FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | Questionnaire |
| Id | MI_SplittingExample.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh-eforms@1.0.0-ballot5&canonical=urn:uuid:ae47a011-027d-43f6-9855-1029fcc0944f |
| URL | urn:uuid:ae47a011-027d-43f6-9855-1029fcc0944f |
| Version | 0.0.1 |
| Status | active |
| Date | 2026-01-28T16:19:05.195-05:00 |
| Title | Medical Imaging - Standardized Provincial Form Template - Splitting Example |
| 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/StructureDefinition/artifact-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": "urn:uuid:ae47a011-027d-43f6-9855-1029fcc0944f",
"version": "0.0.1",
"title": "Medical Imaging - Standardized Provincial Form Template - Splitting Example",
"_title": {
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/core-short-string",
"valueString": "test short string"
}
]
},
"status": "active",
"experimental": false,
"subjectType": [
"Patient"
],
"date": "2026-01-28T16:19:05.195-05:00",
"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": [
{
"linkId": "283714301370",
"text": "Please note that screening programs such the Ontario Breast Screening Program (OBSP) and Ontario Lung Screening Program (OLSP) have dedicated provincial intake forms and eligibility criteria. Please check program website for referral forms.",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "Please note that screening programs such the <a href=\"https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-breast-obsp\" rel=\"noopener noreferrer\" target=\"_blank\">Ontario Breast Screening Program (OBSP)</a> and <a href=\"https://www.cancercareontario.ca/en/cancer-care-ontario/programs/screening-programs/ontario-lung-screening-program\" rel=\"noopener noreferrer\" target=\"_blank\">Ontario Lung Screening Program (OLSP)</a> have dedicated provincial intake forms and eligibility criteria. Please check program website for referral forms."
}
]
},
"type": "display"
},
{
"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": "Patient Information"
},
{
"url": "listSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "lastSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "patient_header",
"text": "Patient Information",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "font-weight:bold;"
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Surname"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "patient_surname",
"text": "Surname:",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "First Name"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "DOB"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Gender"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "HN PC"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "HN"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "HN VC"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "patient_hc_vc",
"text": "HN VC:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Address"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Address Line 2"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "City"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Province"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Postal Code"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Mobile #"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Home #"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Business #"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Email"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "patient_email",
"text": "Email:",
"type": "string"
}
]
},
{
"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": 2
},
{
"url": "text",
"valueString": "[Optional] Additional Patient Information"
},
{
"url": "listSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "lastSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_header",
"text": "[Optional] Additional Patient Information",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "font-weight:bold;"
}
]
},
"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": "Sex assigned at birth"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Pronouns"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Other Pronouns"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Preferred language"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Specify"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Translator required"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_preferredlanguage_translatorrequired",
"text": "Translator required",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Preferred name"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_preferredname_select",
"text": "Preferred name",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Preferred Name:"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_preferredname",
"text": "Prefered name String",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Best method of contact"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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://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": "Voicemails acceptable"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%resource.repeat(item).where(linkId = 'additionalinfo_bestmethodofcontact').answer.value.where(display.lower() = 'home' or display.lower() = 'mobile' or display.lower() = 'business').exists()"
}
}
],
"linkId": "additionalinfo_bestmethodofcontact_voicemails",
"text": "Voicemails acceptable",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"type": "choice",
"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": "Alternate contact"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_alternatecontact_select",
"text": "Alternate contact",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Name"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Alternate contact phone #"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_alternatecontact_phone",
"text": "Alternate contact phone #:",
"type": "string",
"enableWhen": [
{
"question": "additionalinfo_alternatecontact_select",
"operator": "=",
"answerCoding": {
"display": "Alternate contact"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Relationship"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_alternatecontact_relationship",
"text": "Relationship:",
"type": "string",
"enableWhen": [
{
"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": "Is Alternate contact the appointment booking contact?"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Unsafe contact persons (do not speak with)"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_unsafecontacts_select",
