FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | Questionnaire |
| Id | carefirst_family_hea.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh-eforms@1.0.0-ballot5&canonical=http://ontariohealth.ca/legacy/Questionnaire/carefirst-family-hea |
| URL | http://ontariohealth.ca/legacy/Questionnaire/carefirst-family-hea |
| Version | 0 |
| Status | active |
| Title | Carefirst Family Health Team Diabetes Education Program (DEP) eReferral Form [FINAL SEPT 2022] |
| Realm | ca |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "carefirst-family-hea",
"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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gZW5kZm9yICV9eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGlmIGZvcmxvb3AubGFzdC5ub3QoKSAlfXslIGlmIGZvcmxvb3AubmV4dGl0ZW0gJX08YnIvPnslIGVsc2UgJX08YnIvPnslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtOTEzMzMyMjEnICV9R0xQLTEgUmV2aWV3eyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnc2VjdGlvbjg5NTc1OTM1JyAlfTxzcGFuLz4geyUgZm9yIGN1cnJlbnRJdGVtIGluIGN1cnJlbnRJdGVtLml0ZW0ud2hlcmUoKGxpbmtJZCA9ICdpdGVtNDI1OTA4MDMnIGFuZCBhbnN3ZXIuZXhpc3RzKCkpIG9yIChsaW5rSWQgPSAnaXRlbTgyMTY1NzQ3JyBhbmQgYW5zd2VyLmV4aXN0cygpKSBvciAobGlua0lkID0gJ2l0ZW02ODQ5MDc0NScgYW5kIGFuc3dlci5leGlzdHMoKSkpICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW00MjU5MDgwMycgJX17JSBpZiBjdXJyZW50SXRlbS5hbnN3ZXIuZXhpc3RzKCkgJX1UeXBlOiB7JSBmb3IgYW5zd2VyIGluIGN1cnJlbnRJdGVtLmFuc3dlciAlfXt7IGFuc3dlci52YWx1ZS5vZlR5cGUoc3RyaW5nKSB9fXslIGVuZGZvciAlfXslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnaXRlbTgyMTY1NzQ3JyAlfXslIGlmIGN1cnJlbnRJdGVtLmFuc3dlci5leGlzdHMoKSAlfURvc2UgJmFtcDsgVGltZTogeyUgZm9yIGFuc3dlciBpbiBjdXJyZW50SXRlbS5hbnN3ZXIgJX17eyBhbnN3ZXIudmFsdWUub2ZUeXBlKHN0cmluZykgfX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW02ODQ5MDc0NScgJX17JSBpZiBjdXJyZW50SXRlbS5hbnN3ZXIuZXhpc3RzKCkgJX1Db21tZW50czogeyUgZm9yIGFuc3dlciBpbiBjdXJyZW50SXRlbS5hbnN3ZXIgJX17eyBhbnN3ZXIudmFsdWUgfX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgaWYgZm9ybG9vcC5sYXN0Lm5vdCgpICV9eyUgaWYgZm9ybG9vcC5uZXh0aXRlbSAlfTxici8+eyUgZWxzZSAlfTxici8+eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGVuZGZvciAlfXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW02MTk5ODgzOScgJX1SZWZlcnJhbCB0byBTb2NpYWwgV29ya2VyIGF0IENhcmVmaXJzdCBEaWFiZXRlcyBFZHVjYXRpb24gUHJvZ3JhbXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW00MTgwODI2JyAlfUVuZG9jcmlub2xvZ2lzdCBDb25zdWx0IChpZiBhdmFpbGFibGUgb24gc2l0ZSl7JSBlbmRpZiAlfXslIGlmIGZvcmxvb3AubGFzdC5ub3QoKSAlfXslIGlmIGZvcmxvb3AubmV4dGl0ZW0gJX08YnIvPnslIGVsc2UgJX08YnIvPnslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBlbmRmb3IgJX08YnIvPjxzcGFuLz57JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdzZWN0aW9uODk4NjcyOTMnICV9Q2xpbmljYWwgSW5mb3JtYXRpb248YnIvPiB7JSBmb3IgY3VycmVudEl0ZW0gaW4gY3VycmVudEl0ZW0uaXRlbS53aGVyZSgobGlua0lkID0gJ3NlY3Rpb240MzYxODczNCcpIG9yIChsaW5rSWQgPSAnc2VjdGlvbjgzMjUyNDAwJykpICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ3NlY3Rpb240MzYxODczNCcgJX1SZWxldmFudCBNZWRpY2FsIEhpc3Rvcnk8YnIvPiB7JSBmb3IgY3VycmVudEl0ZW0gaW4gY3VycmVudEl0ZW0uaXRlbS53aGVyZSgobGlua0lkID0gJ2l0ZW05MTU0MTEyOCcgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ2l0ZW02NTU0OTY5JyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTUwNjUwOTk1JyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTc3OTk4NjE2JyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTk4OTEzMTcxJyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTc0MzA5ODM4JyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTg5NzMxNTkzJyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTEzNTg1NDUyJyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTM4MDE2MTg2JyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnaXRlbTQyMDU3MjQ5JyBhbmQgYW5zd2VyLmV4aXN0cyh2YWx1ZS5vZlR5cGUoYm9vbGVhbik9dHJ1ZSkpIG9yIChsaW5rSWQgPSAnY21fbWVudGFsSGVhbHRoJyBhbmQgYW5zd2VyLmV4aXN0cygpKSBvciAobGlua0lkID0gJ2h4T3RoZXInIGFuZCBhbnN3ZXIuZXhpc3RzKCkpKSAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtOTE1NDExMjgnICV9SHlwZXJ0ZW5zaW9ueyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnaXRlbTY1NTQ5NjknICV9TmVwaHJvcGF0aHl7JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtNTA2NTA5OTUnICV9RHlzbGlwaWRlbWlheyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnaXRlbTc3OTk4NjE2JyAlfUV4ZXJjaXNlIHJlc3RyaWN0aW9uc3slIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW05ODkxMzE3MScgJX1DQUR7JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtNzQzMDk4MzgnICV9UmV0aW5vcGF0aHl7JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtODk3MzE1OTMnICV9T2Jlc2l0eXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW0xMzU4NTQ1MicgJX1QQUR7JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtMzgwMTYxODYnICV9TmV1cm9wYXRoeXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW00MjA1NzI0OScgJX1Gb290IHByb2JsZW1zeyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnY21fbWVudGFsSGVhbHRoJyAlfXslIGlmIGN1cnJlbnRJdGVtLmFuc3dlci5leGlzdHMoKSAlfVBzeWNob3NvY2lhbDogeyUgZm9yIGFuc3dlciBpbiBjdXJyZW50SXRlbS5hbnN3ZXIgJX17eyBhbnN3ZXIudmFsdWUgfX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2h4T3RoZXInICV9eyUgaWYgY3VycmVudEl0ZW0uYW5zd2VyLmV4aXN0cygpICV9T3RoZXI6IHslIGZvciBhbnN3ZXIgaW4gY3VycmVudEl0ZW0uYW5zd2VyICV9e3sgYW5zd2VyLnZhbHVlIH19eyUgZW5kZm9yICV9eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGlmIGZvcmxvb3AubGFzdC5ub3QoKSAlfXslIGlmIGZvcmxvb3AubmV4dGl0ZW0gJX07IHslIGVsc2UgJX07IHslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdzZWN0aW9uODMyNTI0MDAnICV9Q3VycmVudCBNZWRpY2F0aW9ucyB7JSBmb3IgY3VycmVudEl0ZW0gaW4gY3VycmVudEl0ZW0uaXRlbS53aGVyZSgobGlua0lkID0gJ2l0ZW02ODg1NTYzOCcgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ3NlY3Rpb241MDc0NDc0NCcpKSAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtNjg4NTU2MzgnICV9Tm9uZXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ3NlY3Rpb241MDc0NDc0NCcgJX17JSBmb3IgY3VycmVudEl0ZW0gaW4gY3VycmVudEl0ZW0uaXRlbS53aGVyZSgobGlua0lkID0gJ2l0ZW0zMDM2OTI4NicgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ2l0ZW0xNzE0NjM2NScgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ2l0ZW04OTk1NDg2NycgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ2l0ZW05MTIwMjQ0MicgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ2l0ZW0yODU5NjQ4MCcgYW5kIGFuc3dlci5leGlzdHMoKSkpICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW0zMDM2OTI4NicgJX1PcmFsIEh5cG9nbHljZW1pYyBBZ2VudHN7JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtMTcxNDYzNjUnICV9QUNFaS9BUkJ7JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtODk5NTQ4NjcnICV9U3RhdGlueyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnaXRlbTkxMjAyNDQyJyAlfUluc3VsaW4vR0xQLTEgYW5hbG9neyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnaXRlbTI4NTk2NDgwJyAlfXslIGlmIGN1cnJlbnRJdGVtLmFuc3dlci5leGlzdHMoKSAlfXslIGNhcHR1cmUgYW5zd2VyICV9eyUgZm9yIGFuc3dlciBpbiBjdXJyZW50SXRlbS5hbnN3ZXIgJX17eyBhbnN3ZXIudmFsdWUgfX17JSBlbmRmb3IgJX17JSBlbmRjYXB0dXJlICV9T3RoZXI6IHt7YW5zd2VyfX17JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgaWYgZm9ybG9vcC5sYXN0Lm5vdCgpICV9eyUgaWYgZm9ybG9vcC5uZXh0aXRlbSAlfTxici8+eyUgZWxzZSAlfTxici8+eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGVuZGZvciAlfXslIGVuZGlmICV9eyUgaWYgZm9ybG9vcC5sYXN0Lm5vdCgpICV9eyUgaWYgZm9ybG9vcC5uZXh0aXRlbSAlfTxici8+eyUgZWxzZSAlfTxici8+eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGVuZGZvciAlfXslIGVuZGlmICV9eyUgaWYgZm9ybG9vcC5sYXN0Lm5vdCgpICV9eyUgaWYgZm9ybG9vcC5uZXh0aXRlbSAlfTxici8+eyUgZWxzZSAlfTxici8+eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGVuZGZvciAlfTxici8+PHNwYW4vPnslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ3NlY3Rpb242MTQyODYxNycgJX1DdW11bGF0aXZlIFBhdGllbnQgUHJvZmlsZTxici8+IHslIGZvciBjdXJyZW50SXRlbSBpbiBjdXJyZW50SXRlbS5pdGVtLndoZXJlKChsaW5rSWQgPSAnQ1BQQXR0YWNobWVudCcgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSBvciAobGlua0lkID0gJ3NlY3Rpb241ODE0ODMyMScpKSAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdDUFBBdHRhY2htZW50JyAlfUNQUCBBdHRhY2hlZCBTZXBhcmF0ZWx5eyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnc2VjdGlvbjU4MTQ4MzIxJyAlfXslIGZvciBjdXJyZW50SXRlbSBpbiBjdXJyZW50SXRlbS5pdGVtLndoZXJlKChsaW5rSWQgPSAncHJvYicgYW5kIGFuc3dlci5leGlzdHMoKSkgb3IgKGxpbmtJZCA9ICdpdGVtMTk1MzI0NzUnIGFuZCBhbnN3ZXIuZXhpc3RzKCkpIG9yIChsaW5rSWQgPSAncngnIGFuZCBhbnN3ZXIuZXhpc3RzKCkpIG9yIChsaW5rSWQgPSAncG1oeCcgYW5kIGFuc3dlci5leGlzdHMoKSkgb3IgKGxpbmtJZCA9ICdpdGVtNjg2MTMzNjcnIGFuZCBhbnN3ZXIuZXhpc3RzKCkpKSAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdwcm9iJyAlfXslIGlmIGN1cnJlbnRJdGVtLmFuc3dlci5leGlzdHMoKSAlfUN1cnJlbnQgUHJvYmxlbXM6IHslIGZvciBhbnN3ZXIgaW4gY3VycmVudEl0ZW0uYW5zd2VyICV9e3sgYW5zd2VyLnZhbHVlIH19eyUgZW5kZm9yICV9eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtMTk1MzI0NzUnICV9eyUgaWYgY3VycmVudEl0ZW0uYW5zd2VyLmV4aXN0cygpICV9QWxsZXJnaWVzOiB7JSBmb3IgYW5zd2VyIGluIGN1cnJlbnRJdGVtLmFuc3dlciAlfXt7IGFuc3dlci52YWx1ZSB9fXslIGVuZGZvciAlfXslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAncngnICV9eyUgaWYgY3VycmVudEl0ZW0uYW5zd2VyLmV4aXN0cygpICV9Q3VycmVudCBNZWRpY2F0aW9uczogeyUgZm9yIGFuc3dlciBpbiBjdXJyZW50SXRlbS5hbnN3ZXIgJX17eyBhbnN3ZXIudmFsdWUgfX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ3BtaHgnICV9eyUgaWYgY3VycmVudEl0ZW0uYW5zd2VyLmV4aXN0cygpICV9UGFzdCBNZWRpY2FsIEhpc3Rvcnk6IHslIGZvciBhbnN3ZXIgaW4gY3VycmVudEl0ZW0uYW5zd2VyICV9e3sgYW5zd2VyLnZhbHVlIH19eyUgZW5kZm9yICV9eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdpdGVtNjg2MTMzNjcnICV9eyUgaWYgY3VycmVudEl0ZW0uYW5zd2VyLmV4aXN0cygpICV9RmFtaWx5IEhpc3Rvcnk6IHslIGZvciBhbnN3ZXIgaW4gY3VycmVudEl0ZW0uYW5zd2VyICV9e3sgYW5zd2VyLnZhbHVlIH19eyUgZW5kZm9yICV9eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGlmIGZvcmxvb3AubGFzdC5ub3QoKSAlfXslIGlmIGZvcmxvb3AubmV4dGl0ZW0gJX08YnIvPnslIGVsc2UgJX08YnIvPnslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGlmIGZvcmxvb3AubGFzdC5ub3QoKSAlfXslIGlmIGZvcmxvb3AubmV4dGl0ZW0gJX08YnIvPnslIGVsc2UgJX08YnIvPnslIGVuZGlmICV9eyUgZW5kaWYgJX17JSBlbmRmb3IgJX08YnIvPjxzcGFuLz57JSBlbmRpZiAlfXslIGlmIGN1cnJlbnRJdGVtLmxpbmtJZCA9ICdzZWN0aW9uNTU0ODkxMjQnICV9QWRkaXRpb25hbCBJbmZvcm1hdGlvbiAvIENvbW1lbnRzOiB7JSBmb3IgY3VycmVudEl0ZW0gaW4gY3VycmVudEl0ZW0uaXRlbS53aGVyZSgobGlua0lkID0gJ2l0ZW0zNTc1Mjc2NicgYW5kIGFuc3dlci5leGlzdHMoKSkpICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ2l0ZW0zNTc1Mjc2NicgJX17JSBpZiBjdXJyZW50SXRlbS5hbnN3ZXIuZXhpc3RzKCkgJX0geyUgZm9yIGFuc3dlciBpbiBjdXJyZW50SXRlbS5hbnN3ZXIgJX17eyBhbnN3ZXIudmFsdWUgfX17JSBlbmRmb3IgJX17JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgaWYgZm9ybG9vcC5sYXN0Lm5vdCgpICV9eyUgaWYgZm9ybG9vcC5uZXh0aXRlbSAlfTxici8+eyUgZWxzZSAlfTxici8+eyUgZW5kaWYgJX17JSBlbmRpZiAlfXslIGVuZGZvciAlfTxici8+PHNwYW4vPnslIGVuZGlmICV9eyUgaWYgY3VycmVudEl0ZW0ubGlua0lkID0gJ3NlY3Rpb243OTExOTE0OCcgJX1TdXBwb3J0aW5nIERvY3VtZW50YXRpb248YnIvPiB7JSBmb3IgY3VycmVudEl0ZW0gaW4gY3VycmVudEl0ZW0uaXRlbS53aGVyZSgobGlua0lkID0gJ2l0ZW04OTM5NTE5NycgYW5kIGFuc3dlci5leGlzdHModmFsdWUub2ZUeXBlKGJvb2xlYW4pPXRydWUpKSkgJX17JSBpZiBjdXJyZW50SXRlbS5saW5rSWQgPSAnaXRlbTg5Mzk1MTk3JyAlfUxhYiByZXBvcnQgaW5jbHVkaW5nIDxiPjxzcGFuIHN0eWxlPSJ0ZXh0LWRlY29yYXRpb246dW5kZXJsaW5lOyI+QTFDPC9zcGFuPjwvYj4gY29tcGxldGVkIHdpdGhpbiB0aGUgbGFzdCAzLTYgbW9udGhzLCBhbmQgPGI+PHNwYW4gc3R5bGU9InRleHQtZGVjb3JhdGlvbjp1bmRlcmxpbmU7Ij5sYXRlc3QgbGlwaWQgcHJvZmlsZSwgcmVuYWwgZnVuY3Rpb24gYW5kIEFDUjwvc3Bhbj48L2I+IGF0dGFjaGVkeyUgZW5kaWYgJX17JSBpZiBmb3Jsb29wLmxhc3Qubm90KCkgJX17JSBpZiBmb3Jsb29wLm5leHRpdGVtICV9PGJyLz57JSBlbHNlICV9PGJyLz57JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgZW5kZm9yICV9eyUgZW5kaWYgJX17JSBpZiBmb3Jsb29wLmxhc3Qubm90KCkgJX17JSBpZiBmb3Jsb29wLm5leHRpdGVtICV9PGJyLz57JSBlbHNlICV9PGJyLz57JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgZW5kZm9yICV9eyUgZW5kaWYgJX17JSBpZiBmb3Jsb29wLmxhc3Qubm90KCkgJX17JSBpZiBmb3Jsb29wLm5leHRpdGVtICV9PGJyLz57JSBlbHNlICV9PGJyLz57JSBlbmRpZiAlfXslIGVuZGlmICV9eyUgZW5kZm9yICV9PC9kaXY+"
}
]
}
],
"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://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext",
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "patient"
}
},
{
"url": "type",
"valueCode": "Patient"
}
]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "query-ips",
"language": "application/x-fhir-query",
"expression": "Bundle?composition.patient={{%patient.id}}&composition.code=http%3A//loinc.org|60591-5&composition.status=final,ammended&_sort=-composition.date&_count=1"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "var-ptCpp.allg",
"language": "text/fhirpath",
"expression": "%`query-ips`.entry.resource.first().section.where(code.coding.exists(code='http%3A//loinc.org' and code='48765-2')).text.div"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "var-ptCpp.pmhx",
"language": "text/fhirpath",
"expression": "%`query-ips`.entry.resource.first().section.where(code.coding.exists(code='http%3A//loinc.org' and code='47519-4')).text.div"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "var-ptLanguage",
