FHIR IG analytics| Package | ca.on.oh.setp.iar.dev |
| Resource Type | Questionnaire |
| Id | Questionnaire-iar-interrai-chymh-screener-v.1.0.0.json |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=ca.on.oh.setp.iar.dev@1.0.0-ballot1-dev&canonical=http://ontariohealth.ca/fhir/iar/Questionnaire/interrai-child-and-youth-mental-health-screener |
| URL | http://ontariohealth.ca/fhir/iar/Questionnaire/interrai-child-and-youth-mental-health-screener |
| Version | 9.3.0_OH |
| Status | retired |
| Date | 2025-11-21T21:47:22.96+00:00 |
| Title | interRAI™ Child and Youth Mental Health Screener (ChYMH-S) 9.3.0_OH |
| Realm | ca |
| Authority | hl7 |
| Description | interRAI™ Child and Youth Mental Health Screener (ChYMH-S) 9.3.0_OH |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
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"id": "questionnaire-iar-interrai-chymh-screener",
"language": "en",
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{
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"valueCoding": {
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]
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]
},
{
"linkId": "A16b",
"text": "b. Parent lives with child/youth",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "A16b1",
"text": "Parent lives with child/youth - Parent 1",
"prefix": "1",
"answerOption": [
{
"valueCoding": {
"code": "1",
"display": "Yes, 51% of the time or more"
}
},
{
"valueCoding": {
"code": "2",
"display": "Yes, less than or equal to 50% of the time"
}
},
{
"valueCoding": {
"code": "8",
"display": "Not applicable (no second parent/primary caregiver) "
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "A16b2",
"text": "Parent lives with child/youth - Parent 2",
"prefix": "2",
"answerOption": [
{
"valueCoding": {
"code": "1",
"display": "Yes, 51% of the time or more"
}
},
{
"valueCoding": {
"code": "2",
"display": "Yes, less than or equal to 50% of the time"
}
},
{
"valueCoding": {
"code": "8",
"display": "Not applicable (no second parent/primary caregiver) "
}
}
]
}
]
}
]
}
]
},
{
"linkId": "B",
"text": "Section B: Mental State indicators",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section B: Mental State indicators 1</b>"
}
]
},
"item": [
{
"linkId": "Ba",
"text": "1. MENTAL STATE INDICATORS Code for indicators observed in the last 3 days, irrespective of the assumed cause [Note: Whenever possible, ask child / youth]",
"type": "group",
"item": [
{
"linkId": "B1",
"text": "Distraction and Hyperactivity",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1a",
"text": "Impulsive - e.g., running into traffic; takes risky actions without thinking; difficulty taking turns; interrupts",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1b",
"text": "Easily distracted - e.g., episodes of difficulty paying attention; gets sidetracked",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1c",
"text": "Hyperactivity - Excessive level of activity",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1d",
"text": "Disorganization - e.g., problems organizing personal belongings; difficulty adhering to schedule",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "B2",
"text": "Mood Distrubance",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1e",
"text": "Sad, pained, or worried facial expressions - e.g., furrowed brow, constant frowning",
"prefix": "e. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1f",
"text": "Crying, Tearfulness",
"prefix": "f. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1g",
"text": "Made negative statements - e.g., “Nothing matters; No one likes me; I hate my life; Would rather be dead; What’s the use; Let me die”",
"prefix": "g. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1h",
"text": "Self-deprecation - e.g., “I am stupid; I am bad; I can’t do anything right; I am nothing; I am of no use to anyone”",
"prefix": "h. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1i",
"text": "Expressions of guilt or shame - e.g., “I’ve done something awful; This is all my fault; I am a terrible person”",
"prefix": "i. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1j",
"text": "Expressions of hopelessness - e.g., “There’s no hope for the future; Nothing’s going to change for the better”",
"prefix": "j. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1k",
"text": "Irritability-Marked increase in being short-tempered or easily upset",
"prefix": "k. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1l",
"text": "Labile affect-Affect fluctuates frequently with or without an external explanation",
"prefix": "l. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "B3",
"text": "Anxiety",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1m",
"text": "Repetitive anxious complaints/concerns (non-health-related) - e.g., persistently seeks attention/reassurance regarding schedules, school, sports, clothing, relationships",
"prefix": "m. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1n",
"text": "Expressions, including non-verbal, of what appear to be unrealistic fears - e.g., fear of being abandoned, being left alone, being with others; intense fear of specific objects or situations",
"prefix": "n. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1o",
"text": "Obsessive thoughts - Unwanted ideas or thoughts that cannot be eliminated",
"prefix": "o. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1p",
"text": "Compulsive behaviour - e.g., hand washing, repetitive checking of room, counting, hoarding",
"prefix": "p. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1q",
"text": "Intrusive thoughts or flashbacks - Disturbing memories or images that intrude into thoughts, unexpected recall of adverse events",
"prefix": "q. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1r",
"text": "Episodes of panic - Cascade of symptoms of fear, anxiety, loss of control",
"prefix": "r. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1s",
"text": "Nightmares - e.g., reports frightening dreams, wakes from sleep with expressions of fear (including non-verbal)",
"prefix": "s. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1t",
"text": "Hypervigilance - “Jumpiness” or feeling as though in danger",
"prefix": "t. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1u",
"text": "Converses only in specific social situations - e.g., speaks at home but not at school",
"prefix": "u. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "B4",
"text": "Psychosis",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1v",
"text": "Hallucinations - False sensory perception, of any type, with or without insight, without corresponding stimuli (e.g., auditory, visual, tactile, olfactory, gustatory, excluding command hallucinations)",
"prefix": "v. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1w",
"text": "Command hallucinations - Hallucinations directing the child / youth to do something or to act in a particular manner (e.g., to harm self or others)",
"prefix": "w. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1x",
"text": "Delusions - Fixed false beliefs (e.g., grandiose, paranoid, somatic, excluding beliefs specific to child’s / youth’s culture or religion)",
"prefix": "x. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1y",
"text": "Abnormal thought process - e.g., loosening of associations, blocking, fight of ideas, tangentiality, circumstantiality",
"prefix": "y. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "B5",
"text": "Negative Symptoms",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1z",
"text": "Lack of Interest in Social Interaction",
"prefix": "z. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1aa",
"text": "Lack of motivation - Absence of spontaneous goal-directed activity",
"prefix": "aa. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1bb",
"text": "Expressions, including non-verbal, of a lack of pleasure in life (anhedonia) - e.g., “I don’t have fun anymore”; gloomy during favourite activities",
"prefix": "bb. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1cc",
"text": "Withdrawal from activities of interest - e.g., long-standing activities, being with family/friends",
"prefix": "cc. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "B6",
"text": "Other Indicators",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1dd",
"text": "Hygiene - Unusually poor hygiene, unkempt, dishevelled",
"prefix": "dd. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "B1ee",
"text": "Difficulty falling asleep or staying asleep; waking up too early; restlessness; non-restful sleep",
"prefix": "ee. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
}
]
}
]
},
{
"linkId": "C",
"text": "Section C: Substance Use OR Excessive Behaviour",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section C: Substance Use OR Excessive Behaviour</b>"
}
]
