FHIR IG analytics| Package | ca.infoway.io.pcare |
| Resource Type | QuestionnaireResponse |
| Id | QuestionnaireResponse-questionnaire-response-02.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: QuestionnaireResponse questionnaire-response-02
| LinkID | Text | Definition | Answer |
|---|---|---|---|
  questionnaire-response-02 | Questionnaire:urn:uuid:1b12e576-c039-4395-ad20-2d7e8633fe70|0.0.1 | ||
  patient_header | Patient Information | ||
  patient_surname | Surname: | Patel | |
| patient_firstname | First Name: | Alisha | |
| patient_date_of_birth | DOB: | 1987-04-12 | |
| patient_gender | Gender: | AdministrativeGender: female (Female) | |
| patient_hc_number | HN: | 1234567890 | |
| patient_hc_vc | HN VC: | AB | |
| patient_address_line1 | Address (Line 1): | 2453 Dundas St W | |
| patient_address_line2 | Address (Line 2): | Apt 708 | |
| patient_address_city | City: | Toronto | |
| patient_address_province | Province: | ON | |
| patient_address_postalcode | Postal Code: | M6P 1X3 | |
| patient_phone_mobile | Mobile #: | 416-555-0198 | |
| patient_phone_home | Home #: | 416-555-0131 | |
 patient_email | Email: | alisha.patel87@example.com | |
| additionalinfo_header | [Optional] Additional Patient Information | ||
| additionalinfo_sexassignedatbirth | Sex assigned at birth: | LOINC: LA3-6 (Female) | |
| additionalinfo_pronouns | Pronouns: | LOINC: LA29519-8 (she/her/her/hers/herself) | |
| additionalinfo_preferredlanguage | Preferred language: | Other | |
| additionalinfo_preferredlanguage_specify | Specify: | Urdu | |
| additionalinfo_preferredlanguage_translatorrequired | Translator required | Translator Required | |
| additionalinfo_bestmethodofcontact | Best method of contact: | ContactPointSystem: phone (Phone) | |
| additionalinfo_bestmethodofcontact_voicemails | Voicemails acceptable | Voicemails acceptable | |
| additionalinfo_alternatecontact_select | Alternate contact | Alternate contact | |
| additionalinfo_alternatecontact_name | Name: | Imran Patel | |
| additionalinfo_alternatecontact_phone | Alternate contact phone #: | 416-555-0144 | |
| additionalinfo_alternatecontact_relationship | Relationship: | Spouse | |
| additionalinfo_alternatecontact_bookingcontact | Is Alternate contact the appointment booking contact?: | Yes | |
| additionalinfo_accessibilityconcernsordisability_selectt | Accessibility concerns or disability | Accessibility concerns or disability | |
| additionalinfo_accessibilityconcernsordisability | Accessibility concerns Options | SNOMED CT: 105503008 (Dependence on wheelchair) | |
| additionalinfo_specialconsiderations_select | Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues) | Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues) | |
| additionalinfo_specialconsiderations | Details of special considerations: | Patient has significant anxiety in medical settings. Please explain steps in advance; prefers a quiet waiting area when possible. | |
| additionalinfo_sendcopiestoadditionalproviders | Send copies of reports to additional providers | Send copies of reports to additional providers | |
| additionalinfo_sendcopiestoadditionalproviders_names | Name(s): | Dr. Farah Alvi (Endocrinology) | |
| additionalinfo_sendcopiestoadditionalproviders_contactinfo | Contact information: | Fax 416-555-0187 | |
| 274716928898 | Referral Details | ||
| 836886186557 | Triage Considerations | ||
| referral_requestedpriority | Requested Priority: | RequestPriority: urgent (Urgent) | |
| referral_requestedpriority_urgentreason | Reason for urgent triage: | Progressive exertional chest tightness with reduced exercise tolerance over the past 3 weeks. | |
| 200848944281 | Name of the suspected diagnosis/problem triggering referral: | New exertional chest tightness; rule out stable angina / ischemic heart disease. | |
