FHIR IG analytics| Package | ca.on.health.idms.agreementmvp |
| Resource Type | Questionnaire |
| Id | Screening - Single Source Line Ext.json |
| FHIR Version | R5 |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "e211c6b9-5d03-4658-a46b-97b4a78f450b",
"meta": {
"versionId": "1",
"lastUpdated": "2024-07-26T15:17:01.624+00:00",
"source": "#smileutil-8b7e1d",
"profile": [
"https://health.gov.on.ca/idms/fhir/StructureDefinition/IDMS-Questionnaire|1.0.0"
]
},
"version": "3.0.10",
"title": "SS - Line Ext",
"status": "active",
"experimental": false,
"publisher": "DIRECT",
"description": "Line Extension - additional strength, dosage form, package format, etc. for an existing drug (e.g., a liquid form now to be offered in tablet form, a lower dose now being offered in a higher dose)",
"code": [
{
"system": "https://health.gov.on.ca/idms/fhir/CodeSystem/Internal-Request-Category-Types",
"code": "REQUEST-CATEGORY-DRUG-SUBMISSION",
"display": "Drug Submission"
},
{
"system": "https://health.gov.on.ca/idms/fhir/CodeSystem/Internal-Product-Types",
"code": "PRODUCT-SINGLE-SOURCE",
"display": "Single Source"
},
{
"system": "https://health.gov.on.ca/idms/fhir/CodeSystem/Internal-Submission-Types",
"code": "SUB-NEW-LINE",
"display": "Line Extension"
},
{
"system": "https://health.gov.on.ca/idms/fhir/CodeSystem/Questionnaire-Type",
"code": "SCREENING",
"display": "Screening"
}
],
"item": [
{
"linkId": "GENERAL",
"text": "General",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "GENERALHEAD",
"text": "General",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
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"extension": [
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"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "COVERLETTER",
"text": "Is the cover letter provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
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"expression": "%context.item.where(linkId='GENERAL').item.where(linkId='GENERALHEAD').item.where(linkId='COVERLETTER').answer.exists()"
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}
],
"linkId": "COVERLETTERDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "COVERLETTERNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
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{
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"linkId": "COVERLETTERGROUP",
"type": "group",
"repeats": false
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{
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}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
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"display": "Radio Button"
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"text": "Radio Button"
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}
],
"linkId": "COVERLETTERREFERENCE",
"text": "Does the cover letter references the correct division name \"Health Programs and Delivery Division\" (HPDD)?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
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}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
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"valueExpression": {
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],
"linkId": "COVERLETTERREFERENCEDATE",
"text": "Date",
"type": "date",
"required": true
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{
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],
"linkId": "COVERLETTERREFERENCECOVERLETTERNOTE",
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}
],
"linkId": "COVERLETTERREFERENCEGROUP",
"type": "group",
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{
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"code": "radio-button",
"display": "Radio Button"
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],
"text": "Radio Button"
}
}
],
"linkId": "TABLEOFCONTENTS",
"text": "Is the table of contents provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
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}
}
],
"linkId": "TABLEOFCONTENTSDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "TABLEOFCONTENTSNOTE",
"text": "Note",
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{
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"code": "radio-button",
"display": "Radio Button"
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],
"text": "Radio Button"
}
}
],
"linkId": "THIRDPARTINVOLVEMENT",
"text": "Is Third Party involvement disclosed appropriately with business arrangement letters, if applicable?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
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}
}
],
"linkId": "THIRDPARTINVOLVEMENTDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "THIRDPARTINVOLVEMENTNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
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"display": "Group table"
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"repeats": false
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"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "SUBMISSIONFORMATTING",
"text": "Is the submission formatted and organized appropriately?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
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}
}
],
"linkId": "SUBMISSIONFORMATTINGDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "SUBMISSIONFORMATTINGNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
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"linkId": "SUBMISSIONFORMATTINGGROUP",
"type": "group",
"repeats": false
}
]
}
]
},
{
"linkId": "PRODUCTDETAILS",
"text": "Product Details and Pricing",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "PRODUCTDETAILSHEAD",
"text": "Product Details and Pricing",
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"item": [
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],
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}
],
"linkId": "PROPOSEDBENEFITPRICE",
"text": "Is the Proposed Drug Benefit Price provided with the correct format?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
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"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
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{
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"expression": "%context.item.where(linkId='PRODUCTDETAILS').item.where(linkId='PRODUCTDETAILSHEAD').item.where(linkId='PROPOSEDBENEFITPRICE').answer.exists()"
}
}
],
"linkId": "PROPOSEDBENEFITPRICEDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "PROPOSEDBENEFITPRICENOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
