FHIR IG analytics| Package | ca.on.oh-eforms |
| Resource Type | QuestionnaireResponse |
| Id | dr_garvey_chilopora_-1.json |
| FHIR Version | R4 |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
FHIR
FHIRsmith{
"resourceType": "QuestionnaireResponse",
"id": "dr-garvey-chilopora-QR",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"questionnaire": "http://ontariohealth.ca/legacy/Questionnaire/dr-garvey-chilopora-|0",
"status": "completed",
"subject": {
"reference": "Patient/pat-53234",
"display": "MOMO ABBAS"
},
"authored": "2026-03-09T16:17:14.658Z",
"author": {
"reference": "Practitioner/smart-Practitioner-71482713",
"type": "Practitioner",
"display": "Susan Clark"
},
"item": [
{
"linkId": "questionnaire",
"item": [
{
"linkId": "section47163071",
"text": "Patient Information",
"item": [
{
"linkId": "item29578021",
"text": "Height (cm):",
"answer": [
{
"valueString": "170"
}
]
},
{
"linkId": "item67890802",
"text": "Weight (kg):",
"answer": [
{
"valueString": "80"
}
]
}
]
},
{
"linkId": "section2763158",
"text": "Referral Information",
"item": [
{
"linkId": "item48807357",
"text": "Reason for Referral:",
"answer": [
{
"valueString": "Some reason"
}
]
},
{
"linkId": "section42000384",
"text": "Pregnancy History",
"item": [
{
"linkId": "item67762889",
"text": "Total number of pregnancies:",
"answer": [
{
"valueInteger": 2
}
]
},
{
"linkId": "item91252875",
"text": "Number of vaginal deliveries:",
"answer": [
{
"valueInteger": 1
}
]
},
{
"linkId": "item47328769",
"text": "Number of C-sections:",
"answer": [
{
"valueInteger": 1
}
]
},
{
"linkId": "item36834119",
"text": "Number of miscarriages/pregnancy losses/ectopic pregnancies:",
"answer": [
{
"valueInteger": 3
}
]
},
{
"linkId": "item29828101",
"text": "Number of abortions/pregnancy terminations:",
"answer": [
{
"valueInteger": 2
}
]
}
]
},
{
"linkId": "section41623208",
"text": "Menstrual History",
"item": [
{
"linkId": "item68062550",
"text": "Date of Last Menstrual Period:",
"answer": [
{
"valueDate": "2025-01-03"
}
]
},
{
"linkId": "item35661442",
"text": "Number of days between periods:",
"answer": [
{
"valueInteger": 32
}
]
},
{
"linkId": "item34464904",
"text": "Number of days period lasts:",
"answer": [
{
"valueInteger": 8
}
]
},
{
"linkId": "item12983596",
"text": "Are patient's periods painful:",
"answer": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
]
},
{
"linkId": "item93188178",
"text": "Are patient's periods heavy:",
"answer": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
]
},
{
"linkId": "item9542494",
"text": "Number of pads/tampons used on the heaviest day of period:",
"answer": [
{
"valueInteger": 3
}
]
}
]
},
{
"linkId": "section87236956",
"text": "Gynecologic History",
"item": [
{
"linkId": "section90671878",
"item": [
{
"linkId": "item27527635",
"text": "None",
"answer": [
{
"valueBoolean": false
}
]
},
{
"linkId": "section95740632",
"item": [
{
"linkId": "item97846576",
"text": "Abnormal pap tests",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item76524094",
"text": "Fibroids",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item62031353",
"text": "Endometriosis",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item78555427",
"text": "Ovarian cysts",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item86136829",
"text": "Sexually transmitted infection(s)",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item50977523",
"text": "Specify:",
"answer": [
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
"code": "Gonorrhea",
"display": "Gonorrhea"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
"code": "Chlamydia",
"display": "Chlamydia"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
"code": "Herpes",
"display": "Herpes"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 4
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
"code": "Genital warts",
"display": "Genital warts"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
"code": "Syphilis",
"display": "Syphilis"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
"code": "Other",
"display": "Other"
}
}
]
}
]
}
]
},
{
"linkId": "item127317",
"text": "Date of last pap test:",
"answer": [
{
"valueDate": "2026-02-28"
}
]
},
{
"linkId": "item54300787",
"text": "Patient is sexually active:",
"answer": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
]
},
{
"linkId": "item96682694",
"text": "With:",
"answer": [
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item96682694",
"code": "Both",
"display": "Both"
}
}
]
},
{
"linkId": "item86913170",
"text": "Form of birth control used:",
"answer": [
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Birth Control pill / patch / ring",
"display": "Birth Control pill / patch / ring"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Condoms",
"display": "Condoms"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "IUD (hormone)",
"display": "IUD (hormone)"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 4
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "IUD (copper)",
"display": "IUD (copper)"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Pull-out/withdrawal",
