |
| REOP_RECONSTRUCTION | What type of reconstruction did the patient receive during reoperation? | 1..1 | choice | Enable When: REOP_BREAST = Mastectomy with immediate reconstruction (Breast surgery types CodeSystem#mastectomy-with-immediate-reconstruction) Value Set: Type of reconstruction surgery ValueSet |
| REOPDATE_BREAST-Known | Is the date of the reoperation due to positive margins known? | 1..1 | boolean | Enable When: REOP_BREAST != unknown (NullFlavor#UNK) |
| REOPDATE_BREAST | Provide the date of the reoperation due to positive margins | 1..1 | date | Enable When: REOPDATE_BREAST-Known = true |
| ComplicationImpact | What was the impact of the complication experienced by the patient | 1..* | choice | Enable When:
Value Set: Impact of complication ValueSet |
| ComplicationAttrTreatment | Indicate whether the complication is attributable to treatment | 1..1 | choice | Enable When:
Value Set: Yes, No and Unknown Valueset |
| COMPL_BREAST | Indicate the type of complication | 1..1 | choice | Enable When: ComplicationAttrTreatment = Yes (expandedYes-NoIndicator#Y) Value Set: Type of complication ValueSet |
| Documentation for this format | ||||
FHIR{
"resourceType": "Questionnaire",
"id": "ClinicalResponseSixMonths",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
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"extension": [
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"version": "1.0.0",
"name": "ClinicalResponseSixMonths",
"title": "Clinical response at 6 months post-treatment follow-up",
"status": "draft",
"experimental": true,
"date": "2023-08-21T16:37:24+00:00",
"publisher": "HL7 International - Clinical Interoperability Council Group",
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"item": [
{
"linkId": "General-Information-Clinical",
"text": "General information",
"type": "group",
"required": true,
"item": [
{
"linkId": "NA-Clinical",
"text": "What is the patient's medical record number?",
"type": "string",
"required": true
},
{
"linkId": "LastName-Clinical",
"text": "What is the patient's last name?",
"type": "string",
"required": true
}
]
},
{
"linkId": "Tumor-Factors",
"text": "Tumor factors",
"type": "group",
"required": true,
"item": [
{
"linkId": "received_surgery",
"text": "Has the patient received surgery?",
"type": "boolean",
"required": true
},
{
"linkId": "TNMPT_BREAST",
"text": "Indicate the pathological tumor stage (per AJCC 8th Ed.)",
"type": "choice",
"enableWhen": [
{
"question": "received_surgery",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TNMPrimaryTumorVS"
},
{
"linkId": "TNMPN_BREAST",
"text": "Indicate the pathological nodal stage (per AJCC 8th Ed.)",
"type": "choice",
"enableWhen": [
{
"question": "received_surgery",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TNMRegionalNodesVS"
},
{
"linkId": "TNMPM_BREAST",
"text": "Indicate the pathological distant metastasis (per AJCC 8th Ed.)",
"type": "choice",
"enableWhen": [
{
"question": "received_surgery",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TNMDistantMetastasesVS"
},
{
"linkId": "SIZEINV",
"text": "Indicate size of invasive component of tumor (in mm)",
"type": "integer",
"enableWhen": [
{
"question": "received_surgery",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "NumLymphNodesResect",
"text": "Indicate the number of lymph nodes resected",
"type": "integer",
"enableWhen": [
{
"question": "received_surgery",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "LYMPHINV_BREAST",
"text": "Indicate the number of lymph nodes involved according to the TNM stage AJCC 8th Ed.",
"type": "integer",
"enableWhen": [
{
"question": "received_surgery",
"operator": "=",
"answerBoolean": true
}
],
"required": true
}
]
},
{
"linkId": "Treatment-Variables",
"text": "Treatment Variables",
"type": "group",
"required": true,
"item": [
{
"linkId": "TREATMENT_BREAST",
"text": "Indicate whether the patient received one of the following treatment during the last year (select all that apply)",
"type": "choice",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TreatmentTypeVS"
},
{
"linkId": "SURGERY_BREAST",
"text": "Indicate whether the patient received surgery during the last year",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "387713003"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/BreastSurgeryTypeVS"
},
{
"linkId": "SurgeryDateKnown",
"text": "Is the date of surgery known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "387713003"
}
}
],
"required": true
},
{
"linkId": "SurgeryDate",
"text": "Please provide the date of surgery",
"type": "date",
"enableWhen": [
{
"question": "SurgeryDateKnown",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "SURGERYAX",
"text": "Indicate whether the patient received surgery to the axilla",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "699455008"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/AxillaSurgeryVS"
},
{
"linkId": "SURGERYAXDATE-Known",