"text": "Unsafe contact persons (do not speak with)",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Only speak with patient directly"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_unsafecontacts_speakwithpatientdirectly",
"text": "Only speak with patient directly",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Do not speak with:"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_unsafecontacts_donotspeakwith",
"text": "Do not speak with:",
"type": "string",
"enableWhen": [
{
"question": "additionalinfo_unsafecontacts_select",
"operator": "=",
"answerCoding": {
"display": "Unsafe contact persons (do not speak with)"
}
}
],
"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": "check-box",
"display": "Check-box"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Accessibility concerns or disability"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_accessibilityconcernsordisability_selectt",
"text": "Accessibility concerns or disability",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"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": "Specific"
},
{
"url": "listSeparator",
"valueString": ";"
},
{
"url": "lastSeparator",
"valueString": "and"
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "additionalinfo_accessibilityconcernsordisability",
"text": "Accessibility concerns Options",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
},
"type": "choice",
"enableWhen": [
{
"question": "additionalinfo_accessibilityconcernsordisability_selectt",
"operator": "=",
"answerCoding": {
"display": "Accessibility concerns or disability"
}
}
],
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "129839007",
"display": "Falls risk"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "301621006",
"display": "Patient requires lift"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "105503008",
"display": "Wheelchair"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "15188001",
"display": "Hearing impaired"
}
}
]
},
{
"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": "Special considerations"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_specialconsiderations_select",
"text": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"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": "Details of special considerations"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "additionalinfo_specialconsiderations",
"text": "Details of special considerations:",
"type": "text",
"enableWhen": [
{
"question": "additionalinfo_specialconsiderations_select",
"operator": "=",
"answerCoding": {
"display": "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
}
}
],
"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": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Payer Type"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "780152781664",
"text": "Payer Type",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"display": "OHIP"
},
"initialSelected": true
},
{
"valueCoding": {
"display": "WSIB Case"
}
},
{
"valueCoding": {
"display": "DND"
}
},
{
"valueCoding": {
"display": "IFH"
}
},
{
"valueCoding": {
"display": "RAMQ"
}
},
{
"valueCoding": {
"display": "Other"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Other payer"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "273459321091",
"text": "Other",
"type": "string",
"enableWhen": [
{
"question": "780152781664",
"operator": "=",
"answerCoding": {
"display": "Other"
}
}
],
"enableBehavior": "all"
}
]
},
{
"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": 3
},
{
"url": "text",
"valueString": "Select Exam Request(s)"
},
{
"url": "listSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "lastSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "274716928898",
"text": "Select Exam Request(s)",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "font-weight:bold;color:#202035;"
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
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]
}
],
"linkId": "cpp_currentprob",
"code": [
{
"system": "http://snomed.info/sct",
"code": "55607006",
"display": "Problem"
}
],
"text": "Current Problem List:",
"type": "text",
"enableWhen": [
{
"question": "cpp_separate",
"operator": "!=",
"answerCoding": {
"display": "CPP attached separately (if not entered below)"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Past Medical History"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "cpp_pastmedicalhistory",
"code": [
{
"system": "http://snomed.info/sct",
"code": "417662000",
"display": "History of clinical finding in subject"
}
],
"text": "Past Medical History:",
"type": "text",
"enableWhen": [
{
"question": "cpp_separate",
"operator": "!=",
"answerCoding": {
"display": "CPP attached separately (if not entered below)"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Current Medication"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "cpp_currentmedications",
"code": [
{
"system": "http://snomed.info/sct",
"code": "129019007",
"display": "Taking medication"
}
],
"text": "Current Medications:",
"type": "text",
"enableWhen": [
{
"question": "cpp_separate",
"operator": "!=",
"answerCoding": {
"display": "CPP attached separately (if not entered below)"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Family History"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "cpp_familyhistory",
"code": [
{
"system": "http://snomed.info/sct",
"code": "57177007",
"display": "Family history with explicit context"
}
],
"text": "Family History:",
"type": "text",
"enableWhen": [
{
"question": "cpp_separate",
"operator": "!=",
"answerCoding": {
"display": "CPP attached separately (if not entered below)"
}
}
],
"enableBehavior": "all"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Allergies"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "cpp_allergies",
"code": [
{
"system": "http://snomed.info/sct",
"code": "609328004",
"display": "Allergic disposition"
}
],
"text": "Allergies:",
"type": "text",
"enableWhen": [
{
"question": "cpp_separate",
"operator": "!=",
"answerCoding": {
"display": "CPP attached separately (if not entered below)"
}
}
],
"enableBehavior": "all"
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 12
},
{
"url": "text",
"valueString": "Preferred Consultant or Location"
},
{
"url": "listSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "lastSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "preferredconsultlocation_header",
"text": "Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Preferred Consultant or Location</b><br/>All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered."