"language": "text/fhirpath",
"expression": "%patient.communication.where(preferred='true').language.select(text | coding.display).first()"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "var-ptCpp.prob",
"language": "text/fhirpath",
"expression": "%`query-ips`.entry.resource.first().section.where(code.coding.exists(code='http%3A//loinc.org' and code='11450-4')).text.div"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
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"language": "text/fhirpath",
"expression": "%`query-ips`.entry.resource.first().section.where(code.coding.exists(code='http%3A//loinc.org' and code='46264-8')).text.div"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
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"language": "application/x-fhir-query",
"expression": "Observation?patient={{%patient.id}}&code=http%3A//loinc.org|10157-6&status=final,ammended&_sort=-date&_count=1"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
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"language": "text/fhirpath",
"expression": "%`query-ptCpp.fhx`.entry.resource.ofType(Observation).first().value"
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/sdc-responseRenderingLiquid",
"valueReference": {
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}
}
],
"url": "http://ontariohealth.ca/legacy/Questionnaire/carefirst-family-hea",
"version": "0",
"title": "Carefirst Family Health Team Diabetes Education Program (DEP) eReferral Form [FINAL SEPT 2022]",
"status": "active",
"experimental": false,
"subjectType": [
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],
"useContext": [
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},
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}
}
],
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{
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "background-color:grey;"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
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"url": "style",
"valueString": "font-weight:bold;"
}
]
}
],
"linkId": "questionnaire",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/translation",
"extension": [
{
"url": "lang",
"valueCode": "fr"
},
{
"url": "content",
"valueString": "Community Diabetes Education Programs of Ottawa Referral Form"
}
]
}
]
},
"type": "group",
"item": [
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "text",
"valueString": "* indicates required field"
},
{
"url": "style",
"valueString": "font-style:italic;"
}
]
}
],
"linkId": "item84851356",
"text": "* Indicates required field",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/translation",
"extension": [
{
"url": "lang",
"valueCode": "fr"
},
{
"url": "content",
"valueString": "* indicates required field",
"_valueString": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "* indicates required field"
}
]
}
}
]
},
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "font-weight:bold;font-style:italic;"
}
]
},
"type": "display"
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "background-color:white;border-style:solid;"
