FHIR IG Statistics: Questionnaire/Gambling-Questionnaire-Template

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{
  "resourceType": "Questionnaire",
  "url": "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-gambling-questionnaire-template",
  "title": "MHA Gambling Questionnaire Template",
  "status": "draft",
  "description": "Sample questionnaire using all questions from the Catalyst Problem Gambling Required Data Form",
  "purpose": "To serve as a model to build required MHA Gambling questionnaires.",
  "item": [
    {
      "linkId": "Q1",
      "text": "Reason for Seeking Help With Gambling Behaviour",
      "type": "choice",
      "required": true,
      "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-help-seeking-reason"
    },
    {
      "linkId": "Q2-Q7",
      "type": "group",
      "enableWhen": [
        {
          "question": "Q1",
          "operator": "=",
          "answerCoding": {
            "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason",
            "code": "1",
            "display": "Related to others gambling problem"
          }
        },
        {
          "question": "Q1",
          "operator": "=",
          "answerCoding": {
            "system": "http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason",
            "code": "2",
            "display": "Both"
          }
        }
      ],
      "enableBehavior": "any",
      "item": [
        {
          "linkId": "Q2",
          "type": "integer",
          "text": "Number of Months Life Negatively Affected by Gambling Behaviour"
        },
        {
          "linkId": "Q3",
          "type": "integer",
          "text": "Length of Time Since Last Gambling Activity (Days)"
        },
        {
          "linkId": "Q4",
          "type": "choice",
          "text": "Sequence of Gambling Problem Identification",
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/sequence-of-gambling-problem"
        },
        {
          "linkId": "Q5",
          "type": "choice",
          "text": "Primary Gambling Activity in the last 12 months",
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year",
          "item": [
            {
              "type": "choice",
              "linkId": "Q5-a",
              "text": "Primary Gambling Activity Frequency in last 12 months",
              "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            },
            {
              "type": "choice",
              "linkId": "Q5-b",
              "text": "Primary Gambling Location in last 12 months",
              "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
            },
            {
              "type": "choice",
              "linkId": "Q5-c",
              "text": "Primary Gambling Location Frequency in last 12 months",
              "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            }
          ]
        },
        {
          "linkId": "Q6",
          "type": "choice",
          "text": "Additional Gambling Activity in the last 12 months",
          "repeats": true,
          "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year",
          "item": [
            {
              "type": "choice",
              "linkId": "Q6-a",
              "text": "Additional Gambling Activity Frequency in last 12 months",
              "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            },
            {
              "type": "choice",
              "linkId": "Q6-b",
              "text": "Additional Gambling Location in last 12 months",
              "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-location"
            },
            {
              "type": "choice",
              "linkId": "Q6-c",
              "text": "Addtional Gambling Location Frequency in last 12 months",
              "answerValueSet": "http://ontariohealth.ca/fhir/ValueSet/gambling-frequency"
            }
          ]
        },
        {
          "linkId": "Q7",
          "type": "group",
          "text": "Percentage of Time Spent Gambling by Jurisdiction",
          "item": [
            {
              "type": "integer",
              "linkId": "Q7_A",
              "text": "Percentage of Time Spent Gambling in Ontario"
            },
            {
              "type": "integer",
              "linkId": "Q7_B",
              "text": "Percentage of Time Spent Gambling in another province"
            },
            {
              "type": "integer",
              "linkId": "Q7_C",
              "text": "Percentage of Time Spent Gambling Outside of Canada"
            }
          ]
        }
      ]
    }
  ]
}