FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | Questionnaire |
| Id | carefirst_family_hea.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh-eforms@1.0.0-ballot4&canonical=http://ontariohealth.ca/legacy/Questionnaire/carefirst-family-hea |
| URL | http://ontariohealth.ca/legacy/Questionnaire/carefirst-family-hea |
| Version | 0 |
| Status | active |
| Title | Carefirst Family Health Team Diabetes Education Program (DEP) eReferral Form [FINAL SEPT 2022] |
| Realm | ca |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "carefirst-family-hea",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire"
],
"security": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
"code": "N"
}
]
},
"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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],
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