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info",
"extension": [
{
"url": "style",
"valueString": "font-weight:bold;text-decoration:underline;"
}
]
}
],
"linkId": "section54392738",
"text": "Additional Patient Information",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
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{
"system": "http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls",
"code": "push-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%`var-ptLanguage`"
}
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info",
"extension": [
{
"url": "text",
"valueString": "Language: {{answer}}"
}
]
}
],
"linkId": "ax_language",
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"_text": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "Language <i>(select all that apply)</i>:"
}
]
},
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/carefirst-family-hea_ax_language",
"code": "English",
"display": "English"
}
},
{
"valueCoding": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 2
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/carefirst-family-hea_ax_language",
"code": "Cantonese",
"display": "Cantonese"
}
},
{
"valueCoding": {
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{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 3
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/carefirst-family-hea_ax_language",
"code": "Mandarin",
"display": "Mandarin"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "vertical"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls",
"code": "push-button"
}
]
}
}
],
"linkId": "item66127845",
"text": "Preferred Site:",
"type": "choice",
"repeats": false,
"answerOption": [
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 1
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/carefirst-family-hea_item66127845",
"code": "No Preference",
"display": "No Preference"
},
"initialSelected": true
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 2
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/carefirst-family-hea_item66127845",
"code": "Richmond Hill",
"display": "Richmond Hill"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/itemWeight",
"valueDecimal": 3
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/carefirst-family-hea_item66127845",
"code": "Scarborough",
"display": "Scarborough"
}
}
]
},
{
"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": "#blank_line#"
}
]
}
],
"linkId": "item64299713",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-style",
"valueString": "background-color:white;border-style:solid;"
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{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
},
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "enableWhenExpression",
"valueExpression": {
"description": "false",
"language": "text/fhirpath",
"expression": "false"
}
},
{
"url": "text",
"valueString": "ax_diagnosis: {{answer}}"
}
]
}
],
"linkId": "ax_diagnosis",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"description": "(function() {; var descs = \"\"; if (diabetesType.r == 'Pre-Diabetes') {descs+='Pre-Diabetes';} if (diabetesType.r == 'Type 2 Diabetes') {descs+='Type 2 Diabetes';} if (diabetesType.r == 'At Risk') {descs+='At Risk for Diabetes';} return descs.substring(0, (descs.length-0)); })()",