},
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "C1",
"text": "Alchohol - Highest number of drinks in any “single sitting” in LAST 14 DAYS",
"prefix": "1. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"code": "1",
"display": "1"
}
},
{
"valueCoding": {
"code": "2",
"display": "2 to 4"
}
},
{
"valueCoding": {
"code": "3",
"display": "5 or more"
}
}
]
},
{
"linkId": "C2",
"text": "2. SUBSTANCE USE IN LAST 14 DAYS",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "C2a",
"text": "Drug use - Includes both illegal and legal (e.g., inhalants) street",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "C2b",
"text": "Intentional misuse of prescription or over-the-counter medication",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "C3",
"text": "ANY INDICATOR OF EATING DISORDER IN LAST 30 DAYS - e.g., binge eating, purging, major restriction of diet",
"prefix": "3. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "C4",
"text": "PROBLEM VIDEO GAMING IN LAST 90 DAYS - Code for disruption caused by child’s / youth’s usual video gaming pattern",
"prefix": "4. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"code": "1",
"display": "Minimal - Video gaming results in disruption of in-person social activities, but completes normal day-to-day activities, attends to paid and unpaid work responsibilities (e.g., competitive employment, school, household chores)."
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate — Video gaming results in reduced attention to personal needs (e.g., hygiene, sleeping, eating); limited in-person social activity outside of video gaming interactions; poor productivity and attendance at work or school."
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe — Video gaming results in inattention to personal needs; negligible participation in in-person social or household activities; not attending work or school, or at serious risk of workplace dismissal or failure at school."
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "C5",
"text": "PROBLEM INTERNET USE IN LAST 90 DAYS - Code for disruption caused by child’s/youth’s usual pattern of Internet use",
"prefix": "5. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"code": "1",
"display": "Minimal — Internet use results in disruption of in-person social activities, but completes normal day-to-day activities, attends to paid and unpaid work responsibilities (e.g., competitive employment, school, household chores)."
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate — Internet use results in reduced attention to personal needs (e.g., hygiene, sleeping, eating); limited inperson social activity outside of online interactions; poor productivity and attendance at work or school."
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe — Internet use results in inattention to personal needs; negligible participation in in-person social or household activities; not attending work or school, or at serious risk of workplace dismissal or failure at school."
}
}
]
}
]
},
{
"linkId": "D",
"text": "Section D: Harm to Self and Others",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section D: Harm to Self and Others</b>"
}
]
},
"item": [
{
"linkId": "D1",
"text": "1. SELF-INJURIOUS IDEATION OR ATTEMPT",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "D1a",
"text": "Considered Performing Self-Injurious Act",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "D1b",
"text": "Most Recent Self-Injurious Attempt",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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]
}
}
],
"linkId": "D2",
"text": "Intent of Any Self-Injurious Attempt Was to Kill Self",
"prefix": "2. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/intent-to-kill-self",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/intent-to-kill-self",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/intent-to-kill-self",
"code": "8",
"display": "No attempt"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
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]
}
}
],
"linkId": "D3",
"text": "Family/Caregiver/Friend/Staff Express Concern Person at Risk for Self-Injury",
"prefix": "3. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"linkId": "D4",
"text": "4. VIOLENCE",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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}
}
],
"linkId": "D4a",
"text": "Violent Ideation - e.g., reports of premeditated thoughts, statements, plans to commit violence",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "D4b",
"text": "Cruelty to animals - Deliberate mistreatment of or physical injury to animals - EXCLUDE BEHAVIOURS THAT ARE CONSISTENT WITH CULTURAL NORMS",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "D4c",
"text": "Intimidation of others or threatened violence - Intentionally makes threatening gestures, verbalizations or stance with no physical contact (e.g., throwing furniture, explicit threats)",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "D4d",
"text": "Violence to Others - Acts with purposeful, malicious, or vicious intent, resulting in physical harm to another (e.g., stabbing, choking, beating)",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
}
]
}
]
},
{
"linkId": "E",
"text": "Section E: Behaviour",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section E: Behaviour</b>"
}
]
},
"item": [
{
"linkId": "E1",
"text": "1. BEHAVIOUR SYMPTOMS",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E1a",
"text": "Verbal abuse - e.g., others were threatened, cursed at",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E1b",
"text": "Physical abuse - e.g., others were hit, shoved, scratched",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E1c",
"text": "Socially inappropriate or disruptive behaviour - e.g., screamed out, smeared or threw food or feces",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E1d",
"text": "Self-injurious behaviour - e.g., bangs head; pinching, biting, scratching, hitting self; pulling own hair",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E1e",
"text": "Destructive behaviour toward property - e.g., throwing or breaking objects, turning over beds or tables, vandalism",
"prefix": "e. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "E2",
"text": "2. CONDUCT PROBLEMS",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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}
}
],
"linkId": "E2a",
"text": "Stealing - e.g., theft from family, shoplifting",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E2b",
"text": "Bullying peers - Pattern of repeated oppression or victimization of others",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "E2c",
"text": "Fire setting or misuse of ignition materials or accelerants",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "E3",
"text": "FAMILY, CAREGIVER, FRIEND, OR STAFF EXPRESS CONCERN ABOUT HIGHLY RISKY OR PROBLEMATIC SEXUAL BEHAVIOUR",
"prefix": "3. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"linkId": "F",
"text": "Section F: Cognitive Communication and Development",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section F: Cognitive Communication and Development</b>"
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]
},
"item": [
{
"type": "choice",
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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]
}
}
],
"linkId": "F1",
"text": "COGNITIVE SKILLS FOR DAILY DECISION MAKING - Making decisions regarding tasks of daily life - e.g., when to get up or have meals, which clothes to wear or activities to do",
"prefix": "1. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Independent"
}
},
{
"valueCoding": {
"code": "1",
"display": "Modified independence"
}
},
{
"valueCoding": {
"code": "2",
"display": "Minimally dependent"
}
},
{
"valueCoding": {
"code": "3",
"display": "Moderately dependent"
}
},
{
"valueCoding": {
"code": "4",
"display": "Severely dependent"
}
},
{
"valueCoding": {
"code": "5",
"display": "No discernable consciousness"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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}
}
],
"linkId": "F2",
"text": "MAKING SELF UNDERSTOOD (Expression) - Expressing information content - both verbal and nonverbal",
"prefix": "2. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Understood- Expresses ideas without difficulty"
}
},
{
"valueCoding": {
"code": "1",
"display": "Any difficulty making self understood"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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]
}
}
],
"linkId": "F3",
"text": "ABILITY TO UNDERSTAND OTHERS (Comprehension) - Understanding verbal information content (however able; with hearing appliance normally used)",
"prefix": "3. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Understands—Clear comprehension"
