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Source1

{
  "resourceType": "Questionnaire",
  "id": "b28ff0d7-5372-48a5-9591-fb22900568f3",
  "meta": {
    "versionId": "3",
    "lastUpdated": "2026-02-03T16:22:34.911+00:00",
    "source": "#72ec80d3ac62ab8b",
    "profile": [
      "https://health.gov.on.ca/idms/fhir/StructureDefinition/IDMS-Questionnaire|1.0.0"
    ]
  },
  "extension": [
    {
      "url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Questionnaire-External-Indicator",
      "valueBoolean": true
    }
  ],
  "version": "3.0.10",
  "title": "DeviceListChg",
  "status": "active",
  "experimental": false,
  "publisher": "DIRECT",
  "purpose": "https://www.ontario.ca/files/2025-03/moh-drug-submission-ontario-guidelines-flash-glucose-monitoring-en-2025-03-04.pdf",
  "code": [
    {
      "code": "SUB-GLUCOSE-PRODUCT-NAME",
      "display": "Product Name Change"
    },
    {
      "system": "https://health.gov.on.ca/idms/fhir/CodeSystem/Questionnaire-Type",
      "code": "SUBMIT",
      "display": "Submit "
    }
  ],
  "item": [
    {
      "linkId": "CHANGEDETAILSNAV",
      "text": "Change Details",
      "type": "group",
      "required": false,
      "repeats": false,
      "readOnly": false,
      "item": [
        {
          "linkId": "CHANGEDETAILSGROUP",
          "text": "Change Details",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "extension": [
                {
                  "url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
                  "valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
                }
              ],
              "linkId": "CURRENTVALUE",
              "definition": "https://health.gov.on.ca/idms/fhir/StructureDefinition/IDMS-ServiceRequest-New#ServiceRequest.extension.where(url='https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Indication').valueString",
              "text": "Value as it currently appears",
              "type": "text",
              "required": true,
              "maxLength": 100
            },
            {
              "extension": [
                {
                  "url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
                  "valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
                }
              ],
              "linkId": "NEWVALUE",
              "definition": "https://health.gov.on.ca/idms/fhir/StructureDefinition/IDMS-ServiceRequest-New#ServiceRequest.extension.where(url='https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Indication').valueString",
              "text": "New Value",
              "type": "text",
              "required": true,
              "maxLength": 100
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.ms-excel"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/msword"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/pdf"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/maxSize",
                  "valueDecimal": 10
                },
                {
                  "url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
                  "valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
                }
              ],
              "linkId": "CHANGERATIONALEDOC",
              "text": "Rationale for the change(s)",
              "type": "attachment",
              "required": true,
              "repeats": false
            },
            {
              "extension": [
                {
                  "url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
                  "valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
                }
              ],
              "linkId": "EFFECTIVECHANGEDATE",
              "text": "Effective date for the change(s)",
              "type": "date",
              "required": true,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "help",
                            "display": "Help-Button"
                          }
                        ],
                        "text": "Help-Button"
                      }
                    }
                  ],
                  "linkId": "EFFECTIVECHANGEDATEHELP",
                  "text": "If no specific date is available, please specify the expected target date for the change.",
                  "type": "display"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
                  "valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
                }
              ],
              "linkId": "DISCONTINUEDDATE",
              "text": "Date the currently listed product will be discontinued and removed from the market",
              "type": "date",
              "required": true
            },
            {
              "linkId": "EXPIRYDATE",
              "text": "Expiry date of the last lot of the currently listed product",
              "type": "date",
              "required": false
            }
          ]
        }
      ]
    },
    {
      "linkId": "SUPPLEMENTALNAV",
      "text": "Supplemental Information",
      "type": "group",
      "required": false,
      "repeats": false,
      "readOnly": false,
      "item": [
        {
          "linkId": "SUPPLEMENTALGROUP",
          "text": "Supplemental Information",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "help",
                        "display": "Help-Button"
                      }
                    ],
                    "text": "Help-Button"
                  }
                }
              ],
              "linkId": "SUPPLEMENTALGROUPHELP",
              "text": "Please provide any additional information and/or materials that may aid the ministry in assessing your submission (e.g., Health Canada evaluation reports).",
              "type": "display"
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.ms-excel"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/msword"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/pdf"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/maxSize",
                  "valueDecimal": 10
                }
              ],
              "linkId": "SUPPLEMENTALSUPPORTING",
              "text": "Supporting Documents",
              "type": "attachment",
              "required": false,
              "repeats": true,
              "readOnly": false
            },
            {
              "linkId": "SUPPLEMENTALADDITIONALINFO",
              "text": "Additional Information",
              "type": "text",
              "required": false,
              "maxLength": 1000
            }
          ]
        }
      ]
    }
  ]
}