FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | Questionnaire |
| Id | Universal_Questionnaire.json.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh-eforms@1.0.0-ballot4&canonical=urn:uuid:1b12e576-c039-4395-ad20-2d7e8633fe70 |
| URL | urn:uuid:1b12e576-c039-4395-ad20-2d7e8633fe70 |
| Version | 0.0.1 |
| Status | active |
| Date | 2026-01-08T15:58:16.445-05:00 |
| Title | Universal - Standardized Provincial Form Template - Clinical Summary Note Sample |
| Realm | ca |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "479ecda0-2b51-436a-8f78-1b3346b7e53b",
"language": "en",
"contained": [
{
"resourceType": "Library",
"id": "liquid",
"status": "active",
"type": {
"coding": [
{
"system": "http://ontariohealth.ca/fhir/eforms/CodeSystem/library-types",
"code": "qr-narrative-liquid"
}
]
},
"description": "HTML with embedded [FHIRPath Liquid](https://confluence.hl7.org/spaces/FHIR/pages/66938964/FHIR+Liquid+Profile) that is intended to be executed against QuestionnaireResponses based on this Questionnaire.",
"content": [
{
"contentType": "text/html",
"data": 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"
}
]
}
],
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
"valueCode": "random"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/sdc-responseRenderingLiquid",
"valueReference": {
"reference": "#liquid"
}
}
],
"url": "urn:uuid:1b12e576-c039-4395-ad20-2d7e8633fe70",
"version": "0.0.1",
"title": "Universal - Standardized Provincial Form Template - Clinical Summary Note Sample",
"_title": {
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/core-short-string",
"valueString": "test short string"
}
]
},
"status": "active",
"experimental": false,
"subjectType": [
"Patient"
],
"date": "2026-01-08T15:58:16.445-05:00",
"publisher": "Ontario Health & Amplify Care",
"_description": {
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/core-short-string",
"valueString": "test description"
}
]
},
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166:-2",
"code": "CA-ON"
}
],
"text": "Ontario"
}
],
"effectivePeriod": {
"start": "2025-07-29"
},
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "list",
"display": "List"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 1
},
{
"url": "text",
"valueString": "<strong><span style=\"text-decoration:underline;\">Patient Information</span></strong>"
},
{
"url": "listSeparator",
"valueString": "<br>"
},
{
"url": "lastSeparator",
"valueString": "<br>"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "patient_header",
"text": "Patient Information",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Patient Information</b>"
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Surname</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_surname",
"text": "Surname:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>First Name</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_firstname",
"text": "First Name:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "yyyy/MM/dd"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>DOB</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_date_of_birth",
"text": "DOB:",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Gender</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_gender",
"text": "Gender:",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female",
"display": "Female"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "other",
"display": "Other"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "</p><strong>HN PC</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_hc_pc",
"text": "HN PC:",
"type": "string",
"maxLength": 2
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>HN</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_hc_number",
"text": "HN:",
"type": "string",
"maxLength": 10
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minLength",
"valueInteger": 10
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>HN VC</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_hc_vc",
"text": "HN VC:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<br><strong>Address</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_address_line1",
"text": "Address (Line 1):",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Address Line 2</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_address_line2",
"text": "Address (Line 2):",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>City</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_address_city",
"text": "City:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Province</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_address_province",
"text": "Province:",
"type": "string",
"required": true,
"maxLength": 2
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "postalcode1"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='patient_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9][%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid Canadian postal code in the format A1A 1A1."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Postal Code</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_address_postalcode",
"text": "Postal Code:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "phone1"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}[%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<br><strong>Mobile #</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_phone_mobile",
"text": "Mobile #:",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "phone2"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}[%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Home #</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_phone_home",
"text": "Home #:",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "phone3"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}[%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Business #</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_phone_business",
"text": "Business #:",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "email1"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='patient_email').answer.all(value.matches('(?:[a-z0-9!#$%&'*+/=?^_`{|}~-]+(?:\\\\.[a-z0-9!#$%&'*+/=?^_`{|}~-]+)*|\\\"(?:[\\\\x01-\\\\x08\\\\x0b\\\\x0c\\\\x0e-\\\\x1f\\\\x21\\\\x23-\\\\x5b\\\\x5d-\\\\x7f]|\\\\\\\\[\\\\x01-\\\\x09\\\\x0b\\\\x0c\\\\x0e-\\\\x7f])*\\\")@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\\\\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\\\\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\\\\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21-\\x5a\\x53-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])+)\\])'))"
}
},
{
"url": "human",
"valueString": "Please enter a valid email address."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Email</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "patient_email",
"text": "Email:",
"type": "string"
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 2
},
{
"url": "text",
"valueString": "<strong><span style=\"text-decoration:underline;\">[Optional] Additional Patient Information</span></strong>"
},
{
"url": "listSeparator",
"valueString": "<br>"
},
{
"url": "lastSeparator",
"valueString": "<br>"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_header",
"text": "[Optional] Additional Patient Information",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p><strong>[Optional] Additional Patient Information</strong></p>"
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"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"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Sex assigned at birth</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_sexassignedatbirth",
"text": "Sex assigned at birth:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA3-6",
"display": "Female"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA2-8",
"display": "Male"
}
},
{
"valueCoding": {
"display": "Intersex"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA4489-6",
"display": "Unknown"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"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"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Pronouns</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_pronouns",
"text": "Pronouns:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA29519-8",
"display": "She/Her"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA29518-0",
"display": "He/Him"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA29519-8",
"display": "They/Them"
}
},
{
"valueCoding": {
"display": "Other"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Other Pronouns</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_pronouns_other",
"text": "Other pronouns:",
"type": "string",
"enableWhen": [
{
"question": "additionalinfo_pronouns",
"operator": "=",
"answerCoding": {
"display": "Other"
}
}
],