}
},
{
"valueCoding": {
"code": "1",
"display": "Any difficulty understanding others"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "F4",
"text": "FAMILY, CAREGIVER, OR STAFF EXPRESS CONCERN ABOUT CHILD/YOUTH’S SELF-CARE ABILITY - e.g., how performs daily hygiene routine, feeds self, uses toilet appropriately",
"prefix": "4. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"linkId": "G",
"text": "Section G: Stress, Trauma and Social Relationships",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section G: Stress, Trauma and Social Relationships</b>"
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]
},
"item": [
{
"linkId": "G1",
"text": "1. LIFE EVENTS",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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]
}
}
],
"linkId": "G1a",
"text": "Death or loss of parent or primary caregiver",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G1b",
"text": "Victim of sexual assault or abuse",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G1c",
"text": "Victim of physical assault or abuse",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G1d",
"text": "Victim of emotional abuse",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G1e",
"text": "Victim of bullying",
"prefix": "e. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G1f",
"text": "Witnessed domestic violence",
"prefix": "f. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G1g",
"text": "Parental addiction or substance abuse",
"prefix": "g. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G2",
"text": "DESCRIBES ONE OR MORE OF THESE LIFE EVENTS (ITEM G1) AS INVOKING A SENSE OF HORROR OR INTENSE FEAR",
"prefix": "2. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/no-or-na-could-not-respond",
"code": "0",
"display": "No or not applicable"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/no-or-na-could-not-respond",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Could Not (would Not) respond"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "G3",
"text": "STRONG AND SUPPORTIVE RELATIONSHIP WITH FAMILY",
"prefix": "3. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G4",
"text": "BELIEF THAT PARENT(S) / PRIMARY CAREGIVER(S) ARE NOT ADEQUATELY ENGAGED IN CHILD’S / YOUTH’S LIFE",
"prefix": "4. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Belief not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Only child/youth believes"
}
},
{
"valueCoding": {
"code": "2",
"display": "Family, staff, or others believe"
}
},
{
"valueCoding": {
"code": "3",
"display": "Both child/youth AND others believe"
}
}
]
},
{
"linkId": "G5",
"text": "5. UNSETTLED RELATIONSHIPS",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G5a",
"text": "Conflict with or repeated criticism of family",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G5b",
"text": "Family are persistently hostile or critical of child/youth",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G5c",
"text": "Friends are persistently hostile or critical of child/youth",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G5d",
"text": "Pervasive conflict with peers (exclude close friends)",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G5e",
"text": "Family members report feeling overwhelmed by child/youth’s condition - e.g., severe behaviour problems",
"prefix": "e. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "G5f",
"text": "Parent/primary caregiver is unable or unwilling to continue in caring activities - e.g., decline in the health of the caregiver makes it difficult to continue; lack of desire; competing responsibilities",
"prefix": "f. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "G6",
"text": "PARENT/PRIMARY CAREGIVER HAS CURRENT DEVELOPMENTAL OR MENTAL HEALTH ISSUES",
"prefix": "6. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"linkId": "H",
"text": "Section H: Education",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section H: Education</b>"
}
]
},
"item": [
{
"linkId": "H1",
"text": "1. RISK OF DISRUPTED EDUCATION IN LAST 90 DAYS",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "H1a",
"text": "Increase in lateness or absenteeism",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "H1b",
"text": "Poor productivity or disruptiveness at school",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "H1c",
"text": "Expresses intent to quit school",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "H1d",
"text": "Conflict with school staff - e.g., persistent arguing with teachers; threatening principal",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "H2",
"text": "CHILD/YOUTH CURRENTLY REMOVED FROM SCHOOL DUE TO DISRUPTIVE BEHAVIOUR - e.g., currently suspended or expelled",
"prefix": "2. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"linkId": "I",
"text": "Section I: Summary",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section I: Summary</b>"
}
]
},
"item": [
{
"linkId": "I1",
"text": "1. SUMMARY OF RISK - (See manual for a description of coding guidelines)",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I1a",
"text": "Danger to self",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Minimal"
}
},
{
"valueCoding": {
"code": "1",
"display": "Mild"
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate"
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe"
}
},
{
"valueCoding": {
"code": "4",
"display": "Very severe or imminent"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I1b",
"text": "Danger to others",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Minimal"
}
},
{
"valueCoding": {
"code": "1",
"display": "Mild"
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate"
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe"
}
},
{
"valueCoding": {
"code": "4",
"display": "Very severe or imminent"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I1c",
"text": "Abuse by others",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Minimal"
}
},
{
"valueCoding": {
"code": "1",
"display": "Mild"
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate"
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe"
}
},
{
"valueCoding": {
"code": "4",
"display": "Very severe or imminent"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I1d",
"text": "Family/placement breakdown",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Minimal"
}
},
{
"valueCoding": {
"code": "1",
"display": "Mild"
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate"
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe"
}
},
{
"valueCoding": {
"code": "4",
"display": "Very severe or imminent"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "I2",
"text": "MENTAL HEALTH SERVICES REQUIRED FOR THIS CHILD/ YOUTH",
"prefix": "2. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"linkId": "I3",
"text": "3. URGENCY - Urgency for comprehensive, face-to-face mental health assessment or for initiation of mental health services",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I3a",
"text": "Mental health assessment",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not required"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 14 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "8 to 14 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "4 to 7 days"
}
},
{
"valueCoding": {
"code": "4",
"display": "1 to 3 days"
}
},
{
"valueCoding": {
"code": "5",
"display": "Same day"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I3b",
"text": "Mental health services",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not required"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 14 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "8 to 14 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "4 to 7 days"
}
},
{
"valueCoding": {
"code": "4",
"display": "1 to 3 days"
}
},
{
"valueCoding": {
"code": "5",
"display": "Same day"
}
}
]
}
]
},
{
"linkId": "I4",
"text": "4. SOURCES OF INFORMATION USED TO COMPLETE CHYMH-S",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I4a",
"text": "Client",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not applicable"
}
},
{
"valueCoding": {
"code": "1",
"display": "Primary"
}
},
{
"valueCoding": {
"code": "2",
"display": "Secondary"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I4b",
"text": "Parent / primary caregiver",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not applicable"
}
},
{
"valueCoding": {
"code": "1",
"display": "Primary"
}
},
{
"valueCoding": {
"code": "2",
"display": "Secondary"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I4c",
"text": "Other relative",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not applicable"
}
},
{
"valueCoding": {
"code": "1",
"display": "Primary"
}
},
{
"valueCoding": {
"code": "2",
"display": "Secondary"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I4d",
