FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | Questionnaire |
| Id | sleep_disorder_clini.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh-eforms@1.0.0-ballot4&canonical=http://ontariohealth.ca/legacy/Questionnaire/sleep-disorder-clini |
| URL | http://ontariohealth.ca/legacy/Questionnaire/sleep-disorder-clini |
| Version | 0 |
| Status | active |
| Title | Sleep Disorder Clinic eReferral Form [FINAL JULY 2024] |
| Realm | ca |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "sleep-disorder-clini",
"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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}
]
}
],
"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/sleep-disorder-clini",
"version": "0",
"title": "Sleep Disorder Clinic eReferral Form [FINAL JULY 2024]",
"status": "active",
"experimental": false,
"subjectType": [
"Patient"
],
"item": [
{
"linkId": "KidneyWiseForm",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "body",
"type": "group",
"item": [
{
"linkId": "item47143865",
"text": "<b>* Indicates a required field</b>",
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
}
]
}
],
"linkId": "AdditionalPatientInfo",
"text": "<b>Additional Patient Information</b>",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "@ptLanguage",
"language": "text/fhirpath",
"expression": "true"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Preferred Language:"
},
{
"url": "enableWhenExpression",
"valueExpression": {
"description": "PreferredLanguage.r.includes('English') || PreferredLanguage.r.includes('French') == true",
"language": "text/fhirpath",
"expression": "true"
}
}
]
}
],
"linkId": "PreferredLanguage",
"text": "Preferred Language:",
"type": "choice",
"repeats": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "eng"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "fre"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "Other"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "@ptLanguage",
"language": "text/fhirpath",
"expression": "true"
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Preferred Language:"
}
]
}
],
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{
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"code": "Other"
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}
],
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"required": true
},
{
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{
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"coding": [
{
"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": "Translator <b><u>NOT</u></b> needed"
},
{
"url": "enableWhenExpression",
"valueExpression": {
"description": "PreferredLanguage.r.includes('Other') == true",
"language": "text/fhirpath",
"expression": "true"
}
}
]
}
],
"linkId": "Translator",
"text": "Translator Required",
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{
"question": "PreferredLanguage",
"operator": "=",
"answerCoding": {
"code": "Other"
}
}
],
"enableBehavior": "all"
},
{
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{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "@ptPmoc",
"language": "text/fhirpath",
"expression": "true"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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{
"url": "text",
"valueString": "Best Method of Contact:"
}
]
}
],
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{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "OTHER"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "HOME"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "BUSINESS"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "EMAIL"
}
}
]
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"coding": [
{
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"code": "check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Voicemail acceptable: No"
},
{
"url": "enableWhenExpression",
"valueExpression": {
"description": "BestContactMethod.r.includes('OTHER') || BestContactMethod.r.includes('HOME') || BestContactMethod.r.includes('BUSINESS')== true",
"language": "text/fhirpath",
"expression": "true"
}
}
]
}
],
"linkId": "item73068595",
"text": "Voicemails acceptable",
"type": "boolean",
"enableWhen": [
{
"question": "BestContactMethod",
"operator": "=",
"answerCoding": {
"code": "OTHER"
}
},
{
"question": "BestContactMethod",
"operator": "=",
"answerCoding": {
"code": "HOME"
}
},
{
"question": "BestContactMethod",
"operator": "=",
"answerCoding": {
"code": "BUSINESS"
}
}
],
"enableBehavior": "all"
},
{
"linkId": "item95810306",
"text": "Where appropriate, please provide:",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "<u>Appointment booking contact</u>"
}
]
}
],
"linkId": "AlternateContact",
"text": "Appointment booking contact (if not patient)",
"type": "boolean"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "@ptEmergencyContact",
"language": "text/fhirpath",
"expression": "true"
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Name:"
}
]
}
],
"linkId": "item6554535",
"text": "Contact Name:",
"type": "string",
"enableWhen": [
{
"question": "AlternateContact",
"operator": "=",
"answerBoolean": true
}
],
"enableBehavior": "all",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"description": "@ptEmergencyContactPhone",
"language": "text/fhirpath",
"expression": "true"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "item80027355"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "human",
"valueString": "Please enter a valid north-american phone number. e.g. XXX-XXX-XXXX."
