FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | Questionnaire |
| Id | dr_garvey_chilopora_.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh-eforms@1.0.0-ballot4&canonical=http://ontariohealth.ca/legacy/Questionnaire/dr-garvey-chilopora- |
| URL | http://ontariohealth.ca/legacy/Questionnaire/dr-garvey-chilopora- |
| Version | 0 |
| Status | active |
| Title | Dr. Chilopora eReferral Form [FINAL MAY 2022] |
| Realm | ca |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "dr-garvey-chilopora-",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire"
]
},
"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/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm",
"valueCoding": {
"system": "http://hl7.org/fhir/version-algorithm",
"code": "semver"
}
},
{
"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": "http://ontariohealth.ca/legacy/Questionnaire/dr-garvey-chilopora-",
"version": "0",
"title": "Dr. Chilopora eReferral Form [FINAL MAY 2022]",
"status": "active",
"experimental": false,
"subjectType": [
"Patient"
],
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
}
]
}
],
"linkId": "questionnaire",
"type": "group",
"item": [
{
"linkId": "item47143865",
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"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
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"url": "listSeparator",
"valueString": "\\n"
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}
],
"linkId": "section47163071",
"text": "Patient Information",
"type": "group",
"item": [
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"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
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"language": "text/fhirpath",
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}
],
"linkId": "item29578021",
"text": "Height (cm):",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
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"language": "text/fhirpath",
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],
"linkId": "item67890802",
"text": "Weight (kg):",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
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"url": "text",
"_valueString": {
"extension": [
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"linkId": "item84833268",
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{
"extension": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
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"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "listSeparator",
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}
],
"linkId": "section2763158",
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"linkId": "item48807357",
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{
"extension": [
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"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
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"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "listSeparator",
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}
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}
],
"linkId": "section42000384",
"text": "Pregnancy History",
"type": "group",
"item": [
{
"linkId": "item67762889",
"text": "Total number of pregnancies:",
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"required": true
},
{
"linkId": "item91252875",
"text": "Number of vaginal deliveries:",
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},
{
"linkId": "item47328769",
"text": "Number of C-sections:",
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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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},
{
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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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}
],
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}
},
{
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}
],
"valueCoding": {
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}
},
{
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}
],
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}
}
]
}
]
}
]
},
{
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"text": "Date of last pap test:",
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"required": true
},
{
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"text": "Patient is sexually active:",
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"answerOption": [
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"display": "No"
}
},
{
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}
}
]
},
{
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]
}
}
],
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}
],
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}
],
"valueCoding": {
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}
},
{
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}
],
"valueCoding": {
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}
},
{
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}
],
"valueCoding": {
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}
}
]
},
{
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}
],
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}
],
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],
"valueCoding": {
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},
{
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}
],
"valueCoding": {
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}
},
{
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}
],
"valueCoding": {
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}
},
{
"extension": [
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}
],
"valueCoding": {
"code": "IUD (copper)"
}
},
{
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"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 5
}
],
"valueCoding": {
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}
},
{
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"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
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}
],
"valueCoding": {
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}
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 0
}
],
"valueCoding": {
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}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 0
}
],
"valueCoding": {
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}
},
{
"extension": [
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}
],
"valueCoding": {
"code": "Subdermal implant"
}
},
{
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{
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"valueDecimal": 0
}
],
"valueCoding": {
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}
}
]
}
]
},
{
"extension": [
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"valueBoolean": true
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "text",
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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]
}
}
]
}
],
"linkId": "item95005032",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "lastSeparator",
"valueString": "\\n"
},
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "section4572141",
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{
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"language": "text/fhirpath",
"expression": "true"
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},
{
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}
],
"linkId": "prob",
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{
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"answerBoolean": true
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],
"enableBehavior": "all",
"item": [
{
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"text": "<i>Select all that apply:</i>",
"type": "display"
},
{
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{
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]
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}
],
"linkId": "item16667176",
"text": "High blood pressure",
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},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"code": "check-box"
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]
}
}
],
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"text": "Diabetes",
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},
{
"extension": [
{
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]
}
}
],
"linkId": "item35434575",
"text": "Blood clots in lungs/legs",
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},
{
"extension": [
{
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"valueCodeableConcept": {
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]
}
}
],
"linkId": "item69273958",
"text": "Migraine headaches",
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},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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]
}
}
],
"linkId": "item47066864",
"text": "Liver disease/hepatitis",
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},
{
"extension": [
{
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]
}
}
],
"linkId": "item75358255",
"text": "Osteoporosis",
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},
{
"extension": [
{
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]
}
}
],
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},
{
"extension": [
{
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]
}
}
],
"linkId": "item18292760",
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},
{
"extension": [
{
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{
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]
}
],
"linkId": "item66877002",
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],
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"required": true
},
{
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]
}
}
],
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},
{
"extension": [
{
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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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},
{
"extension": [
{
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}
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],
"linkId": "item37884318",
"text": "Incontinence (urine/stool)",
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},
{
"extension": [
{
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],
"linkId": "item41904126",
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},
{
"extension": [
{
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]
}
}
],
"linkId": "item51470870",
"text": "Frequent bladder infections",
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},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"coding": [
{
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]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "enableWhenExpression",
"valueExpression": {
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"language": "text/fhirpath",
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}
]
}
],
"linkId": "item15815594",
"text": "Other",
"type": "boolean"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Other: $"
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]
}
],
"linkId": "item78475900",
"text": "Specify:",
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"operator": "=",
"answerBoolean": true
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],
"enableBehavior": "all",
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]
}
]
},
{
"extension": [
{
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{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
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]
}
],
"linkId": "i_nmedications_n",
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{
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