FHIR IG analytics| Package | ca.on.health.idms.agreementmvp |
| Resource Type | Questionnaire |
| Id | External-NurtListChgDistributor.json |
| FHIR Version | R5 |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "e534aac8-dc62-45be-94b0-f8cef548c52e",
"meta": {
"versionId": "3",
"lastUpdated": "2025-12-16T15:57:35.552+00:00",
"source": "#94e1694d70a3af32",
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"valueBoolean": true
}
],
"version": "3.0.10",
"title": "NutrListChg",
"status": "active",
"experimental": false,
"publisher": "DIRECT",
"code": [
{
"code": "SUB-NUTRITIONAL-DISTRIBUTOR",
"display": "Distributor 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": [
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
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],
"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": [
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"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": [
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"valueCode": "application/vnd.ms-excel"
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"valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
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"valueDecimal": 10
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{
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
}
],
"linkId": "CHANGERATIONALEDOC",
"text": "Rationale for the change(s)",
"type": "attachment",
"required": true,
"repeats": false
},
{
"extension": [
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"valueCode": "application/msword"
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"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": "OLDPRODUCTLABELDOC",
"text": "Old product label for sale in the Canadian market",
"type": "attachment",
"required": true,
"repeats": false
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/vnd.ms-excel"
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"valueDecimal": 10
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
}
],
"linkId": "NEWPRODUCTLABELDOC",
"text": "New product label for sale in the Canadian market",
"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": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"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"
}
]
},
{
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"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
},
{
"extension": [
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"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
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],
"linkId": "EXPIRYDATE",
"text": "Expiry date of the last lot of the currently listed product",
"type": "date",
"required": true
},
{
"linkId": "FORMULATIONINFORMAITONGROUP",
"text": "Formulation Information",
"type": "group",
"item": [
{
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"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
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}
],
"linkId": "FORMULATIONCHANGE",
"text": "Has there been a change to formulation?",
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],
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"text": "If formulation has changed i.e. the product efficacy, tolerance and/or safety are altered, the ministry requires the old and new quantitative formula, and nutrient formulation with the differences highlighted.",
"type": "display"
}
]
},
{
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"code": "check-box",
"display": "Check box"
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"text": "Check box"
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"linkId": "CONFIRMNOFORMULATIONCHANGE",
"text": "I confirm that formulation has not changed.",
"type": "boolean",
"enableWhen": [
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"question": "FORMULATIONCHANGE",
"operator": "=",
"answerBoolean": false
}
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"linkId": "CONFIRMNOCLINICALIMPACT",
"text": "I confirm that clinical response or product safety have not been impacted.",
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"operator": "=",
"answerBoolean": false
}
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"linkId": "CLINICALRESPONSECHANGE",
"text": "Does the change impact clinical response or product safety?",
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"operator": "=",
"answerBoolean": true
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"required": true
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"valueCode": "application/vnd.ms-excel"
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"valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
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"valueCode": "application/msword"
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"valueDecimal": 10
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
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],
"linkId": "NOTALTEREDEVIDENCE",
"text": "Evidence that the product efficacy, tolerance and/or safety are not altered",
"type": "attachment",
"enableWhen": [
{
"question": "CLINICALRESPONSECHANGE",
"operator": "=",
"answerBoolean": false
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"required": true,
"repeats": false
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"valueDecimal": 10
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
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],
"linkId": "OLDNEWFORMULADOC",
"text": "Documentation with respect to the old and new quantitative formula, and nutrient formulation with the differences highlighted",
"type": "attachment",
"enableWhen": [
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"question": "CLINICALRESPONSECHANGE",
"operator": "=",
"answerBoolean": true
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],
"required": true,
"repeats": false
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"valueDecimal": 10
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{
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
}
],
"linkId": "PRODUCTSPECIFICSTUDIES",
"text": "Product specific clinical studies for the new formulation",
"type": "attachment",
"enableWhen": [
{
"question": "CLINICALRESPONSECHANGE",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"repeats": false
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"valueDecimal": 10
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
}
],
"linkId": "NUTRITIONPRODUCTWORKSHEET",
"text": "Nutrition Product Worksheet",
"type": "attachment",
"enableWhen": [
{
"question": "CLINICALRESPONSECHANGE",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"repeats": false,
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"code": "help",
"display": "Help-Button"
}
],
"text": "Help-Button"
}
}
],
"linkId": "NUTRITIONPRODUCTWORKSHEETHELP",
"text": "Please refer to the Drug Submissions website for the most recent template.",
"type": "display"
}
]
},
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"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-KIND-OF"
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],
"linkId": "SUPPORTINGSTUDYINFORMATION",
"text": "Supporting information or study listed for the Nutrition Product Work Sheet ",
"type": "attachment",
"enableWhen": [
{
"question": "CLINICALRESPONSECHANGE",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"repeats": true,
"readOnly": false
}
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]
},
{
"linkId": "SUPPLEMENTALNAV",
"text": "Supplemental Information",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
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"linkId": "SUPPLEMENTALGROUP",
"text": "Supplemental Information",
"type": "group",
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"repeats": false,
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"item": [
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"code": "help",
"display": "Help-Button"
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"text": "Help-Button"
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],
"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": [
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"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
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"valueCode": "application/msword"
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"valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
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},
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}
],
"linkId": "SUPPLEMENTALSUPPORTING",
"text": "Supporting Documents",
"type": "attachment",
"required": false,
"repeats": true,
"readOnly": false
},
{
"linkId": "SUPPLEMENTALADDITIONALINFO",
"text": "Additional Information",
"type": "text",
"required": false,
"maxLength": 1000
}
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}
]
}
]
}