},
{
"url": "expression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId='item80027355').answer.all(value.matches('^(\\\\+\\\\d{1,2}\\\\s?)?\\\\(?\\\\d{3}\\\\)?[\\\\s.-]?\\\\d{3}[\\\\s.-]?\\\\d{4}[%content%]#39;))"
}
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
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{
"url": "text",
"valueString": "Phone Number:"
}
]
}
],
"linkId": "item80027355",
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"type": "string",
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{
"question": "AlternateContact",
"operator": "=",
"answerBoolean": true
}
],
"enableBehavior": "all"
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
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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": "Special Considerations:"
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{
"url": "enableWhenExpression",
"valueExpression": {
"description": "false",
"language": "text/fhirpath",
"expression": "false"
}
}
]
}
],
"linkId": "SpecialConsiderations",
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},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Special Considerations: $"
}
]
}
],
"linkId": "item38347402",
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{
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"answerBoolean": true
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],
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
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{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "text",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
}
]
}
],
"linkId": "item25397237",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "item10476570"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "human",
"valueString": "Please obey rules specified in instructions"
},
{
"url": "expression",
"valueExpression": {
"description": "ScriptUtil.percentComplete( PreferredLoc) != 0",
"language": "text/fhirpath",
"expression": "true"
}
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "text",
"valueString": "Preferred Location(s)"
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "PreferredLoc",
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"type": "group",
"item": [
{
"linkId": "item10476570",
"text": "<i>Select all that apply</i>:",
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "section95718570",
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{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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{
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"code": "check-box"
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}
],
"linkId": "item7852115",
"text": "Hamilton",
"type": "boolean"
},
{
"linkId": "section31627363",
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{
"question": "item7852115",
"operator": "=",
"answerBoolean": true
}
],
"enableBehavior": "all",
"item": [
{
"linkId": "item42030680",
"text": "<b>Telephone:</b> 905 529 2259\n<b>Fax:</b> 905 529 2262",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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{
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"code": "check-box"
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]
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}
],
"linkId": "item59448874",
"text": "St. Catharines",
"type": "boolean"
},
{
"linkId": "section55723098",
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{
"question": "item59448874",
"operator": "=",
"answerBoolean": true
}
],
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"item": [
{
"linkId": "item90358461",
"text": "<b>Telephone:</b> 905 529 2259\n<b>Fax:</b> 905 529 2262",
"type": "display"
}
]
},
{
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{
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"code": "check-box"
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]
}
}
],
"linkId": "item44065286",
"text": "Cambridge Memorial Hospital",
"type": "boolean"
},
{
"linkId": "section18070968",
"type": "group",
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{
"question": "item44065286",
"operator": "=",
"answerBoolean": true
}
],
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"item": [
{
"linkId": "item8918930",
"text": "<b>Telephone:</b> 905 529 2259\n<b>Fax:</b> 905 529 2262",
"type": "display"
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "text",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
}
]
}
],
"linkId": "item74312441",
"type": "display"
}
]
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "item3508830"
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{
"url": "severity",
"valueCode": "error"
},
{
"url": "human",
"valueString": "Please obey rules specified in instructions"
},
{
"url": "expression",
"valueExpression": {
"description": "ScriptUtil.percentComplete( section9816307) != 0",
"language": "text/fhirpath",
"expression": "true"
}
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "text",
"valueString": "Service Request(s)"
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "section9816307",
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{
"linkId": "item3508830",
"text": "<i>Select all that apply</i>:",
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "listSeparator",
"valueString": "\\n"
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]
}
],
"linkId": "section68958263",
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{
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{
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{
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},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "• Sleep study; consult; treatment if required"
}
]
}
],
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{
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"operator": "exists",
"answerBoolean": true
}
],
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},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"code": "check-box"
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},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "• Diagnostic sleep study only, no consult, no treatment"
}
]
}
],
"linkId": "item45390734",
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{
"question": "item84731201",
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"answerBoolean": true
}
],
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},
{
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{
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{
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"code": "check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "• Consult; followed by diagnosis and treatment if required"
}
]
}
],
"linkId": "item46379923",
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"type": "boolean"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "text",
"_valueString": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
}
]
}
],
"linkId": "item53780705",
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}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "text",
"valueString": "Reason for Referral"
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "reasonforreferralsec",
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{
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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": "radio-button"
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]
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},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Urgency:"
}
]
}
],
"linkId": "Urgency",
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"required": true,
"repeats": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
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{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "style",
"valueString": "color:green;"
}
]
}
],
"valueCoding": {
"code": "Routine"
},
"initialSelected": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 3
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "style",
"valueString": "color:orange;"
}
]
}
],
"valueCoding": {
"code": "High Priority"
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},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 2
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{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "style",
"valueString": "color:red;"
}
]
}
],
"valueCoding": {
"code": "Urgent"
}
}
]
},
{
"linkId": "item40810108",
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{
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"operator": "=",
"answerCoding": {
"code": "Urgent"
}
}
],
"enableBehavior": "all",
"required": true
},
{
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"url": "http://hl7.org/fhir/StructureDefinition/targetConstraint",
"extension": [
{
"url": "key",
"valueId": "item54277157"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "human",
"valueString": "Please obey rules specified in instructions"
},
{
"url": "expression",
"valueExpression": {
"description": "ScriptUtil.percentComplete( section75710709 ) != 0",
"language": "text/fhirpath",
"expression": "true"
}
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "text",
"valueString": "Symptom(s) Leading to Referral"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "section75710709",
"text": "Symptom(s) Leading to Referral *",
"type": "group",
"item": [
{
"linkId": "item54277157",
"text": "<i> Select all that apply:</i>",
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "listSeparator",
"valueString": "\\n"
}
]
}
],
"linkId": "reason_for_referral",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 11
}
]
}
],
"linkId": "item72495479",
"text": "Snoring",
"type": "boolean"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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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": "sortIndex",
"valuePositiveInt": 12
}
]
}
],
"linkId": "item83826274",
"text": "Snoring with apnea",
"type": "boolean"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box"
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{
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{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
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