FHIR IG analytics| Package | fhir.nwgenomics.nhs.uk |
| Resource Type | Questionnaire |
| Id | Questionnaire-CancerTestAdditionalAskAtOrderQuestions.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/nw-gmsa/nw-gmsa.github.com/Questionnaire-CancerTestAdditionalAskAtOrderQuestions.html |
| URL | https://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions |
| Version | 2.2.0 |
| Status | draft |
| Date | 2026-09-27T08:17:18+00:00 |
| Title | Cancer Test Additional Ask At Order Entry Questions |
| Realm | us |
| Authority | hl7 |
| Description | **This Questionnaire is a proposal, not an active or planned project.** **Test Specific Additional Ask At Order Entry Questions** for Cancer orders - used *alongside* the [common core order form](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry Questions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the same "Test Specific" tier pattern [WGS Test Additional Ask At Order Entry Questions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already follows for WGS orders - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). Its content is **inferred**, not yet confirmed against a live order-entry screen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below is a concept that recurs independently across the two Cancer-category NW GLH paper forms - [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national form) - see [NW GLH Paper Test Request Forms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms). Neither of those two Questionnaires has been changed to actually use this one yet - both remain independent, standalone Questionnaires, each already carrying its own copy of the fields proposed here. |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire CancerTestAdditionalAskAtOrderQuestions
Profile: Questionnaire
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | **This Questionnaire is a proposal, not an active or planned project.** **Test Specific Additional Ask At Order Entry Questions** for Cancer orders - used *alongside* the [common core order form](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry Questions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the same "Test Specific" tier pattern [WGS Test Additional Ask At Order Entry Questions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already follows for WGS orders - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). Its content is **inferred**, not yet confirmed against a live order-entry screen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below is a concept that recurs independently across the two Cancer-category NW GLH paper forms - [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national form) - see [NW GLH Paper Test Request Forms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms). Neither of those two Questionnaires has been changed to actually use this one yet - both remain independent, standalone Questionnaires, each already carrying its own copy of the fields proposed here. | Questionnaire | https://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions#2.2.0 | |
  AskAtOrderEntry | Ask At Order Entry Questions | 0..1 | group | |
   NOS/PresentationStatus | Presentation status | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 3 options |
  NOS/PresentationStatus-designNote | Inferred from [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own `NOS/PresentationStatus` item. Generalises the same distinction [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) makes via its own `Pathway` choice (HRD test = newly diagnosed, Tumour BRCA-only = relapsed) plus separate `NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation` booleans - that form conflates presentation status with test selection itself, since the pathway and the presentation are the same choice on that specific form; here they are kept separate, as GMS WGS Cancer already does. | 0..1 | display | |
 NOS/NeoplasticCellContent | Neoplastic/malignant cell content (%) | 0..1 | quantity | Definition: Observation.valueQuantity |
| NOS/NeoplasticCellContent-designNote | The same underlying concept is independently modelled three times today, each under its own linkId despite sharing this same `NWGMSA` code: [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s `NOS/NeoplasticCellContent` ("Approximate % neoplastic nuclei in tumour area highlighted"), [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s `NOS/NeoplasticCellContent-gms` ("% Malignant nuclei / blasts (or equivalent)"), and [WGS Local Test Order](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own `NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared field this tier is for, rather than each Cancer-adjacent form continuing to reinvent its own suffixed linkId for the same value. | 0..1 | display | |
 NOS/PathologistName | Pathologist | 0..1 | string | Definition: Observation.valueString |
| NOS/PathologistName-designNote | Present as its own named field on [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask for the pathologist by name, only a Histopathology Lab ID (see `Pathology hospital / laboratory` below) - proposed here as a genuinely Cancer-wide concept even though only one of the two source forms currently asks for it. | 0..1 | display | |
