| Package | ca.on.health.sadie |
| Type | Questionnaire |
| Id | Id |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.health.sadie@1.4.11&canonical=http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL |
| Url | http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL |
| Version | 1.0.0 |
| Status | active |
| Name | ODSP_Additional_Medical_Information |
| Title | Additional Medical Information |
| Experimental | False |
| Authority | hl7 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
FHIR{
"resourceType" : "Questionnaire",
"id" : "b2e24662-0ee1-4c95-9088-7be895d97c99",
"meta" : {
"profile" : [
"http://health.gov.on.ca/sadie/fhir/StructureDefinition/FlexForm"
]
},
"text" : {
"status" : "empty",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No human-readable text provided in this case.</div>"
},
"url" : "http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL",
"identifier" : [
{
"use" : "official",
"system" : "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
"value" : "ODSP-ADDITIONAL"
}
],
"version" : "1.0.0",
"name" : "ODSP_Additional_Medical_Information",
"title" : "Additional Medical Information",
"status" : "active",
"experimental" : false,
"subjectType" : [
"Patient"
],
"publisher" : "ODSP",
"effectivePeriod" : {
"start" : "2021-01-01T05:00:00.000Z"
},
"code" : [
{
"system" : "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
"code" : "DocumentType",
"display" : "DDP"
},
{
"system" : "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
"code" : "DocumentSubType",
"display" : "ADDITIONAL"
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "header",
"display" : "Header"
}
],
"text" : "Header"
}
}
],
"linkId" : "0",
"text" : "Additional Medical Information",
"type" : "group",
"required" : false,
"repeats" : false,
"readOnly" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory",
"valueCode" : "display-in-progress"
}
],
"linkId" : "attachment_error_guide_additional",
"text" : "If you encounter an upload error or failure, please try again or fax the attachment to the Disability Adjudication Unit at 416-326-3374. The fax must include the client's first and last name, Member ID and Referral ID on the document or fax cover page.",
"type" : "display",
"required" : false,
"repeats" : false,
"readOnly" : false
},
{
"linkId" : "0.1",
"text" : "Additional Medical Information",
"type" : "group",
"required" : false,
"repeats" : false,
"readOnly" : false,
"item" : [
{
"linkId" : "0.0.1",
"text" : "Do you have a \"Consent to the Release of Medical and Related Information\" form to attach?",
"type" : "boolean",
"required" : true,
"repeats" : false,
"readOnly" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/msword"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/rtf"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "image/tiff"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/pdf"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "image/gif"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal" : 10
}
],
"linkId" : "0.0.1-attachment",
"text" : "Attachments",
"type" : "attachment",
"enableWhen" : [
{
"question" : "0.0.1",
"operator" : "=",
"answerBoolean" : true
}
],
"required" : true,
"repeats" : false,
"readOnly" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean" : true
}
],
"linkId" : "0.0.1-DocumentType",
"type" : "string",
"required" : false,
"repeats" : false,
"readOnly" : false,
"initial" : [
{
"valueString" : "DDP"
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean" : true
}
],
"linkId" : "0.0.1-DocumentSubType",
"type" : "string",
"required" : false,
"repeats" : false,
"readOnly" : false,
"initial" : [
{
"valueString" : "Consent"
}
]
}
]
},
{
"linkId" : "0.1.1",
"text" : "Do you have any medical information you wish to attach?",
"type" : "boolean",
"required" : true,
"repeats" : false,
"readOnly" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/msword"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/rtf"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "image/tiff"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "application/pdf"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode" : "image/gif"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal" : 10
}
],
"linkId" : "0.1.1-attachment",
"text" : "Attachments",
"type" : "attachment",
"enableWhen" : [
{
"question" : "0.1.1",
"operator" : "=",
"answerBoolean" : true
}
],
"required" : true,
"repeats" : true,
"readOnly" : false,
"item" : [
{
"linkId" : "0.1.1-categories",
"text" : "Attachment Categories",
"type" : "choice",
"required" : false,
"repeats" : false,
"readOnly" : false,
"answerValueSet" : "http://health.on.ca/sadie/fhir/ValueSet/HSR-AttachmentCategories"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean" : true
}
],
"linkId" : "0.1.1-DocumentType",
"type" : "string",
"required" : false,
"repeats" : false,
"readOnly" : false,
"initial" : [
{
"valueString" : "AMI"
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean" : true
}
],
"linkId" : "0.1.1-DocumentSubType",
"type" : "string",
"required" : false,
"repeats" : false,
"readOnly" : false,
"initial" : [
{
"valueString" : "Regular or IR AMI"
}
]
}
]
},
{
"linkId" : "0.1.2",
"text" : "Notes",
"type" : "text",
"required" : false,
"repeats" : false,
"readOnly" : false,
"maxLength" : 2000,
"enableBehavior" : "any",
"enableWhen" : [
{
"question" : "0.0.1",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "0.1.1",
"operator" : "=",
"answerBoolean" : true
}
]
},
{
"linkId" : "0.1.3",
"text" : "Notes",
"type" : "text",
"required" : true,
"repeats" : false,
"readOnly" : false,
"maxLength" : 2000,
"enableBehavior" : "all",
"enableWhen" : [
{
"question" : "0.0.1",
"operator" : "=",
"answerBoolean" : false
},
{
"question" : "0.1.1",
"operator" : "=",
"answerBoolean" : false
}
]
}
]
}
]
}
]
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.