"enableBehavior": "all",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"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"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Preferred language</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_preferredlanguage",
"text": "Preferred language:",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "urn:ietf:bcp:47",
"code": "en",
"display": "English"
}
},
{
"valueCoding": {
"system": "urn:ietf:bcp:47",
"code": "fr",
"display": "French"
}
},
{
"valueCoding": {
"display": "Other"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Specify</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_preferredlanguage_specify",
"text": "Specify:",
"type": "string",
"enableWhen": [
{
"question": "additionalinfo_preferredlanguage",
"operator": "=",
"answerCoding": {
"display": "Other"
}
}
],
"enableBehavior": "all",
"required": true
},
{
"extension": [
{
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Translator required</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_preferredlanguage_translatorrequired",
"text": "Translator required",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"enableWhen": [
{
"question": "additionalinfo_preferredlanguage",
"operator": "=",
"answerCoding": {
"display": "Other"
}
}
],
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Translator Required"
}
}
]
},
{
"extension": [
{
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Preferred name</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_preferredname_select",
"text": "Preferred name",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Preferred Name"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Preferred Name:</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_preferredname",
"text": "Prefered name String",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "string",
"enableWhen": [
{
"question": "additionalinfo_preferredname_select",
"operator": "=",
"answerCoding": {
"display": "Preferred Name"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"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"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Best method of contact</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_bestmethodofcontact",
"text": "Best method of contact:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/contact-point-system",
"code": "phone",
"display": "Mobile"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/contact-point-system",
"code": "phone",
"display": "Home"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/contact-point-system",
"code": "phone",
"display": "Business"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/contact-point-system",
"code": "email",
"display": "Email"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Voicemails acceptable</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check-box"
}
]
}
}
],
"linkId": "additionalinfo_bestmethodofcontact_voicemails",
"text": "Voicemails acceptable",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"enableWhen": [
{
"question": "additionalinfo_bestmethodofcontact",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/contact-point-system",
"code": "phone",
"display": "Mobile"
}
}
],
"enableBehavior": "any",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": " Voicemails acceptable"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<br><strong>Alternate contact</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_alternatecontact_select",
"text": "Alternate contact",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Alternate contact"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Name</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_alternatecontact_name",
"text": "Name:",
"type": "string",
"enableWhen": [
{
"question": "additionalinfo_alternatecontact_select",
"operator": "=",
"answerCoding": {
"display": "Alternate contact"
}
}
],
"enableBehavior": "all",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "phone4"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}[%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Alternate contact phone #</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_alternatecontact_phone",
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{
"question": "additionalinfo_alternatecontact_select",
"operator": "=",
"answerCoding": {
"display": "Alternate contact"
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}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Relationship</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_alternatecontact_relationship",
"text": "Relationship:",
"type": "string",
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{
"question": "additionalinfo_alternatecontact_select",
"operator": "=",
"answerCoding": {
"display": "Alternate contact"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"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"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Is Alternate contact the appointment booking contact?</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_alternatecontact_bookingcontact",
"text": "Is Alternate contact the appointment booking contact?:",
"type": "choice",
"enableWhen": [
{
"question": "additionalinfo_alternatecontact_select",
"operator": "=",
"answerCoding": {
"display": "Alternate contact"
}
}
],
"enableBehavior": "all",
"answerOption": [
{
"valueCoding": {
"display": "Yes"
}
},
{
"valueCoding": {
"display": "No"
}
}
]
},
{
"extension": [
{
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<br><strong>Unsafe contact persons (do not speak with)</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_unsafecontacts_select",
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"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Unsafe contact persons (do not speak with)"
}
}
]
},
{
"extension": [
{
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Only speak with patient directly</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_unsafecontacts_speakwithpatientdirectly",
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"_text": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"enableWhen": [
{
"question": "additionalinfo_unsafecontacts_select",
"operator": "=",
"answerCoding": {
"display": "Unsafe contact persons (do not speak with)"
}
}
],
"enableBehavior": "all",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"valueCoding": {
"display": "Only speak with patient directly"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Do not speak with:</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_unsafecontacts_donotspeakwith",
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}
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"enableBehavior": "all"
},
{
"extension": [
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"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<br><strong>Accessibility concerns or disability</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_accessibilityconcernsordisability_selectt",
"text": "Accessibility concerns or disability",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p style=\"display:none;\"></p>"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Accessibility concerns or disability"
}
}
]
},
{
"extension": [
{
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Specific</strong>"
},
{
"url": "listSeparator",
"valueString": ";"
},
{
"url": "lastSeparator",
"valueString": "and"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_accessibilityconcernsordisability",
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"_text": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br>"
}
]
},
"type": "choice",
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"question": "additionalinfo_accessibilityconcernsordisability_selectt",
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"answerCoding": {
"display": "Accessibility concerns or disability"
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}
],
"repeats": true,
"answerOption": [
{
"valueCoding": {
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"code": "129839007",
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}
},
{
"valueCoding": {
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"code": "301621006",
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}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "105503008",
"display": "Wheelchair"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "15188001",
"display": "Hearing impaired"
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}
]
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
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}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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{
"url": "text",
"valueString": "</p><strong>Special considerations</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