}
]
},
"type": "group",
"item": [
{
"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": "Preferred consultant or location"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
},
{
"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": "preferredconsultlocation_selector",
"text": "Preferred consultant or location",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Preferred consultant or location"
}
}
]
},
{
"linkId": "preferredconsultlocation_specify",
"text": "Please specify either a preferred consultant or location",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "Please specify either a <b>preferred</b> consultant or location"
}
]
},
"type": "group",
"enableWhen": [
{
"question": "preferredconsultlocation_selector",
"operator": "=",
"answerCoding": {
"display": "Preferred consultant or location"
}
}
],
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Consultant"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "preferredconsultlocation_consultant",
"text": "Consultant:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Location"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "preferredconsultlocation_location",
"text": "Location:",
"type": "string"
}
]
},
{
"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": "Patient willing to travel for shorter wait time"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "preferredconsultlocation_willingtotravel",
"text": "Patient willing to travel for shorter wait time",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info",
"extension": [
{
"url": "text",
"valueString": "Yes"
}
]
}
],
"valueCoding": {
"display": "Patient willing to travel for shorter wait time"
}
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Other"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "preferredconsultlocation_otherconsiderations",
"text": "Other considerations:",
"type": "string"
}
]
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 13
},
{
"url": "listSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "lastSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "style",
"valueString": "font-weight:bold;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "supportingdocumentation_header",
"text": "Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Supporting Documentation</b><br/>Please attach all <b><span style=\"text-decoration: underline\">relevant</span></b> laboratory and diagnostic investigations."
}
]
},
"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",
"display": "Check-box"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "supportingdocumentation_details",
"text": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient.",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "display:none;"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"display": "Personal Health Information that is medically relevant has not been disclosed at the request of the patient."
}
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/pdf"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/gif"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/bmp"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "video/mp4"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "text/csv"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/jpeg"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/msword"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/png"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "application/vnd.ms-excel"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "text/plain"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "audio/mp4"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "audio/mpeg"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/mimeType",
"valueCode": "image/tiff"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxSize",
"valueDecimal": 1024000
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 14
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
}
]
}
],
"linkId": "supportingdocumentation_attachment",
"text": "Add Attachments",
"type": "attachment"
},
{
"linkId": "feedbacksurvey_universal",
"text": "Click here to provide feedback on this form",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<a href=\"https://www.surveymonkey.com/r/universalSRF\" rel=\"noopener noreferrer\" target=\"_blank\">Click here to provide feedback on this form</a>"
}
]
},
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "sortIndex",
"valuePositiveInt": 15
},
{
"url": "text",
"valueString": "Referrer's Information"
},
{
"url": "listSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "lastSeparator",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<br/>"
}
]
}
},
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
},
{
"url": "groupItems",
"valueBoolean": false
}
]
}
],
"linkId": "referrer_header",
"text": "Referrer's Information",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "font-weight:bold;"
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Site Name"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "referrer_sitename",
"text": "Site Name:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Address (Line 1)"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Address (Line 2)"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "City"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Province"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Must be a valid Canadian postal code"
}
]
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Postal Code"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Phone #"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Fax #"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "referrer_fax",
"text": "Fax #:",
"type": "string"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Billing Number"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "referrer_billing",
"text": "Billing Number:",
"type": "integer"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Professional ID"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "referrer_professionalid",
"text": "Professional ID:",
"type": "integer"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Signed"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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": "Role"
},
{
"url": "sameLine",
"valueBoolean": false
},
{
"url": "quoteAnswer",
"valueBoolean": false
},
{
"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"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"
}
}
]
}
]
}
]
}