| 602158378622 | Brief Description of Referral, History, Management, and Investigations | 38F with 3-month history of exertional substernal chest tightness when climbing stairs, relieved by rest in 3–5 minutes. No syncope. Occasional palpitations. Risk factors: type 2 diabetes (A1c 7.6%), hypertension, dyslipidemia, strong family history (father MI at 52). Vitals today: BP 146/92, HR 82. Physical exam unremarkable. Baseline ECG in clinic: normal sinus rhythm, no acute ischemic changes. Started ASA 81 mg daily and optimized statin (rosuvastatin 20 mg). | |
| preferredconsultlocation_header | Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered. | ||
| preferredconsultlocation_selector | Preferred consultant or location | Preferred consultant or location | |
| preferredconsultlocation_specify | Please specify either a preferred consultant or location | ||
| preferredconsultlocation_consultant | Consultant: | Dr. Samantha Chen | |
| preferredconsultlocation_location | Location: | Toronto General Hospital – Cardiology Clinic | |
| preferredconsultlocation_willingtotravel | Patient willing to travel for shorter wait time | Patient willing to travel for shorter wait time | |
| preferredconsultlocation_otherconsiderations | Other considerations: | Prefers weekday mornings; relies on translator services. | |
| referrer_header | Referrer's Information | ||
 referrer_sitename | Site Name: | Parkdale Family Health Team | |
| referrer_address_line1 | Address (Line 1): | 123 Brock Ave | |
| referrer_address_line2 | Address (Line 2): | Suite 401 | |
| referrer_address_city | City: | Toronto | |
| referrer_address_province | Province: | ON | |
| referrer_address_postalcode | Postal Code: | M6K 2L5 | |
| referrer_phone | Phone #: | 416-555-0101 | |
| referrer_fax | Fax #: | 416-555-0102 | |
| referrer_professionalid | Professional ID: | 7654321 | |
| referrer_signature | Signed: | Dr. Nadia Rahman, MD CCFP | |
| referrer_role | Role: | SNOMED CT: 449161006 (Physician assistant) | |
| Documentation for this format | |||
FHIR
FHIRsmith{
"resourceType": "QuestionnaireResponse",
"id": "questionnaire-response-02",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"questionnaire": "urn:uuid:1b12e576-c039-4395-ad20-2d7e8633fe70|0.0.1",
"status": "completed",
"subject": {
"reference": "Patient/patient-01",
"display": "MOMO ABBAS"
},
"authored": "2026-01-08T19:01:48.738Z",
"author": {
"reference": "PractitionerRole/practitioner-role-01",
"type": "PractitionerRole",
"display": "Susan Clark"
},
"item": [
{
"linkId": "patient_header",
"text": "Patient Information",
"item": [
{
"linkId": "patient_surname",
"text": "Surname:",
"answer": [
{
"valueString": "Patel"
}
]
},
{
"linkId": "patient_firstname",
"text": "First Name:",
"answer": [
{
"valueString": "Alisha"
}
]
},
{
"linkId": "patient_date_of_birth",
"text": "DOB:",
"answer": [
{
"valueDate": "1987-04-12"
}
]
},
{
"linkId": "patient_gender",
"text": "Gender:",
"answer": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female",
"display": "Female"
}
}
]
},
{
"linkId": "patient_hc_number",
"text": "HN:",
"answer": [
{
"valueString": "1234567890"
}
]
},
{
"linkId": "patient_hc_vc",
"text": "HN VC:",
"answer": [
{
"valueString": "AB"
}
]
},
{
"linkId": "patient_address_line1",
"text": "Address (Line 1):",
"answer": [
{
"valueString": "2453 Dundas St W"
}
]
},
{
"linkId": "patient_address_line2",
"text": "Address (Line 2):",
"answer": [
{
"valueString": "Apt 708"
}
]
},
{
"linkId": "patient_address_city",
"text": "City:",
"answer": [
{
"valueString": "Toronto"
}
]
},
{
"linkId": "patient_address_province",
"text": "Province:",
"answer": [
{
"valueString": "ON"
}
]
},
{
"linkId": "patient_address_postalcode",
"text": "Postal Code:",
"answer": [
{
"valueString": "M6P 1X3"
}
]
},
{
"linkId": "patient_phone_mobile",
"text": "Mobile #:",
"answer": [
{
"valueString": "416-555-0198"
}
]
},
{
"linkId": "patient_phone_home",
"text": "Home #:",
"answer": [
{
"valueString": "416-555-0131"
}
]
},
{
"linkId": "patient_email",
"text": "Email:",
"answer": [
{
