Resource Questionnaire/FHIR Server from package ca.on.oh.mha-pds#0.9.0-alpha-1.9.7.38 (31 ms)

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{
  "resourceType" : "Questionnaire",
  "url" : "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-gambling-questionnaire-template",
  "title" : "MHA Gambling Questionnaire Template",
  "status" : "draft",
  "description" : "Sample questionnaire using all questions from the Catalyst Problem Gambling Required Data Form",
  "purpose" : "To serve as a model to build required MHA Gambling questionnaires.",
  "item" : [
    {
      "linkId" : "Q1",
      "text" : "Reason for Seeking Help With Gambling Behaviour",
      "type" : "choice",
      "required" : true,
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-help-seeking-reason"
    },
    {
      "linkId" : "Q2-Q7",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "Q1",
          "operator" : "=",
          "answerCoding" : {
            "system" : "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason",
            "code" : "1",
            "display" : "Related to others gambling problem"
          }
        },
        {
          "question" : "Q1",
          "operator" : "=",
          "answerCoding" : {
            "system" : "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason",
            "code" : "2",
            "display" : "Both"
          }
        }
      ],
      "enableBehavior" : "any",
      "item" : [
        {
          "linkId" : "Q2",
          "type" : "integer",
          "text" : "Number of Months Life Negatively Affected by Gambling Behaviour"
        },
        {
          "linkId" : "Q3",
          "type" : "integer",
          "text" : "Length of Time Since Last Gambling Activity (Days)"
        },
        {
          "linkId" : "Q4",
          "type" : "choice",
          "text" : "Sequence of Gambling Problem Identification",
          "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/sequence-of-gambling-problem"
        },
        {
          "linkId" : "Q5",
          "type" : "choice",
          "text" : "Primary Gambling Activity in the last 12 months",
          "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year",
          "item" : [
            {
              "type" : "choice",
              "linkId" : "Q5-a",
              "text" : "Primary Gambling Activity Frequency in last 12 months",
              "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            },
            {
              "type" : "choice",
              "linkId" : "Q5-b",
              "text" : "Primary Gambling Location in last 12 months",
              "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
            },
            {
              "type" : "choice",
              "linkId" : "Q5-c",
              "text" : "Primary Gambling Location Frequency in last 12 months",
              "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            }
          ]
        },
        {
          "linkId" : "Q6",
          "type" : "choice",
          "text" : "Additional Gambling Activity in the last 12 months",
          "repeats" : true,
          "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year",
          "item" : [
            {
              "type" : "choice",
              "linkId" : "Q6-a",
              "text" : "Additional Gambling Activity Frequency in last 12 months",
              "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            },
            {
              "type" : "choice",
              "linkId" : "Q6-b",
              "text" : "Additional Gambling Location in last 12 months",
              "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
            },
            {
              "type" : "choice",
              "linkId" : "Q6-c",
              "text" : "Addtional Gambling Location Frequency in last 12 months",
              "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            }
          ]
        },
        {
          "linkId" : "Q7",
          "type" : "group",
          "text" : "Percentage of Time Spent Gambling by Jurisdiction",
          "item" : [
            {
              "type" : "integer",
              "linkId" : "Q7_A",
              "text" : "Percentage of Time Spent Gambling in Ontario"
            },
            {
              "type" : "integer",
              "linkId" : "Q7_B",
              "text" : "Percentage of Time Spent Gambling in another province"
            },
            {
              "type" : "integer",
              "linkId" : "Q7_C",
              "text" : "Percentage of Time Spent Gambling Outside of Canada"
            }
          ]
        }
      ]
    }
  ],
  "text" : {
  }
}

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