"text": "Is the date of surgery to the axilla known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "699455008"
}
}
],
"required": true
},
{
"linkId": "SURGERYAXDATE",
"text": "Please provide the date of surgery to the axilla",
"type": "date",
"enableWhen": [
{
"question": "SURGERYAXDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "SURGERYAX2",
"text": "Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year",
"type": "choice",
"enableWhen": [
{
"question": "SURGERYAX",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "396487001",
"display": "Sentinel lymph node biopsy"
}
},
{
"question": "SURGERYAX",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "234262008",
"display": "Excision of axillary lymph node"
}
}
],
"enableBehavior": "any",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "SURGERYAX2DATE-Known",
"text": "Is the date of axillary clearance known?",
"type": "boolean",
"enableWhen": [
{
"question": "SURGERYAX2",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y"
}
}
],
"required": true
},
{
"linkId": "SURGERYAX2DATE",
"text": "Please provide the date of axillary clearance",
"type": "date",
"enableWhen": [
{
"question": "SURGERYAX2DATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "RECONSTRUCTION_DELAY",
"text": "Indicate whether the patient received a delayed reconstruction",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-without-immediate-reconstruction"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "SURGERY_RECONSTRUCTION",
"text": "Indicate what type of reconstruction the patient received",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-without-immediate-reconstruction"
}
},
{
"question": "SURGERY_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-with-immediate-reconstruction"
}
}
],
"enableBehavior": "any",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ReconstructionTypeVS"
},
{
"linkId": "ImplantReconstruction",
"text": "Indicate the location of the implant",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_RECONSTRUCTION",
"operator": "!=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/ReconstructionTypeCodeSystem",
"code": "autologous"
}
},
{
"question": "SURGERY_RECONSTRUCTION",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK"
}
}
],
"enableBehavior": "all",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ImplantLocationVS"
},
{
"linkId": "RECONSTRUCTDATE-Known",
"text": "Is the date of the delayed reconstruction known?",
"type": "boolean",
"enableWhen": [
{
"question": "RECONSTRUCTION_DELAY",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y"
}
}
],
"required": true
},
{
"linkId": "RECONSTRUCTDATE",
"text": "Please provide the date of delayed reconstruction",
"type": "date",
"enableWhen": [
{
"question": "RECONSTRUCTDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "RADIOTX_BREAST",
"text": "What was the intent of radiotherapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TherapyIntentVS"
},
{
"linkId": "RADIOTXTYPE_BREAST",
"text": "Indicate location/type of radiotherapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/LocationRadiotherapyVS"
},
{
"linkId": "RadioTxStartDate-Known",
"text": "Is the start date of radiotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true
},
{
"linkId": "RadioTxStartDate",
"text": "Please provide the start date of radiotherapy",
"type": "date",
"enableWhen": [
{
"question": "RadioTxStartDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "RadioTxStopDate-Known",
"text": "Is the stop date of radiotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true
},
{
"linkId": "RadioTxStopDate",
"text": "Please provide the stop date of radiotherapy",
"type": "date",
"enableWhen": [
{
"question": "RadioTxStopDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "CHEMOTXINTENT",
"text": "Indicate the intent of chemotherapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TherapyIntentVS"
},
{
"linkId": "CHEMOTXTYPE_BREAST",
"text": "Indicate the type of chemotherapy (select all that apply)",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ChemoTherapyTypeVS"
},
{
"linkId": "ChemoTxStartDate-Known",
"text": "Is the start date of chemotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true
},
{
"linkId": "ChemoTxStartDate",
"text": "Please provide the start date of chemotherapy",
"type": "date",
"enableWhen": [
{
"question": "ChemoTxStartDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "ChemoTxStopdate-Known",
"text": "Is the stop date of chemotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true
},
{
"linkId": "ChemoTxStopdate",
"text": "Please provide the stop date of chemotherapy",
"type": "date",
"enableWhen": [
{
"question": "ChemoTxStopdate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "HORMONTX_BREAST",
"text": "Indicate the intent of hormonal therapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TherapyIntentVS"
},
{
"linkId": "HORMONTXTYPE",