| NOS/PathologyHospital | Pathology hospital / laboratory | 0..1 | string | Definition: Observation.valueString |
| NOS/PathologyHospital-designNote | Generalises [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own `NOS/PathologyHospital` and [GMS WGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s `NOS/HistopathologyLabID` ("Histopathology Lab ID", under that form's own Solid tumour sub-group) - both identify where the pathology specimen/report the order relies on came from, just at different granularity (a named hospital vs. a lab identifier). Kept as free text pending a decision on whether an [Organisation Code](StructureDefinition-OrganisationCode.html) reference would be more appropriate. | 0..1 | display | |
| NOS/PathologyHospital-futureQueryAccess | This item, and Pathologist above, most directly relate to the [Cheshire and Merseyside Pathology](CheshireAndMerseysidePathology.html) reflex use case, where a genomic order follows on from a prior pathology order/report (`LAB-1`/`LAB-3`) rather than starting the clinical episode itself. That page's own [Current Process](CheshireAndMerseysidePathology.html#current-process) still models the pathology-to-genomics handoff entirely as HL7 v2/FHIR messaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's answer is free text naming the pathologist/hospital rather than a machine-resolvable reference. A query-based alternative may remove the need to duplicate pathology content into the genomic order/message at all: some NW pathology LIMS deployments (e.g. Medicus) already support the Australian [AU eReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand query access to pathology orders (and potentially reports), and MFT separately exposes pathology data through Epic's own [FHIR Query API](https://fhir.epic.com/). If a genomics laboratory can query pathology directly, these two free-text fields could be replaced by a **reference** instead - the Pathology Order Filler Number, Pathology Patient Identifier and/or Pathology Specimen Identifier - letting the genomic order carry a pointer for on-demand lookup rather than the pathology detail itself. | 0..1 | display | |
| Documentation for this format | ||||
Options Sets
Answer options for NOS/PresentationStatus
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "CancerTestAdditionalAskAtOrderQuestions",
"meta": {
"profile": [
"https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
"valueCoding": {
"system": "http://hl7.org/fhir/version-algorithm",
"code": "semver"
}
}
],
"url": "https://fhir.nwgenomics.nhs.uk/Questionnaire/CancerTestAdditionalAskAtOrderQuestions",
"version": "2.2.0",
"title": "Cancer Test Additional Ask At Order Entry Questions",
"derivedFrom": [
"https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder"
],
"_derivedFrom": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType",
"valueCoding": {
"system": "http://hl7.org/fhir/questionnaire-derivationType",
"code": "extends"
}
}
]
}
],
"status": "draft",
"date": "2026-09-27T08:17:18+00:00",
"publisher": "NHS North West Genomics",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "https://www.nwgenomics.nhs.uk/contact-us"
}
]
}
],
"description": "**This Questionnaire is a proposal, not an active or planned project.**\n\n**Test Specific Additional Ask At Order Entry Questions** for Cancer\norders - used *alongside* the [common core order\nform](Questionnaire-GenomicTestOrder.html) **and** [Ask At Order Entry\nQuestions Common](Questionnaire-GenomicGeneralAskAtOrderEntry.html), the\nsame \"Test Specific\" tier pattern [WGS Test Additional Ask At Order Entry\nQuestions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) already\nfollows for WGS orders - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions).\n\nIts content is **inferred**, not yet confirmed against a live order-entry\nscreen the way `WGSTestAdditionalAskAtOrderQuestions` was: each item below\nis a concept that recurs independently across the two Cancer-category NW\nGLH paper forms - [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) (GB-27189) and [GMS\nWGS Cancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) (the national\nform) - see [NW GLH Paper Test Request\nForms](Questionnaire-GenomicTestOrder.html#nw-glh-paper-test-request-forms).\nNeither of those two Questionnaires has been changed to actually use this\none yet - both remain independent, standalone Questionnaires, each already\ncarrying its own copy of the fields proposed here.",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "GB",
"display": "United Kingdom of Great Britain and Northern Ireland"
}
]
}
],
"item": [
{
"linkId": "AskAtOrderEntry",
"text": "Ask At Order Entry Questions",
"type": "group",
"item": [
{
"linkId": "NOS/PresentationStatus",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept",
"text": "Presentation status",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "PresentationFirstDiagnosis"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "PresentationRecurrenceRelapse"
}
},
{
"valueCoding": {
"system": "http://loinc.org",
"code": "LA4489-6",