"language": "text/fhirpath",
"expression": "(iif(%resource.repeat(item).where(linkId='diabetesType').answer.exists(value = 'Pre-Diabetes'),'Pre-Diabetes') | iif(%resource.repeat(item).where(linkId='diabetesType').answer.exists(value = 'Type 2 Diabetes'),'Type 2 Diabetes') | iif(%resource.repeat(item).where(linkId='diabetesType').answer.exists(value = 'At Risk'),'At Risk for Diabetes')).aggregate($total & $this, '')"
}
}
]
},
"type": "display"
},
{
"extension": [
{
"url": "http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info",
"extension": [
{
"url": "enableWhenExpression",
"valueExpression": {
"description": "false",
"language": "text/fhirpath",
"expression": "false"
}
}
]
}
],
"linkId": "ax_reasonForReferral",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-expression",
"valueExpression": {
"description": "(function() {; var descs = \"\"; if (item76597097.r == 'Y' || item84430472.r == 'Y') {descs+='Diabetes Education' + '; ';} if (item93032788.p) {descs+='Diabetes Foot Care' + '; ';} if (item90036939.p || item88820032.p || item93616553.p || item91333221.p) {descs+='Diabetes Medication Initiation/Review' + '; ';} if (item61998839.p) {descs+='Social Worker' + '; ';} if (item4180826.p) {descs+='Endocrinologist Consult' + '; ';} return descs.substring(0, (descs.length-2)); })()",
"language": "text/fhirpath",
"expression": "(iif(%resource.repeat(item).where(linkId='item76597097').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item84430472').answer.exists(value = 'Y'),'Diabetes Education' + '; ') | iif(%resource.repeat(item).where(linkId='item93032788').answer.iif(value=true, 1, 0),'Diabetes Foot Care' + '; ') | iif(%resource.repeat(item).where(linkId='item90036939').answer.iif(value=true, 1, 0) or %resource.repeat(item).where(linkId='item88820032').answer.iif(value=true, 1, 0) or %resource.repeat(item).where(linkId='item93616553').answer.iif(value=true, 1, 0) or %resource.repeat(item).where(linkId='item91333221').answer.iif(value=true, 1, 0),'Diabetes Medication Initiation/Review' + '; ') | iif(%resource.repeat(item).where(linkId='item61998839').answer.iif(value=true, 1, 0),'Social Worker' + '; ') | iif(%resource.repeat(item).where(linkId='item4180826').answer.iif(value=true, 1, 0),'Endocrinologist Consult' + '; ')).aggregate($total & $this, '')"
}
}
]
},
"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": "enableWhenExpression",
"valueExpression": {
"description": "false",
"language": "text/fhirpath",
"expression": "false"
}
},
{
"url": "text",
"valueString": "ax_diagnosis: {{answer}}"
}
]
}
],
"linkId": "ax_bodySite",
"text": "Pancreas",
"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": "enableWhenExpression",
"valueExpression": {
"description": "false",
"language": "text/fhirpath",
"expression": "false"
}
}
]
}
],
"linkId": "ax_v_bp",
"text": "Carefirst Family Health Team Diabetes Education Program (DEP) eReferral Form [FINAL SEPT 2022]; 2022.09.30",
"type": "display"
}
]
}
]
}
]
}