"text": "Physician",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not applicable"
}
},
{
"valueCoding": {
"code": "1",
"display": "Primary"
}
},
{
"valueCoding": {
"code": "2",
"display": "Secondary"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I4e",
"text": "Staff at School",
"prefix": "e. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not applicable"
}
},
{
"valueCoding": {
"code": "1",
"display": "Primary"
}
},
{
"valueCoding": {
"code": "2",
"display": "Secondary"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "I4f",
"text": "Other",
"prefix": "f. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not applicable"
}
},
{
"valueCoding": {
"code": "1",
"display": "Primary"
}
},
{
"valueCoding": {
"code": "2",
"display": "Secondary"
}
}
]
},
{
"type": "string",
"linkId": "I4f1",
"text": "Other (Specify)",
"prefix": "g. "
}
]
},
{
"linkId": "I5",
"text": "5. TYPE OF COMMUNICATION USED TO COMPLETE ChYMH-S",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "I5a",
"text": "Telephone",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "I5b",
"text": "In person",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "5c",
"text": "Fax / written / e-mail",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
}
]
},
{
"linkId": "J",
"text": "Section J: Assessment Information",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section J: Assessment Information</b>"
}
]
},
"item": [
{
"type": "string",
"linkId": "J1",
"text": "SIGNATURE OF PERSON COORDINATING / COMPLETING THE ASSESSMENT",
"prefix": "1. "
},
{
"type": "date",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "yyyy/MM/dd"
}
],
"linkId": "J2",
"text": "DATE ASSESSMENT SIGNED AS COMPLETE",
"prefix": "2. "
},
{
"type": "date",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "yyyy/MM/dd"
}
],
"linkId": "J3",
"text": "Last Day of Stay",
"prefix": "3. "
}
]
},
{
"linkId": "K",
"text": "Section K Additional Supplementary Items.",
"type": "group",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<b>Section K Additional Supplementary Items.</b>"
}
]
},
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K1",
"text": "FLAT OR BLUNTED AFFECT- Indifference, non-responsiveness, hard to get to smile, etc.",
"prefix": "1. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K2",
"text": "CHANGE IN SEVERITY OR FREQUENCY OF PSYCHIATRIC SYMPTOMS COMPARED TO 30 DAYS AGO, OR SINCE LAST ASSESSMENT IF LESS THAN 30 DAYS AGO",
"prefix": "2. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/degree-of-improvement-one",
"code": "1",
"display": "Deterioration"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/degree-of-improvement-one",
"code": "2",
"display": "No change"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/degree-of-improvement-one",
"code": "3",
"display": "Improvement"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/degree-of-improvement-one",
"code": "4",
"display": "Marked improvement"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K3",
"text": "NUMBER OF DAYS IN LAST 30 DAYS CONSUMED ALCOHOL TO POINT OF INTOXICATION",
"prefix": "3. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"code": "1",
"display": "1 day"
}
},
{
"valueCoding": {
"code": "2",
"display": "2-8 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "9 or more days, but not daily"
}
},
{
"valueCoding": {
"code": "4",
"display": "Daily"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K4",
"text": "SUICIDE PLAN-In LAST 30 DAYS, formulated a scheme to end own life",
"prefix": "4. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K5",
"text": "CHILD/YOUTH HAS CAUSED SERIOUS INJURY TO ANOTHER PERSON IN LAST 90 DAYS - Code for any injury caused by the child/youth that, without appropriate medical care, would result in disfigurement (e.g., large laceration, broken bone, detached retina) or has the potential to be life-threatening (e.g., concussion, major blood loss)",
"prefix": "5. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K6",
"text": "PREOCCUPATION WITH VIOLENCE - e.g., depictions of violence, verbalizations about violence. Code for most recent instance.",
"prefix": "6. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K7",
"text": "CHILD/YOUTH HAS BEEN KNOWN TO CARRY OR USE WEAPON(S) IN THE LAST YEAR",
"prefix": "7. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"linkId": "K8",
"text": "8. BEHAVIOUR SYMPTOMS.",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K8a",
"text": "Regressive behaviour—Child/youth has behaviours that revert back to a previous stage in development (e.g., begins sucking thumb again)",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K8b",
"text": "Resists care—e.g., taking medications/injections, ADL assistance, eating",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K8c",
"text": "Outburst of anger— Intense flare-up of anger in reaction to a specific action or event (e.g., tantrums when told “no”)",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
}
]
},
{
"linkId": "K9",
"text": "9. LIFE EVENTS.",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K9a",
"text": "Serious accident or physical impairment",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K9b",
"text": "Death or loss of other close family member",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K9c",
"text": "Lived in war zone or area of violent conflict (combatant or civilian)",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K9d",
"text": "Witnessed severe accident, disaster, terrorism, violence, or abuse - EXCLUDE DOMESTIC VIOLENCE OR ABUSE",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K9e",
"text": "Victim of crime - EXCLUDE ASSAULT",
"prefix": "e. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K9f",
"text": "Abandoned by parent(s)/primary caregiver(s)",
"prefix": "f. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
}
]
},
{
"linkId": "K10",
"text": "10. OTHER INDICATORS OF ABUSE OF CHILD/YOUTH - Code for any current concerns regarding the following indicators",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K10a",
"text": "Child/youth has concerns for his/her safety",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K10b",
"text": "Family, caregiver, friend, or staff expresses concern that child/youth is at imminent risk for victimization",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"linkId": "K11",
"text": "11. HISTORY OF CARE INCLUDES SEVERE FAILURE TO PROVIDE FOR BASIC NEEDS—Code for child’s/youth’s age at earliest occurrence",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K11a",
"text": "Emotional neglect - e.g., left in crib for prolonged periods",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "1",
"display": "0-4 years"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "2",
"display": "5-11 years"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "3",
"display": "12-18 years"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K11b",
"text": "Physical needs - e.g., inadequate winter clothing",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "1",
"display": "0-4 years"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "2",
"display": "5-11 years"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "3",
"display": "12-18 years"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K11c",
"text": "Safety needs - e.g., child left in car in summer heat",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "1",
"display": "0-4 years"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "2",
"display": "5-11 years"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/time-period-two",
"code": "3",
"display": "12-18 years"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K12",
"text": "STRONG, PERSISTENT DISSATISFACTION WITH SCHOOL",
"prefix": "12. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"code": "1",
"display": "Child/youth only"
}
},
{
"valueCoding": {
"code": "2",
"display": "Parent/primary caregiver only"
}
},
{
"valueCoding": {
"code": "3",
"display": "Both"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K13",
"text": "CHILD/YOUTH CURRENTLY REFUSES TO ATTEND SCHOOL",
"prefix": "13. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "integer",
"linkId": "K14",
"text": "ATTENDANCE IN SCHOOL - Number of days absent from school in LAST 90 DAYS",
"prefix": "14. "
},
{
"linkId": "K15",
"text": "15. PERSISTENT BEHAVIOUR PATTERNS THAT HINDER SOCIALIZATION",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K15a",
"text": "Narrowly restricted range of interest - e.g., constantly talks about trains",
"prefix": "a. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K15b",
"text": "Excessive preoccupation with an activity or routine",
"prefix": "b. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K15c",
"text": "Demonstrates lack of social and emotional conventions when socializing - e.g., lack of eye contact",