"display": "Pull-out/withdrawal"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Calendar / Natural Family Planning",
"display": "Calendar / Natural Family Planning"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Partner had vasectomy",
"display": "Partner had vasectomy"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Permanent tubal sugery",
"display": "Permanent tubal sugery"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "Subdermal implant",
"display": "Subdermal implant"
}
},
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
"code": "None",
"display": "None"
}
}
]
}
]
}
]
},
{
"linkId": "section4572141",
"text": "Medical History",
"item": [
{
"linkId": "section61677093",
"item": [
{
"linkId": "item16667176",
"text": "High blood pressure",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item18948376",
"text": "Diabetes",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item35434575",
"text": "Blood clots in lungs/legs",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item69273958",
"text": "Migraine headaches",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item47066864",
"text": "Liver disease/hepatitis",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item75358255",
"text": "Osteoporosis",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item41631847",
"text": "Infertility",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item18292760",
"text": "Cancer",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item66877002",
"text": "Type(s):",
"answer": [
{
"valueString": "Unknown"
}
]
},
{
"linkId": "item77134898",
"text": "Thyroid problems",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item880791",
"text": "Asthma",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item72238932",
"text": "Anxiety/ Depression",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item37884318",
"text": "Incontinence (urine/stool)",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item41904126",
"text": "Constipation",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item51470870",
"text": "Frequent bladder infections",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item15815594",
"text": "Other",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item78475900",
"text": "Specify:",
"answer": [
{
"valueString": "Stuff"
}
]
}
]
}
]
},
{
"linkId": "i_nmedications_n",
"text": "Medications",
"item": [
{
"linkId": "rx",
"answer": [
{
"valueString": "Aspirin"
}
]
}
]
},
{
"linkId": "allergies",
"text": "Allergies",
"item": [
{
"linkId": "allg",
"answer": [
{
"valueString": "Cats"
}
]
}
]
},
{
"linkId": "i_npast_medical_histo",
"text": "Past Medical History",
"item": [
{
"linkId": "pmhx",
"answer": [
{
"valueString": "None"
}
]
}
]
},
{
"linkId": "section68506771",
"text": "Family History",
"item": [
{
"linkId": "section48519309",
"item": [
{
"linkId": "item65894204",
"text": "High blood pressure",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item82516489",
"text": "Heart Disease/Stroke",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item30885585",
"text": "Diabetes",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item4088333",
"text": "Bad reaction to anesthetic",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item37784990",
"text": "Breast Cancer",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item53504294",
"text": "Uterine Cancer",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item4801402",
"text": "Ovarian Cancer",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item75842905",
"text": "Colon/Bowel Cancer",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item22994219",
"text": "Other Cancer(s)",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "item29254997",
"text": "Specify:",
"answer": [
{
"valueString": "Unknown"
}
]
}
]
}
]
},
{
"linkId": "i_nsocial_history_n",
"text": "Social History",
"item": [
{
"linkId": "section64573544",
"item": [
{
"linkId": "item57834583",
"text": "Smoker:",
"answer": [
{
"valueCoding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item57834583",
"code": "Yes",
"display": "Yes"
}
}
]
},
{
"linkId": "item10529961",
"text": "Number of years:",
"answer": [
{
"valueString": "3"
}
]
},
{
"linkId": "item44127211",
"text": "Number of cigarettes per day:",
"answer": [
{
"valueString": "20"
}
]
},
{
"linkId": "item151992",
"text": "Consumes alcohol:",
"answer": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
]
},
{
"linkId": "item94627251",
"text": "Number of drinks per week on average:",
"answer": [
{
"valueString": "2"
}
]
},
{
"linkId": "item93764222",
"text": "Uses recreational and/or street drugs:",
"answer": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
]
},
{
"linkId": "item74607677",
"text": "Specify:",
"answer": [
{
"valueString": "unknown"
}
]
},
{
"linkId": "item33664919",
"text": "Consumes caffeine:",
"answer": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
]
},
{
"linkId": "item45718527",
"text": "Number of cups of coffee/tea/cola per day:",
"answer": [
{
"valueString": "2"
}
]
}
]
}
]
}
]
}
]
}