"display": "Unknown"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help"
}
]
}
}
],
"linkId": "NOS/PresentationStatus-designNote",
"text": "Inferred from [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s own\n`NOS/PresentationStatus` item. Generalises the same distinction [HRD\nand Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)\nmakes via its own `Pathway` choice (HRD test = newly diagnosed,\nTumour BRCA-only = relapsed) plus separate\n`NewlyDiagnosedAdvancedDiseaseConfirmation`/`RelapsedDiseaseConfirmation`\nbooleans - that form conflates presentation status with test\nselection itself, since the pathway and the presentation are the same\nchoice on that specific form; here they are kept separate, as GMS WGS\nCancer already does.",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "%",
"display": "%"
}
}
],
"linkId": "NOS/NeoplasticCellContent",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity",
"code": [
{
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "NeoplasticCellContent"
}
],
"text": "Neoplastic/malignant cell content (%)",
"type": "quantity",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help"
}
]
}
}
],
"linkId": "NOS/NeoplasticCellContent-designNote",
"text": "The same underlying concept is independently modelled three times\ntoday, each under its own linkId despite sharing this same\n`NWGMSA` code: [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent` (\"Approximate % neoplastic nuclei in\ntumour area highlighted\"), [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/NeoplasticCellContent-gms` (\"% Malignant nuclei / blasts (or\nequivalent)\"), and [WGS Local Test\nOrder](Questionnaire-WGSLocalTestOrderAskAtOrderEntry.html)'s own\n`NOS/NeoplasticCellContent-wgs`. Proposed here as the single shared\nfield this tier is for, rather than each Cancer-adjacent form\ncontinuing to reinvent its own suffixed linkId for the same value.",
"type": "display"
}
]
},
{
"linkId": "NOS/PathologistName",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"code": [
{
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "PathologistName"
}
],
"text": "Pathologist",
"type": "string",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help"
}
]
}
}
],
"linkId": "NOS/PathologistName-designNote",
"text": "Present as its own named field on [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html). [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html) doesn't ask\nfor the pathologist by name, only a Histopathology Lab ID (see\n`Pathology hospital / laboratory` below) - proposed here as a\ngenuinely Cancer-wide concept even though only one of the two source\nforms currently asks for it.",
"type": "display"
}
]
},
{
"linkId": "NOS/PathologyHospital",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"code": [
{
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "PathologyHospital"
}
],
"text": "Pathology hospital / laboratory",
"type": "string",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help"
}
]
}
}
],
"linkId": "NOS/PathologyHospital-designNote",
"text": "Generalises [HRD and Tumour\nBRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html)'s own\n`NOS/PathologyHospital` and [GMS WGS\nCancer](Questionnaire-GMSWGSCancerAskAtOrderEntry.html)'s\n`NOS/HistopathologyLabID` (\"Histopathology Lab ID\", under that form's\nown Solid tumour sub-group) - both identify where the pathology\nspecimen/report the order relies on came from, just at different\ngranularity (a named hospital vs. a lab identifier). Kept as free\ntext pending a decision on whether an\n[Organisation Code](StructureDefinition-OrganisationCode.html)\nreference would be more appropriate.",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help"
}
]
}
}
],
"linkId": "NOS/PathologyHospital-futureQueryAccess",
"text": "This item, and Pathologist above, most directly relate to the\n[Cheshire and Merseyside\nPathology](CheshireAndMerseysidePathology.html) reflex use case, where\na genomic order follows on from a prior pathology order/report\n(`LAB-1`/`LAB-3`) rather than starting the clinical episode itself.\nThat page's own [Current\nProcess](CheshireAndMerseysidePathology.html#current-process) still\nmodels the pathology-to-genomics handoff entirely as HL7 v2/FHIR\nmessaging (`LAB-1`/`LAB-35`/`LAB-3`/`LAB-36`), which is why today's\nanswer is free text naming the pathologist/hospital rather than a\nmachine-resolvable reference.\n\nA query-based alternative may remove the need to duplicate pathology\ncontent into the genomic order/message at all: some NW pathology LIMS\ndeployments (e.g. Medicus) already support the Australian [AU\neReq](https://hl7.org.au/fhir/ereq/index.html) FHIR IG for on-demand\nquery access to pathology orders (and potentially reports), and MFT\nseparately exposes pathology data through Epic's own [FHIR Query\nAPI](https://fhir.epic.com/). If a genomics laboratory can query\npathology directly, these two free-text fields could be replaced by a\n**reference** instead - the Pathology Order Filler Number, Pathology\nPatient Identifier and/or Pathology Specimen Identifier - letting the\ngenomic order carry a pointer for on-demand lookup rather than the\npathology detail itself.",
"type": "display"
}
]
}
]
}
]
}