"prefix": "c. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
}
],
"linkId": "K15d",
"text": "Extreme shyness - e.g., severe inhibition in familiar social situations",
"prefix": "d. ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
]
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "K16",
"text": "ADAPTABILITY TO CHANGE IN ROUTINE OR ENVIRONMENT",
"prefix": "16. ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Adapts without difficulty"
}
},
{
"valueCoding": {
"code": "1",
"display": "Adapts with some difficulty"
}
},
{
"valueCoding": {
"code": "2",
"display": "Has difficulty adapting to even minor change"
}
}
]
}
]
},
{
"linkId": "outcomes",
"text": "OUTCOMES",
"type": "group",
"item": [
{
"type": "string",
"linkId": "age-at-assessment",
"text": "Age at Assessment (0 - 130) ",
"prefix": " "
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "champs",
"text": "interRAI Children\"s Algorithm for Mental Health and Psychiatric Services (ChAMhPs) ",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "0"
}
},
{
"valueCoding": {
"code": "1",
"display": "1"
}
},
{
"valueCoding": {
"code": "2",
"display": "2"
}
},
{
"valueCoding": {
"code": "3",
"display": "3"
}
},
{
"valueCoding": {
"code": "4",
"display": "4"
}
},
{
"valueCoding": {
"code": "5",
"display": "5"
}
},
{
"valueCoding": {
"code": "6",
"display": "6"
}
}
]
},
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "aggressive-behaviour-scale",
"text": "CY Aggressive Behaviour Scale ",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "No signs of aggression"
}
},
{
"valueCoding": {
"code": "1",
"display": "Mild to moderate aggression"
}
},
{
"valueCoding": {
"code": "2",
"display": "Mild to moderate aggression"
}
},
{
"valueCoding": {
"code": "3",
"display": "Mild to moderate aggression"
}
},
{
"valueCoding": {
"code": "4",
"display": "Mild to moderate aggression"
}
},
{
"valueCoding": {
"code": "5",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "6",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "7",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "8",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "9",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "10",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "11",
"display": "More severe aggression"
}
},
{
"valueCoding": {
"code": "12",
"display": "More severe aggression"
}
}
]
},
{
"type": "integer",
"linkId": "anxiety-scale",
"text": "CY Anxiety Scale ",
"prefix": " "
},
{
"type": "integer",
"linkId": "depressive-severity-index",
"text": "CY Depressive Severity Index ",
"prefix": " "
},
{
"type": "integer",
"linkId": "distractibility-hyperactivity",
"text": "CY Distractibillity/Hyperactivity ",
"prefix": " "
},
{
"type": "integer",
"linkId": "postitive-symptoms-scale",
"text": "CY Positive Symptoms Scale",
"prefix": " "
},
{
"type": "integer",
"linkId": "social-disengagement-scale",
"text": "CY Social Disengagement Scale",
"prefix": " "
}
]
},
{
"linkId": "kinark-risk",
"text": "KINARK RISK",
"type": "group",
"item": [
{
"linkId": "harm-to-others",
"text": "HARM TO OTHERS",
"type": "group",
"item": [
{
"linkId": "harm-to-others.verbal-abuse",
"text": "E1a. Verbal abuse",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.verbal-abuse.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.verbal-abuse.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.physical-abuse",
"text": "E1b. Physical abuse",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.physical-abuse.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.physical-abuse.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.violent-ideation",
"text": "D4a. Violent ideation",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.violent-ideation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.violent-ideation.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.cruelty-to-animals",
"text": "D4b. Cruelty to animals",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.cruelty-to-animals.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.cruelty-to-animals.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.intimidation-to-others-or-threatened-violence",
"text": "D4c. Intimidation to others or threatened violence",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.intimidation-to-others-or-threatened-violence.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.intimidation-to-others-or-threatened-violence.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.violence-to-others",
"text": "D4d. Violence to others",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.violence-to-others.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.violence-to-others.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.serious-injury-to-another-person-last-90-days",
"text": "K5. Child/youth has caused serious injury to another person in last 90 days",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.serious-injury-to-another-person-last-90-days.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.serious-injury-to-another-person-last-90-days.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.preoccupation-with-violence",
"text": "K6. Preoccupation with violence",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.preoccupation-with-violence.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In the last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.preoccupation-with-violence.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-others.carry-or-use-weapons-last-year",
"text": "K7. Child/youth has been known to carry or use weapons in last year",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-others.carry-or-use-weapons-last-year.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-others.carry-or-use-weapons-last-year.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
}
]
},
{
"linkId": "harm-to-self",
"text": "HARM TO SELF",
"type": "group",
"item": [
{
"linkId": "harm-to-self.considered-self-injurious-act",
"text": "D1a. Considered performing a self-injurious act",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-self.considered-self-injurious-act.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-self.considered-self-injurious-act.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-self.most-recent-self-injurious-attempt",
"text": "D1b. Most recent self-injurious attempt",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-self.most-recent-self-injurious-attempt.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-self.most-recent-self-injurious-attempt.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-self.intent-to-kill-self",
"text": "D2. Intent of any self-injurious attempt was to kill self",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-self.intent-to-kill-self.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-intent-to-kill-self",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-intent-to-kill-self",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-intent-to-kill-self",
"code": "8",
"display": "No attempt"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-self.intent-to-kill-self.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-self.suicide-plan",
"text": "K4. Suicide Plan",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-self.suicide-plan.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-self.suicide-plan.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-self.concern-at-risk-for-self-injury",
"text": "D3. Expressed concern child/youth is at risk for self-injury",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-self.concern-at-risk-for-self-injury.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-self.concern-at-risk-for-self-injury.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
}
]
},
{
"linkId": "harm-to-property",
"text": "HARM TO PROPERTY",
"type": "group",
"item": [
{
"linkId": "harm-to-property.destructive-behaviour",
"text": "E1e. Destructive behaviour toward property",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-property.destructive-behaviour.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-property.destructive-behaviour.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "harm-to-property.fire-setting",
"text": "E2c. Fire-setting or misuse of ignition materials or accelerants",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "harm-to-property.fire-setting.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "harm-to-property.fire-setting.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
}
]
},
{
"linkId": "substance-misuse",
"text": "SUBSTANCE MISUSE",
"type": "group",
"item": [
{
"linkId": "substance-misuse.drug-use",
"text": "C2a. Drug use",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "substance-misuse.drug-use.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "substance-misuse.drug-use.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "substance-misuse.intentional-misuse-of-prescription",
