| Package | ca.on.health.sadie |
| Resource Type | Questionnaire |
| Id | b2e24662-0ee1-4c95-9088-7be895d97c99 |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.health.sadie@1.4.11&canonical=http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL |
| URL | http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL |
| Version | 1.0.0 |
| Status | active |
| Name | ODSP_Additional_Medical_Information |
| Title | Additional Medical Information |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
{
"resourceType": "Questionnaire",
"id": "b2e24662-0ee1-4c95-9088-7be895d97c99",
"meta": {
"profile": [
"http://health.gov.on.ca/sadie/fhir/StructureDefinition/FlexForm"
]
},
"text": {
"status": "empty",
"div": "<!-- snip (see above) -->"
},
"url": "http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL",
"identifier": [
{
"use": "official",
"system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
"value": "ODSP-ADDITIONAL"
}
],
"version": "1.0.0",
"name": "ODSP_Additional_Medical_Information",
"title": "Additional Medical Information",
"status": "active",
"experimental": false,
"subjectType": [
"Patient"
],
"publisher": "ODSP",
"effectivePeriod": {
"start": "2021-01-01T05:00:00.000Z"
},
"code": [
{
"system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
"code": "DocumentType",
"display": "DDP"
},
{
"system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
"code": "DocumentSubType",
"display": "ADDITIONAL"
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "header",
"display": "Header"
}
],
"text": "Header"
}
}
],
"linkId": "0",
"text": "Additional Medical Information",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory",
"valueCode": "display-in-progress"
}
],
"linkId": "attachment_error_guide_additional",
"text": "If you encounter an upload error or failure, please try again or fax the attachment to the Disability Adjudication Unit at 416-326-3374. The fax must include the client's first and last name, Member ID and Referral ID on the document or fax cover page.",
"type": "display",
"required": false,
"repeats": false,
"readOnly": false
},
{
"linkId": "0.1",
"text": "Additional Medical Information",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "0.0.1",
"text": "Do you have a \"Consent to the Release of Medical and Related Information\" form to attach?",
"type": "boolean",
"required": true,
"repeats": false,
"readOnly": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/msword"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/rtf"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/tiff"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/pdf"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/gif"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal": 10
}
],
"linkId": "0.0.1-attachment",
"text": "Attachments",
"type": "attachment",
"enableWhen": [
{
"question": "0.0.1",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"repeats": false,
"readOnly": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "0.0.1-DocumentType",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false,
"initial": [
{
"valueString": "DDP"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "0.0.1-DocumentSubType",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false,
"initial": [
{
"valueString": "Consent"
}
]
}
]
},
{
"linkId": "0.1.1",
"text": "Do you have any medical information you wish to attach?",
"type": "boolean",
"required": true,
"repeats": false,
"readOnly": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/msword"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/rtf"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/tiff"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/pdf"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/gif"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal": 10
}
],
"linkId": "0.1.1-attachment",
"text": "Attachments",
"type": "attachment",
"enableWhen": [
{
"question": "0.1.1",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"repeats": true,
"readOnly": false,
"item": [
{
"linkId": "0.1.1-categories",
"text": "Attachment Categories",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-AttachmentCategories"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "0.1.1-DocumentType",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false,
"initial": [
{
"valueString": "AMI"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "0.1.1-DocumentSubType",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false,
"initial": [
{
"valueString": "Regular or IR AMI"
}
]
}
]
},
{
"linkId": "0.1.2",
"text": "Notes",
"type": "text",
"required": false,
"repeats": false,
"readOnly": false,
"maxLength": 2000,
"enableBehavior": "any",
"enableWhen": [
{
"question": "0.0.1",
"operator": "=",
"answerBoolean": true
},
{
"question": "0.1.1",
"operator": "=",
"answerBoolean": true
}
]
},
{
"linkId": "0.1.3",
"text": "Notes",
"type": "text",
"required": true,
"repeats": false,
"readOnly": false,
"maxLength": 2000,
"enableBehavior": "all",
"enableWhen": [
{
"question": "0.0.1",
"operator": "=",
"answerBoolean": false
},
{
"question": "0.1.1",
"operator": "=",
"answerBoolean": false
}
]
}
]
}
]
}
]
}