"valueString": "alisha.patel87@example.com"
}
]
}
]
},
{
"linkId": "additionalinfo_header",
"text": "[Optional] Additional Patient Information",
"item": [
{
"linkId": "additionalinfo_sexassignedatbirth",
"text": "Sex assigned at birth:",
"answer": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA3-6",
"display": "Female"
}
}
]
},
{
"linkId": "additionalinfo_pronouns",
"text": "Pronouns:",
"answer": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA29519-8",
"display": "she/her/her/hers/herself"
}
}
]
},
{
"linkId": "additionalinfo_preferredlanguage",
"text": "Preferred language:",
"answer": [
{
"valueString": "Other"
}
]
},
{
"linkId": "additionalinfo_preferredlanguage_specify",
"text": "Specify:",
"answer": [
{
"valueString": "Urdu"
}
]
},
{
"linkId": "additionalinfo_preferredlanguage_translatorrequired",
"text": "Translator required",
"answer": [
{
"valueString": "Translator Required"
}
]
},
{
"linkId": "additionalinfo_bestmethodofcontact",
"text": "Best method of contact:",
"answer": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/contact-point-system",
"code": "phone",
"display": "Phone"
}
}
]
},
{
"linkId": "additionalinfo_bestmethodofcontact_voicemails",
"text": "Voicemails acceptable",
"answer": [
{
"valueString": "Voicemails acceptable"
}
]
},
{
"linkId": "additionalinfo_alternatecontact_select",
"text": "Alternate contact",
"answer": [
{
"valueString": "Alternate contact"
}
]
},
{
"linkId": "additionalinfo_alternatecontact_name",
"text": "Name:",
"answer": [
{
"valueString": "Imran Patel"
}
]
},
{
"linkId": "additionalinfo_alternatecontact_phone",
"text": "Alternate contact phone #:",
"answer": [
{
"valueString": "416-555-0144"
}
]
},
{
"linkId": "additionalinfo_alternatecontact_relationship",
"text": "Relationship:",
"answer": [
{
"valueString": "Spouse"
}
]
},
{
"linkId": "additionalinfo_alternatecontact_bookingcontact",
"text": "Is Alternate contact the appointment booking contact?:",
"answer": [
{
"valueString": "Yes"
}
]
},
{
"linkId": "additionalinfo_accessibilityconcernsordisability_selectt",
"text": "Accessibility concerns or disability",
"answer": [
{
"valueString": "Accessibility concerns or disability"
}
]
},
{
"linkId": "additionalinfo_accessibilityconcernsordisability",
"text": "Accessibility concerns Options",
"answer": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "105503008",
"display": "Dependence on wheelchair"
}
}
]
},
{
"linkId": "additionalinfo_specialconsiderations_select",
"text": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)",
"answer": [
{
"valueString": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
}
]
},
{
"linkId": "additionalinfo_specialconsiderations",
"text": "Details of special considerations:",
"answer": [
{
"valueString": "Patient has significant anxiety in medical settings. Please explain steps in advance; prefers a quiet waiting area when possible."
}
]
},
{
"linkId": "additionalinfo_sendcopiestoadditionalproviders",
"text": "Send copies of reports to additional providers",
"answer": [
{
"valueString": "Send copies of reports to additional providers"
}
]
},
{
"linkId": "additionalinfo_sendcopiestoadditionalproviders_names",
"text": "Name(s):",
"answer": [
{
"valueString": "Dr. Farah Alvi (Endocrinology)"
}
]
},
{
"linkId": "additionalinfo_sendcopiestoadditionalproviders_contactinfo",
"text": "Contact information:",
"answer": [
{
"valueString": "Fax 416-555-0187"
}
]
}
]
},
{
"linkId": "274716928898",
"text": "Referral Details",
"item": [
{
"linkId": "836886186557",
"text": "Triage Considerations",
"item": [
{
"linkId": "referral_requestedpriority",
"text": "Requested Priority:",
"answer": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/request-priority",
"code": "urgent",
"display": "Urgent"
}
}
]
},
{
"linkId": "referral_requestedpriority_urgentreason",
"text": "Reason for urgent triage:",
"answer": [
{
"valueString": "Progressive exertional chest tightness with reduced exercise tolerance over the past 3 weeks."