"text": "C2b. Intentional misuse of prescription or over-the counter medication",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "substance-misuse.intentional-misuse-of-prescription.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "substance-misuse.intentional-misuse-of-prescription.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "substance-misuse.last-30-days-alcohol-intoxication",
"text": "K3. Number of days in last 30 days consumed alcohol to point of intoxication",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "substance-misuse.last-30-days-alcohol-intoxication.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "None"
}
},
{
"valueCoding": {
"code": "1",
"display": "1 day"
}
},
{
"valueCoding": {
"code": "2",
"display": "2-8 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "9 or more days, but not daily"
}
},
{
"valueCoding": {
"code": "4",
"display": "Daily"
}
}
]
},
{
"type": "string",
"linkId": "substance-misuse.last-30-days-alcohol-intoxication.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
}
]
},
{
"linkId": "victimization-child-protection",
"text": "VICTIMIZATION / CHILD PROTECTION",
"type": "group",
"item": [
{
"linkId": "victimization-child-protection.sexual-assault",
"text": "G1b. Victim of sexual assault or abuse",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "victimization-child-protection.sexual-assault.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "victimization-child-protection.sexual-assault.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "victimization-child-protection.physical-assualt",
"text": "G1c. Victim of physical assault or abuse",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "victimization-child-protection.physical-assualt.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "victimization-child-protection.physical-assualt.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "victimization-child-protection.emotional-abuse",
"text": "G1d. Victim of emotional abuse",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "victimization-child-protection.emotional-abuse.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "victimization-child-protection.emotional-abuse.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "victimization-child-protection.child-youth-concern-safety",
"text": "K10a. Child/youth has concerns for his/her safety",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "victimization-child-protection.child-youth-concern-safety.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "victimization-child-protection.child-youth-concern-safety.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
},
{
"linkId": "victimization-child-protection.imminent-risk-for-victimization",
"text": "K10b. Family, caregiver, friend, or staff expresses concern that the child/youth is at imminent risk for victimization",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "victimization-child-protection.imminent-risk-for-victimization.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "victimization-child-protection.imminent-risk-for-victimization.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
}
]
},
{
"linkId": "family-breakdown",
"text": "FAMILY BREAKDOWN",
"type": "group",
"item": [
{
"linkId": "family-breakdown.summary-of-risk",
"text": "I1d. Summary of Risk: Family / Placement Breakdown",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "family-breakdown.summary-of-risk.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Minimal"
}
},
{
"valueCoding": {
"code": "1",
"display": "Mild"
}
},
{
"valueCoding": {
"code": "2",
"display": "Moderate"
}
},
{
"valueCoding": {
"code": "3",
"display": "Severe"
}
},
{
"valueCoding": {
"code": "4",
"display": "Very severe or imminent"
}
}
]
},
{
"type": "string",
"linkId": "family-breakdown.summary-of-risk.risk-severity",
"text": "Risk severity",
"prefix": " "
}
]
}
]
},
{
"linkId": "case-complexity-focused-acute",
"text": "Case Complexity – Focused – Acute",
"type": "group",
"item": [
{
"linkId": "case-complexity-focused-acute.self-injurious-ideation",
"text": "D1a. Considered performing a self-injurious act",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.self-injurious-ideation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.self-injurious-ideation.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.self-injurious-attempt",
"text": "D1b. Most recent self-injurious attempt",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.self-injurious-attempt.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.self-injurious-attempt.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.intent-to-kill-self",
"text": "D2. Intent of self-injurious attempt was to kill self",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.intent-to-kill-self.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-intent-to-kill-self",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-intent-to-kill-self",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-intent-to-kill-self",
"code": "8",
"display": "No attempt"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.intent-to-kill-self.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.violence-to-others",
"text": "D4d. Violence to others",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.violence-to-others.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.violence-to-others.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.fire-setting",
"text": "E2c. Fire-setting or misuse of ignition materials",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.fire-setting.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.fire-setting.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.risky-sexual-behaviour",
"text": "E3. Concern about highly risky or problematic sexual behaviour",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.risky-sexual-behaviour.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.risky-sexual-behaviour.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.sexual-assault",
"text": "G1b. Victim of sexual assault or abuse",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.sexual-assault.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Never"
}
},
{
"valueCoding": {
"code": "1",
"display": "More than 1 year ago"
}
},
{
"valueCoding": {
"code": "2",
"display": "31 days-1 year ago"
}
},
{
"valueCoding": {
"code": "3",
"display": "8-30 days ago"
}
},
{
"valueCoding": {
"code": "4",
"display": "4-7 days ago"
}
},
{
"valueCoding": {
"code": "5",
"display": "In last 3 days"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.sexual-assault.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.traumatic-life-event",
"text": "G2. Life event invoking horror or intense fear",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.traumatic-life-event.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-no-or-na-could-not-respond",
"code": "0",
"display": "No or not applicable"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-no-or-na-could-not-respond",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Could Not (would Not) respond"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.traumatic-life-event.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.negative-statements",
"text": "B1g. Made negative statements",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.negative-statements.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.negative-statements.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.self-deprecation",
"text": "B1h. Self-deprecation",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.self-deprecation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.self-deprecation.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.guilt-or-shame",
"text": "B1i. Expressions of guilt or shame",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.guilt-or-shame.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.guilt-or-shame.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.hopelessness",
"text": "B1j. Expressions of hopelessness",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.hopelessness.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.hopelessness.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.irritability",
"text": "B1k. Irritability",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.irritability.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.irritability.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.labile-affect",
"text": "B1l. Labile affect",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.labile-affect.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.labile-affect.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.anxious-complaints",