"text": "Indicate the type of hormonal therapy (select all that apply)",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/HormonalTherapyTypeVS"
},
{
"linkId": "HORMONTXSTARTDATE-Known",
"text": "Is the start date of hormonal therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true
},
{
"linkId": "HORMONTXSTARTDATE",
"text": "Please provide the start date of hormonal therapy",
"type": "date",
"enableWhen": [
{
"question": "HORMONTXSTARTDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "HORMONTXSTOPDATE-Known",
"text": "Is the stop date of hormonal therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true
},
{
"linkId": "HORMONTXSTOPDATE",
"text": "Please provide the stop date of hormonal therapy, if applicable",
"type": "date",
"enableWhen": [
{
"question": "HORMONTXSTOPDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "TARGETTX_BREAST",
"text": "Indicate the type of targeted therapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "targeted-therapy"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TargetedTherapyVS"
},
{
"linkId": "TargetTxStartDate-Known",
"text": "Is the start date of targeted therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "targeted-therapy"
}
}
],
"required": true
},
{
"linkId": "TargetTxStartDate",
"text": "Please provide the start date of targeted therapy",
"type": "date",
"enableWhen": [
{
"question": "TargetTxStartDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "TargetTxStopDate-Known",
"text": "Is the stop date of targeted therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "targeted-therapy"
}
}
],
"required": true
},
{
"linkId": "TargetTxStopDate",
"text": "Please provide the stop date of targeted therapy",
"type": "date",
"enableWhen": [
{
"question": "TargetTxStopDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "SURGERYPATIENT",
"text": "Indicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply)",
"type": "choice",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ReoperationTypeVS"
},
{
"linkId": "SURGERYDATEPATIENT-Known",
"text": "Is the date of the reoperation known?",
"type": "boolean",
"enableWhen": [
{
"question": "SURGERYPATIENT",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "unknown"
}
},
{
"question": "SURGERYPATIENT",
"operator": "!=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373572006",
"display": "Clinical finding absent"
}
}
],
"enableBehavior": "all",
"required": true
},
{
"linkId": "SURGERYDATEPATIENT",
"text": "Please provide the date of the reoperation",
"type": "date",
"enableWhen": [
{
"question": "SURGERYDATEPATIENT-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
}
]
},
{
"linkId": "DisutilityofCare",
"text": "Disutility of care",
"type": "group",
"required": true,
"item": [
{
"linkId": "REOP_BREAST",
"text": "Indicate if the patient has undergone a reoperation due to involved margins after primary surgery",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_BREAST",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/InvolvedMarginsReoperationTypeVS"
},
{
"linkId": "REOP_RECONSTRUCTION",
"text": "What type of reconstruction did the patient receive during reoperation?",
"type": "choice",
"enableWhen": [
{
"question": "REOP_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-with-immediate-reconstruction"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ReconstructionTypeVS"
},
{
"linkId": "REOPDATE_BREAST-Known",
"text": "Is the date of the reoperation due to positive margins known?",
"type": "boolean",
"enableWhen": [
{
"question": "REOP_BREAST",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK"
}
}
],
"required": true
},
{
"linkId": "REOPDATE_BREAST",
"text": "Provide the date of the reoperation due to positive margins",
"type": "date",
"enableWhen": [
{
"question": "REOPDATE_BREAST-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "ComplicationImpact",
"text": "What was the impact of the complication experienced by the patient",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "!=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "no-treatment"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK"
}
}
],
"enableBehavior": "all",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ComplicationImpactVS"
},
{
"linkId": "ComplicationAttrTreatment",
"text": "Indicate whether the complication is attributable to treatment",
"type": "choice",
"enableWhen": [
{
"question": "ComplicationImpact",
"operator": "!=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/ComplicationImpactCodeSystem",
"code": "no-complication"
}
},
{
"question": "ComplicationImpact",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK"
}
}
],
"enableBehavior": "all",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "COMPL_BREAST",
"text": "Indicate the type of complication",
"type": "choice",
"enableWhen": [
{
"question": "ComplicationAttrTreatment",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ComplicationTypeVS"
}
]
}
]
}