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Source1

{
  "resourceType": "Questionnaire",
  "url": "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-clinical-summary-questionnaire-template",
  "title": "MHA Clinical Summary Questionnaire Template",
  "status": "active",
  "description": "Sample questionnaire using all questions from the admission clinical summary questionnaire",
  "purpose": "To serve as a model to support MHA admission questionnaires.",
  "item": [
    {
      "linkId": "Q1",
      "text": "Symptoms of Clinical Concern",
      "type": "choice",
      "repeats": true,
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/symptoms-of-clinical-concern"
    },
    {
      "linkId": "Q2",
      "text": "Behavioural Addictions and/or Problematic Substance Use",
      "type": "choice",
      "repeats": true,
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/addiction-substance-use"
    },
    {
      "linkId": "Q3",
      "text": "Other Reasons for Seeking Service",
      "type": "choice",
      "repeats": true,
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/help-seeking-reason"
    },
    {
      "linkId": "Q4",
      "text": "Prescribed pharmacotherapy or anti-craving medication for alcohol use disorder",
      "type": "group",
      "item": [
        {
          "linkId": "Q4-a",
          "text": "Are you receiving prescribed pharmacotherapy or anti-craving medication for alcohol use disorder?",
          "type": "choice",
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/alcohol-anti-craving-medication-enrollment"
        },
        {
          "linkId": "Q4-b",
          "text": "What anti-craving medication prescribed?",
          "type": "choice",
          "repeats": true,
          "enableWhen": [
            {
              "question": "Q4-a",
              "operator": "=",
              "answerCoding": {
                "system": "http://snomed.info/sct",
                "code": "373066001",
                "display": "Yes"
              }
            }
          ],
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/alcohol-anti-craving-medication"
        }
      ]
    },
    {
      "linkId": "Q5",
      "text": "Prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder",
      "type": "group",
      "item": [
        {
          "linkId": "Q5-a",
          "text": "Are you receiving prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder?",
          "type": "choice",
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/opioid-agonist-medication-enrollment"
        },
        {
          "linkId": "Q5-b",
          "text": "What opioid Agonist therapy is prescribed?",
          "type": "choice",
          "enableWhen": [
            {
              "question": "Q5-a",
              "operator": "=",
              "answerCoding": {
                "system": "http://snomed.info/sct",
                "code": "373066001",
                "display": "Yes"
              }
            }
          ],
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/opioid-agonist-medication"
        }
      ]
    },
    {
      "linkId": "Q6",
      "text": "Gambling Problem Identified",
      "type": "choice",
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-problem-identified"
    },
    {
      "linkId": "Q7",
      "text": "Reason for Non-completion of Gambling Data Form",
      "type": "choice",
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-form-non-completion-reason"
    },
    {
      "linkId": "Q8",
      "text": "Gambling Treatment Plan Status",
      "type": "choice",
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-treatment-plan-status"
    }
  ]
}