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]
}
],
"linkId": "additionalinfo_specialconsiderations_select",
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},
"type": "choice",
"repeats": true,
"answerOption": [
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"extension": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong> Details of special considerations</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
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]
}
],
"linkId": "additionalinfo_specialconsiderations",
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"question": "additionalinfo_specialconsiderations_select",
"operator": "=",
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}
],
"required": true
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check-box"
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}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<br><strong>Send copies of reports to additional providers</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_sendcopiestoadditionalproviders",
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"_text": {
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"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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},
"type": "choice",
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"answerOption": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
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"url": "text",
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}
]
}
],
"valueCoding": {
"display": "Send copies of reports to additional providers"
}
}
]
},
{
"extension": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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{
"url": "text",
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{
"url": "sameLine",
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{
"url": "quoteAnswer",
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]
}
],
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"answerCoding": {
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}
],
"enableBehavior": "all",
"required": true
},
{
"extension": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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{
"url": "text",
"valueString": "<strong>Contact information</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_sendcopiestoadditionalproviders_contactinfo",
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"question": "additionalinfo_sendcopiestoadditionalproviders",
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"answerCoding": {
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}
],
"enableBehavior": "all",
"required": true
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
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}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "This is the Primary Care Provider",
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"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "<strong>This is the Primary Care Provider</strong>"
}
]
}
},
{
"url": "sameLine",
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{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_sendcopiestoadditionalproviders_ispcp",
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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]
},
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"question": "additionalinfo_sendcopiestoadditionalproviders",
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"answerCoding": {
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}
],
"enableBehavior": "all",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "This is the Primary Care Provider"
}
}
]
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 3
},
{
"url": "text",
"valueString": "<strong><span style=\"text-decoration:underline;\">Referral Details</span></strong>"
},
{
"url": "listSeparator",
"valueString": "<br>"
},
{
"url": "lastSeparator",
"valueString": "<br>"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "274716928898",
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Triage Considerations</strong>"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "836886186557",
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"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p><strong>Triage Considerations</strong></p>"
}
]
},
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{
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"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
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}
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{
"url": "style",
"valueString": "font-weight:bold;"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
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]
}
],
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"display": "Routine"
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"initialSelected": true
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{
"valueCoding": {
"system": "http://hl7.org/fhir/request-priority",
"code": "urgent",
"display": "Urgent"
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{
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
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"url": "text",
"valueString": "<strong>Reason for urgent triage</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
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}
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}
],
"required": true
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{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
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{
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{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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"url": "text",
"valueString": "<strong>Second Opinion</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
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"linkId": "referral_secondopinion",
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"valueString": "<p style=\"display:none;\"></p>"
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"valueString": "Yes"
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{
"url": "style",
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}
]
}
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{
"extension": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
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"url": "text",
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"url": "style",
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
"valueBoolean": false
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],
"linkId": "200848944281",
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"valueString": "<b>Name of the suspected diagnosis/problem triggering referral :</b>"
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"url": "style",
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{
"url": "text",
"valueString": "<strong><span style=\"text-decoration:underline;\">Cumulative Patient Profile</span></strong>"
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{
"url": "listSeparator",
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{
"url": "lastSeparator",
"valueString": "<br>"
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{
"url": "style",
"valueString": "font-weight:bold;"
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{
"url": "groupItems",
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"linkId": "cpp_header",
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"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Cumulative Patient Profile</b><br>\n<b><i>Please delete any sensitive information you do not intend to share from the CPP</i></b>"
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"url": "text",
"valueString": "<strong>CPP attached separately</strong>"
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{
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{
"url": "quoteAnswer",
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"valueString": "<p style=\"display:none;\"></p>"
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"url": "text",
"valueString": "<strong>Current Problem List</strong>"
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{
"url": "sameLine",
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{
"url": "quoteAnswer",
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],
"linkId": "cpp_currentprob",
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"code": "55607006",
"display": "Problem"
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"url": "text",
"valueString": "<strong>Past Medical History</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