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],
"linkId": "PROPOSEDBENEFITPRICEGROUP",
"type": "group",
"repeats": false
}
]
}
]
},
{
"linkId": "HEALTHCANADADOCUMETANTION",
"text": "Health Canada Documentation",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "HEALTHCANADADOCUMETANTIONHEAD",
"text": "Health Canada Documentation",
"type": "group",
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"repeats": false,
"readOnly": false,
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"display": "Radio Button"
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],
"text": "Radio Button"
}
}
],
"linkId": "NOTICEOFCOMPLIANCE",
"text": "Is the Notice of Compliance provided?",
"type": "coding",
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},
{
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},
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}
}
],
"linkId": "NOTICEOFCOMPLIANCEDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "NOTICEOFCOMPLIANCENOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
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}
}
],
"linkId": "PRENOC",
"text": "Is this product Pre-NOC?",
"type": "boolean",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
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],
"linkId": "NOTICEOFCOMPLIANCEGROUP",
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},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean.exists().not() or %context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean=false"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "PRODUCTMONOGRAPH",
"text": "Is the Product Monograph provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "(%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean.exists().not() or %context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean=false) and %context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPH').answer.exists()"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"linkId": "PRODUCTMONOGRAPHDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean.exists().not() or %context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean=false"
}
}
],
"linkId": "PRODUCTMONOGRAPHNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean.exists().not() or %context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRENOC').answer.valueBoolean=false"
}
}
],
"linkId": "PRODUCTMONOGRAPHGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPH').answer.valueCoding.code='NA'"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "PRODUCTMONOGRAPHSUPPORTINGDOCUMENTS",
"text": "Are the appropriate Supporting Documents provided in place of the Product Monograph?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPH').answer.valueCoding.code='NA'"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "PRODUCTMONOGRAPHSUPPORTINGDOCUMENTSHELP",
"text": "<div>List of the appropriate supporting documents:</div><ul><li>Pharmaceutical information.</li><li>Information with respect to the product's clinical pharmacology.</li><li>Information as to the product's indications and clinical use.</li><li>A list of any contra-indications, warnings or precautions in the use of the product and of possible adverse reactions to its use.</li><li>A list of symptoms of an overdose of the product and information as to the treatment of an overdose.</li><li>Information with respect to the dosage and administration of the product.</li><li>Information regarding the availability of dosage forms for each strength of the product marketed in Canada.</li>",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPH').answer.valueCoding.code='NA' and %context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPHSUPPORTINGDOCUMENTS').answer.exists()"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"linkId": "PRODUCTMONOGRAPHSUPPORTINGDOCUMENTSDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPH').answer.valueCoding.code='NA'"
}
}
],
"linkId": "PRODUCTMONOGRAPHSUPPORTINGDOCUMENTSNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='HEALTHCANADADOCUMETANTION').item.where(linkId='HEALTHCANADADOCUMETANTIONHEAD').item.where(linkId='PRODUCTMONOGRAPH').answer.valueCoding.code='NA'"
}
}
],
"linkId": "PRODUCTMONOGRAPHSUPPORTINGDOCUMENTSGROUP",
"type": "group",
"repeats": false
}
]
}
]
},
{
"linkId": "ATTESTATIONS",
"text": "Attestations",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "ATTESTATIONSHEAD",
"text": "Attestations",
"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-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "CONSENTLETTER",
"text": "Is the Letter of Consent provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='ATTESTATIONS').item.where(linkId='ATTESTATIONSHEAD').item.where(linkId='CONSENTLETTER').answer.exists()"
}
}
],
"linkId": "CONSENTLETTERDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "CONSENTLETTERNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "CONSENTLETTERGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "EVIDENCELETTER",
"text": "Is the Evidence Confirming Ability to Supply Letter provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='ATTESTATIONS').item.where(linkId='ATTESTATIONSHEAD').item.where(linkId='EVIDENCELETTER').answer.exists()"
}
}
],
"linkId": "EVIDENCELETTERDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "EVIDENCELETTERNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "EVIDENCELETTERGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "CERTIFICATIONLETTER",
"text": "Is the Certification Confirming that No Rebates Letter provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='ATTESTATIONS').item.where(linkId='ATTESTATIONSHEAD').item.where(linkId='CERTIFICATIONLETTER').answer.exists()"
}
}
],
"linkId": "CERTIFICATIONLETTERDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "CERTIFICATIONLETTERNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "CERTIFICATIONLETTERGROUP",
"type": "group",
"repeats": false
}
]
}
]
},
{
"linkId": "CLINICALEVIDENCE",
"text": "Evidence/Studies",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "CLINICALEVIDENCEHEAD",
"text": "Evidence/Studies",
"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-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "ADDITIONALSTRENGTH",
"text": "Is justification of need for additional strength and/or new format provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='ADDITIONALSTRENGTH').answer.exists()"
}
}
],
"linkId": "ADDITIONALSTRENGTHDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "ADDITIONALSTRENGTHNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "ADDITIONALSTRENGTHGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "CLINICALSUMMARY",
"text": "Is the Clinical Summary for the currently listed product provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='CLINICALSUMMARY').answer.exists()"
}
}
],
"linkId": "CLINICALSUMMARYDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "CLINICALSUMMARYNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "CLINICALSUMMARYGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "FUNDINGOFADDITIONALSTRENGTH",
"text": "Is the submission requesting funding of additional strength of the product?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='FUNDINGOFADDITIONALSTRENGTH').answer.valueCoding.code='YES'"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "PROPERTIONALITYORBIOEQUIVALENCE",
"text": "Is the Evidence of proportionality in composition or evidence of bioequivalence provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='FUNDINGOFADDITIONALSTRENGTH').answer.valueCoding.code='YES' and %context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='PROPERTIONALITYORBIOEQUIVALENCE').answer.exists()"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"linkId": "PROPERTIONALITYORBIOEQUIVALENCEDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='FUNDINGOFADDITIONALSTRENGTH').answer.valueCoding.code='YES'"
}
}
],
"linkId": "PROPERTIONALITYORBIOEQUIVALENCENOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "PROPERTIONALITYORBIOEQUIVALENCEGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "FUNDINGOFNEWFORMAT",
"text": "Is the submission requesting funding of a new format of the product?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='FUNDINGOFNEWFORMAT').answer.valueCoding.code='YES'"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "BIOEQUIVALENCEORPHARMACEUTICAL",
"text": "Is the Evidence of Bioequivalence or Pharmaceutical Equivalence between the two formats provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='FUNDINGOFNEWFORMAT').answer.valueCoding.code='YES' and %context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='BIOEQUIVALENCEORPHARMACEUTICAL').answer.exists()"
}
},
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"linkId": "BIOEQUIVALENCEORPHARMACEUTICALDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='FUNDINGOFNEWFORMAT').answer.valueCoding.code='YES'"
}
}
],
"linkId": "BIOEQUIVALENCEORPHARMACEUTICALNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "FUNDINGOFNEWFORMATGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "UNPUBLISHEDSTUDIES",
"text": "Is the List of Published and Unpublished Studies provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
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}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='UNPUBLISHEDSTUDIES').answer.exists()"
}
}
],
"linkId": "UNPUBLISHEDSTUDIESDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "UNPUBLISHEDSTUDIESNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "UNPUBLISHEDSTUDIESGROUP",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "CLINICALDATACHECKLIST",
"text": "Is the Clinical Data Checklist provided, if applicable?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='CLINICALEVIDENCE').item.where(linkId='CLINICALEVIDENCEHEAD').item.where(linkId='CLINICALDATACHECKLIST').answer.exists()"
}
}
],
"linkId": "CLINICALDATACHECKLISTDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "CLINICALDATACHECKLISTNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "CLINICALDATACHECKLISTGROUP",
"type": "group",
"repeats": false
}
]
}
]
},
{
"linkId": "FINANCIALIMPACT",
"text": "Financial Impact Analysis",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "FINANCIALIMPACTHEAD",
"text": "Financial Impact Analysis",
"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-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "BIAREPORT",
"text": "Is the BIA Report provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
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"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
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"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='FINANCIALIMPACT').item.where(linkId='FINANCIALIMPACTHEAD').item.where(linkId='BIAREPORT').answer.exists()"
}
}
],
"linkId": "BIAREPORTDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "BIAREPORTNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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{
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"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "BIAREPORTNOTE",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "BIAMODEL",
"text": "Is the BIA model provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
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}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='FINANCIALIMPACT').item.where(linkId='FINANCIALIMPACTHEAD').item.where(linkId='BIAMODEL').answer.exists()"
}
}
],
"linkId": "BIAMODELDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "BIAMODELNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "BIAMODELNOTE",
"type": "group",
"repeats": false
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
],
"text": "Radio Button"
}
}
],
"linkId": "FINANCIALIMPACTSTUDY",
"text": "Is the OPDP Financial Impact Analysis Summary Sheet provided?",
"type": "coding",
"required": true,
"answerValueSet": "https://health.gov.on.ca/idms/fhir/ValueSet/Form-Yes-No-NA|1.0.0"
},
{
"extension": [
{
"url": "https://health.gov.on.ca/idms/fhir/StructureDefinition/Extension-Question-Required-Level",
"valueCode": "QUESTIONNAIRE-REQUIRED-LEVEL-REQUIRED"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
}
],
"url": "http://hl7.org/fhir/StructureDefinition/maxValue"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today() + 1 day"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%context.item.where(linkId='FINANCIALIMPACT').item.where(linkId='FINANCIALIMPACTHEAD').item.where(linkId='FINANCIALIMPACTSTUDY').answer.exists()"
}
}
],
"linkId": "FINANCIALIMPACTSTUDYDATE",
"text": "Date",
"type": "date",
"required": true
},
{
"linkId": "FINANCIALIMPACTSTUDYNOTE",
"text": "Note",
"type": "text",
"required": false,
"maxLength": 1000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "table",
"display": "Group table"
}
],
"text": "Group table"
}
}
],
"linkId": "FINANCIALIMPACTGROUP",
"type": "group",
"repeats": false
}
]
}
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