}
]
}
]
},
{
"linkId": "200848944281",
"text": "Name of the suspected diagnosis/problem triggering referral:",
"answer": [
{
"valueString": "New exertional chest tightness; rule out stable angina / ischemic heart disease."
}
]
},
{
"linkId": "602158378622",
"text": "Brief Description of Referral, History, Management, and Investigations",
"answer": [
{
"valueString": "38F with 3-month history of exertional substernal chest tightness when climbing stairs, relieved by rest in 3–5 minutes. No syncope. Occasional palpitations. Risk factors: type 2 diabetes (A1c 7.6%), hypertension, dyslipidemia, strong family history (father MI at 52). Vitals today: BP 146/92, HR 82. Physical exam unremarkable. Baseline ECG in clinic: normal sinus rhythm, no acute ischemic changes. Started ASA 81 mg daily and optimized statin (rosuvastatin 20 mg)."
}
]
}
]
},
{
"linkId": "preferredconsultlocation_header",
"text": "Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.",
"item": [
{
"linkId": "preferredconsultlocation_selector",
"text": "Preferred consultant or location",
"answer": [
{
"valueString": "Preferred consultant or location"
}
]
},
{
"linkId": "preferredconsultlocation_specify",
"text": "Please specify either a preferred consultant or location",
"item": [
{
"linkId": "preferredconsultlocation_consultant",
"text": "Consultant:",
"answer": [
{
"valueString": "Dr. Samantha Chen"
}
]
},
{
"linkId": "preferredconsultlocation_location",
"text": "Location:",
"answer": [
{
"valueString": "Toronto General Hospital – Cardiology Clinic"
}
]
}
]
},
{
"linkId": "preferredconsultlocation_willingtotravel",
"text": "Patient willing to travel for shorter wait time",
"answer": [
{
"valueString": "Patient willing to travel for shorter wait time"
}
]
},
{
"linkId": "preferredconsultlocation_otherconsiderations",
"text": "Other considerations:",
"answer": [
{
"valueString": "Prefers weekday mornings; relies on translator services."
}
]
}
]
},
{
"linkId": "referrer_header",
"text": "Referrer's Information",
"item": [
{
"linkId": "referrer_sitename",
"text": "Site Name:",
"answer": [
{
"valueString": "Parkdale Family Health Team"
}
]
},
{
"linkId": "referrer_address_line1",
"text": "Address (Line 1):",
"answer": [
{
"valueString": "123 Brock Ave"
}
]
},
{
"linkId": "referrer_address_line2",
"text": "Address (Line 2):",
"answer": [
{
"valueString": "Suite 401"
}
]
},
{
"linkId": "referrer_address_city",
"text": "City:",
"answer": [
{
"valueString": "Toronto"
}
]
},
{
"linkId": "referrer_address_province",
"text": "Province:",
"answer": [
{
"valueString": "ON"
}
]
},
{
"linkId": "referrer_address_postalcode",
"text": "Postal Code:",
"answer": [
{
"valueString": "M6K 2L5"
}
]
},
{
"linkId": "referrer_phone",
"text": "Phone #:",
"answer": [
{
"valueString": "416-555-0101"
}
]
},
{
"linkId": "referrer_fax",
"text": "Fax #:",
"answer": [
{
"valueString": "416-555-0102"
}
]
},
{
"linkId": "referrer_professionalid",
"text": "Professional ID:",
"answer": [
{
"valueInteger": 7654321
}
]
},
{
"linkId": "referrer_signature",
"text": "Signed:",
"answer": [
{
"valueString": "Dr. Nadia Rahman, MD CCFP"
}
]
},
{
"linkId": "referrer_role",
"text": "Role:",
"answer": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "449161006",
"display": "Physician assistant"
}
}
]
}
]
}
]
}