"text": "B1m. Repetitive anxious complaints",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.anxious-complaints.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.anxious-complaints.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.unrealistic-fears",
"text": "B1n. Unrealistic fears",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.unrealistic-fears.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.unrealistic-fears.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.compulsive-behaviour",
"text": "B1p. Compulsive behaviour",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.compulsive-behaviour.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.compulsive-behaviour.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.intrusive-thoughts",
"text": "B1q. Intrusive thoughts or flashbacks",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.intrusive-thoughts.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.intrusive-thoughts.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.panic-episodes",
"text": "B1r. Episodes of panic",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.panic-episodes.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.panic-episodes.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.nightmares",
"text": "B1s. Nightmares",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.nightmares.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.nightmares.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.hypervigilance",
"text": "B1t. Hypervigilance",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.hypervigilance.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.hypervigilance.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.selective-social-conversation",
"text": "B1u. Converses only in specific social situations",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.selective-social-conversation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.selective-social-conversation.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-focused-acute.change-in-psychiatric-symptoms",
"text": "K2. Change in psychiatric symptoms",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-focused-acute.change-in-psychiatric-symptoms.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-degree-of-improvement-one",
"code": "1",
"display": "Deterioration"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-degree-of-improvement-one",
"code": "2",
"display": "No change"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-degree-of-improvement-one",
"code": "3",
"display": "Improvement"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-degree-of-improvement-one",
"code": "4",
"display": "Marked improvement"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-focused-acute.change-in-psychiatric-symptoms.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "case-complexity-specialized",
"text": "Case Complexity – Specialized",
"type": "group",
"item": [
{
"linkId": "case-complexity-specialized.removed-from-school",
"text": "H2. Removed from school due to disruptive behaviour",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-specialized.removed-from-school.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-specialized.removed-from-school.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-specialized.school-dissatisfaction",
"text": "K12. Persistent dissatisfaction with school",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-specialized.school-dissatisfaction.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"code": "1",
"display": "Child/youth only"
}
},
{
"valueCoding": {
"code": "2",
"display": "Parent/primary caregiver only"
}
},
{
"valueCoding": {
"code": "3",
"display": "Both"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-specialized.school-dissatisfaction.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-specialized.school-refusal",
"text": "K13. Refuses to attend school",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "case-complexity-specialized.school-refusal.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "case-complexity-specialized.school-refusal.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "case-complexity-specialized.school-absence",
"text": "K14. Days absent from school (last 90 days)",
"type": "group",
"item": [
{
"type": "string",
"linkId": "case-complexity-specialized.school-absence.field-response",
"text": "Field response",
"prefix": " "
},
{
"type": "string",
"linkId": "case-complexity-specialized.school-absence.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "specialized-grouping-1-school-functioning",
"text": "Specialized – Grouping 1: School Functioning",
"type": "group",
"item": [
{
"linkId": "specialized-grouping-1-school-functioning.lateness-or-absenteeism",
"text": "H1a. Increase in lateness or absenteeism",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-1-school-functioning.lateness-or-absenteeism.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-1-school-functioning.lateness-or-absenteeism.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-1-school-functioning.disruptive-school-behaviour",
"text": "H1b. Poor productivity or disruptiveness at school",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-1-school-functioning.disruptive-school-behaviour.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-1-school-functioning.disruptive-school-behaviour.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-1-school-functioning.intent-to-quit-school",
"text": "H1c. Expresses intent to quit school",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-1-school-functioning.intent-to-quit-school.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-1-school-functioning.intent-to-quit-school.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-1-school-functioning.conflict-with-school-staff",
"text": "H1d. Conflict with school staff",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-1-school-functioning.conflict-with-school-staff.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-1-school-functioning.conflict-with-school-staff.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance",
"text": "Specialized – Grouping 2: Mood Disturbance",
"type": "group",
"item": [
{
"linkId": "specialized-grouping-2-mood-disturbance.sad-or-worried-affect",
"text": "B1e. Sad, pained or worried facial expressions",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.sad-or-worried-affect.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.sad-or-worried-affect.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.crying",
"text": "B1f. Crying, tearfulness",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.crying.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.crying.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.negative-statements",
"text": "B1g. Made negative statements",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.negative-statements.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.negative-statements.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.self-deprecation",
"text": "B1h. Self-deprecation",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.self-deprecation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.self-deprecation.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.guilt-or-shame",
"text": "B1i. Expressions of guilt or shame",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.guilt-or-shame.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.guilt-or-shame.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.hopelessness",
"text": "B1j. Expressions of hopelessness",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.hopelessness.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.hopelessness.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.irritability",
"text": "B1k. Irritability",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.irritability.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.irritability.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-2-mood-disturbance.labile-affect",
"text": "B1l. Labile affect",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-2-mood-disturbance.labile-affect.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-2-mood-disturbance.labile-affect.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "specialized-grouping-3-anxiety",
"text": "Specialized – Grouping 3: Anxiety",
"type": "group",
"item": [
{
"linkId": "specialized-grouping-3-anxiety.anxious-complaints",
"text": "B1m. Repetitive anxious complaints",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.anxious-complaints.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.anxious-complaints.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.unrealistic-fears",