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],
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{
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{
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"code": "129019007",
"display": "Taking medication"
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"url": "text",
"valueString": "<strong>Family History</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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"url": "text",
"valueString": "<strong>Allergies</strong>"
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{
"url": "sameLine",
"valueBoolean": false
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{
"url": "quoteAnswer",
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}
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
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"url": "sortIndex",
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{
"url": "text",
"valueString": "<p><strong><span style=\"text-decoration:underline;\">Preferred Consultant or Location</span></strong>"
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{
"url": "listSeparator",
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{
"url": "lastSeparator",
"valueString": "<br>"
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{
"url": "style",
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{
"url": "groupItems",
"valueBoolean": false
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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"code": "check-box",
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"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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"url": "sameLine",
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{
"url": "quoteAnswer",
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{
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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{
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]
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{
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"url": "text",
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{
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}
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},
{
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"url": "text",
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"url": "sameLine",
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{
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{
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{
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{
"url": "groupItems",
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}
],
"linkId": "supportingdocumentation_header",
"text": "Supporting Documentation Header",
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"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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{
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],
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{
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{
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{
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{
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{
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{
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{
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{
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{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
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{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "audio/mp4"
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{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "audio/mpeg"
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{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/tiff"
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{
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"valueDecimal": 1024000
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{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
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"url": "sortIndex",
"valuePositiveInt": 7
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{
"url": "sameLine",
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{
"url": "quoteAnswer",
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]
}
],
"linkId": "supportingdocumentation_attachment",
"text": "Add Attachments",
"type": "attachment"
},
{
"linkId": "feedbacksurvey_universal",
"text": "Feedback Survey: Universal",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<p><a href=\"https://www.surveymonkey.com/r/universalSRF\" rel=\"noopener noreferrer\" target=\"_blank\">Click here to provide feedback on this form</a></p>"
}
]
},
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 9
},
{
"url": "text",
"valueString": "<strong><span style=\"text-decoration:underline;\">Referrer's Information</span></strong>"
},
{
"url": "listSeparator",
"valueString": "<br>"
},
{
"url": "lastSeparator",
"valueString": "<br>"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_header",
"text": "Referrer's Information",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Referrer's Information</b>"
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Site Name</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_sitename",
"text": "Site Name:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Address (Line 1)</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_address_line1",
"text": "Address (Line 1):",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Address (Line 2)</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_address_line2",
"text": "Address (Line 2):",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>City</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_address_city",
"text": "City:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Province</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_address_province",
"text": "Province:",
"type": "string",
"required": true,
"maxLength": 2
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "postalcode2"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='referrer_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9][%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid Canadian postal code in the format A1A 1A1."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Postal Code</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_address_postalcode",
"text": "Postal Code:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "phone5"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='referrer_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}[%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Phone #</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_phone",
"text": "Phone #:",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "phone6"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='referrer_fax').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}[%content%]#39;))"
}
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Fax #</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_fax",
"text": "Fax #:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Billing Number</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_billing",
"text": "Billing Number:",
"type": "integer"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Professional ID</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_professionalid",
"text": "Professional ID:",
"type": "integer"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Signed</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_signature",
"text": "Signed:",
"type": "text",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer",
"valueUrl": "https://tx.fhir.org/r4"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<strong>Role</strong>"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_role",
"text": "Role:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "309398001",
"display": "Allied Health Professional"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "62247001",
"display": "Family Physician"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "449161006",
"display": "Physician Assistant"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "398130009",
"display": "Medical Student"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "106292003",
"display": "Nurse"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "224571005",
"display": "Nurse Practitioner"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "405277009",
"display": "Resident"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "69280009",
"display": "Specialist"
}
},
{
"valueCoding": {
"display": "Other"
}
}
]
}
]
}
]
}