"text": "B1n. Unrealistic fears",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.unrealistic-fears.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.unrealistic-fears.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.obsessive-thoughts",
"text": "B1o. Obsessive thoughts",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.obsessive-thoughts.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.obsessive-thoughts.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.compulsive-behaviour",
"text": "B1p. Compulsive behavior",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.compulsive-behaviour.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.compulsive-behaviour.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.intrusive-thoughts",
"text": "B1q. Intrusive thoughts or flashbacks",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.intrusive-thoughts.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.intrusive-thoughts.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.panic-episodes",
"text": "B1r. Episodes of panic",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.panic-episodes.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.panic-episodes.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.nightmares",
"text": "B1s. Nightmares",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.nightmares.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.nightmares.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.hypervigilance",
"text": "B1t. Hypervigilance",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.hypervigilance.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.hypervigilance.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-3-anxiety.selective-social-conversation",
"text": "B1u. Converses only in specific social situations",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-3-anxiety.selective-social-conversation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-3-anxiety.selective-social-conversation.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "specialized-grouping-4-psychosis",
"text": "Specialized – Grouping 4: Psychosis",
"type": "group",
"item": [
{
"linkId": "specialized-grouping-4-psychosis.hallucinations",
"text": "B1v. Hallucinations",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-4-psychosis.hallucinations.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-4-psychosis.hallucinations.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-4-psychosis.command-hallucinations",
"text": "B1w. Command hallucinations",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-4-psychosis.command-hallucinations.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-4-psychosis.command-hallucinations.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-4-psychosis.delusions",
"text": "B1x. Delusions",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-4-psychosis.delusions.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-4-psychosis.delusions.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-4-psychosis.abnormal-thought-process",
"text": "B1y. Abnormal thought process",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-4-psychosis.abnormal-thought-process.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-4-psychosis.abnormal-thought-process.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "specialized-grouping-5-negative-symptoms",
"text": "Specialized – Grouping 5: Negative Symptoms / Other",
"type": "group",
"item": [
{
"linkId": "specialized-grouping-5-negative-symptoms.social-withdrawal",
"text": "B1z. Lack of interest in social interaction",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-5-negative-symptoms.social-withdrawal.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-5-negative-symptoms.social-withdrawal.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-5-negative-symptoms.lack-of-motivation",
"text": "B1aa. Lack of motivation",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-5-negative-symptoms.lack-of-motivation.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-5-negative-symptoms.lack-of-motivation.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-5-negative-symptoms.anhedonia",
"text": "B1bb. Anhedonia",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-5-negative-symptoms.anhedonia.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-5-negative-symptoms.anhedonia.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-5-negative-symptoms.activity-withdrawal",
"text": "B1cc. Withdrawal from activities of interest",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-5-negative-symptoms.activity-withdrawal.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-5-negative-symptoms.activity-withdrawal.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-5-negative-symptoms.hygiene",
"text": "B1dd. Hygiene",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-5-negative-symptoms.hygiene.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-5-negative-symptoms.hygiene.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-5-negative-symptoms.sleep-disturbance",
"text": "B1ee. Sleep disturbance",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-5-negative-symptoms.sleep-disturbance.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Present but not exhibited in the last 3 days"
}
},
{
"valueCoding": {
"code": "2",
"display": "Exhibited on 1-2 of last 3 days"
}
},
{
"valueCoding": {
"code": "3",
"display": "Exhibited daily in the last 3 days, 1-2 episodes"
}
},
{
"valueCoding": {
"code": "4",
"display": "Exhibited daily in last 3 days, 3 or more episodes or continuously"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-5-negative-symptoms.sleep-disturbance.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
},
{
"linkId": "specialized-grouping-6-relationships",
"text": "Specialized – Grouping 6: Relationships",
"type": "group",
"item": [
{
"linkId": "specialized-grouping-6-relationships.supportive-family",
"text": "G3. Strong supportive relationship with family",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.supportive-family.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.supportive-family.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.caregiver-disengagement",
"text": "G4. Caregiver not adequately engaged",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.caregiver-disengagement.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"code": "0",
"display": "Belief not present"
}
},
{
"valueCoding": {
"code": "1",
"display": "Only child/youth believes"
}
},
{
"valueCoding": {
"code": "2",
"display": "Family, staff, or others believe"
}
},
{
"valueCoding": {
"code": "3",
"display": "Both child/youth AND others believe"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.caregiver-disengagement.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.family-conflict",
"text": "G5a. Conflict with family",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.family-conflict.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.family-conflict.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.family-hostility",
"text": "G5b. Family persistently hostile",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.family-hostility.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.family-hostility.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.peer-hostility",
"text": "G5c. Friends persistently hostile",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.peer-hostility.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.peer-hostility.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.peer-conflict",
"text": "G5d. Pervasive conflict with peers",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.peer-conflict.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.peer-conflict.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.family-overwhelmed",
"text": "G5e. Family overwhelmed",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.family-overwhelmed.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.family-overwhelmed.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
},
{
"linkId": "specialized-grouping-6-relationships.caregiver-unable",
"text": "G5f. Caregiver unable or unwilling to continue caring",
"type": "group",
"item": [
{
"type": "choice",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "specialized-grouping-6-relationships.caregiver-unable.field-response",
"text": "Field response",
"prefix": " ",
"answerOption": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "0",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-yes-no",
"code": "1",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/CodeSystem/iar-not-applicable",
"code": "8",
"display": "Not applicable"
}
}
]
},
{
"type": "string",
"linkId": "specialized-grouping-6-relationships.caregiver-unable.pathway-eligibility",
"text": "If Present, Qualifies for Pathway Eligibility",
"prefix": " "
}
]
}
]
}
]
}
]
}