FHIR IG analytics| Package | fhir.nwgenomics.nhs.uk |
| Resource Type | Questionnaire |
| Id | Questionnaire-DeafnessR67AskAtOrderEntry.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/nw-gmsa/nw-gmsa.github.com/Questionnaire-DeafnessR67AskAtOrderEntry.html |
| URL | https://fhir.nwgenomics.nhs.uk/Questionnaire/DeafnessR67AskAtOrderEntry |
| Version | 2.2.0 |
| Status | unknown |
| Date | 2026-09-27T08:17:18+00:00 |
| Title | Deafness (R67) Ask At Order Entry Questions |
| Realm | us |
| Authority | hl7 |
| Description | **For analysis purposes only - not an active or planned project.** **Ask At Order Entry Questions** for the **Deafness Testing Proforma (R67 Non-Syndromic Hearing Loss)**, used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). The test code (R67) is fixed by the choice of form rather than entered - the proforma instead exists to capture the clinical detail (audiogram, syndromic features, risk factors) that supports the R67 eligibility criteria. |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire DeafnessR67AskAtOrderEntry
Profile: Questionnaire
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | **For analysis purposes only - not an active or planned project.** **Ask At Order Entry Questions** for the **Deafness Testing Proforma (R67 Non-Syndromic Hearing Loss)**, used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). The test code (R67) is fixed by the choice of form rather than entered - the proforma instead exists to capture the clinical detail (audiogram, syndromic features, risk factors) that supports the R67 eligibility criteria. | Questionnaire | https://fhir.nwgenomics.nhs.uk/Questionnaire/DeafnessR67AskAtOrderEntry#2.2.0 | |
  Patient | Patient Details | 0..1 | group | Definition: Patient |
  NOS/PatientName | Name | 0..1 | string | Definition: Patient.name |
  NOS/PatientName-designNote | Single free-text Name field on this form, unlike the Surname/Forename split most other paper forms use. | 0..1 | display | |
 LN/21112-8 | Date of birth | 0..1 | date | Definition: Patient.birthDate |
 LN/46098-0 | Gender | 0..1 | choice | Definition: Patient.gender Value Set: AdministrativeGender |
| LN/56799-0 | Address | 0..1 | string | Definition: Patient.address.line |
| LN/45401-7 | Postcode | 0..1 | string | Definition: Patient.address.postalCode |
| LN/76435-7 | Hospital Number | 0..1 | string | Definition: Patient.identifier:MedicalRecordNumber |
| LN/89061-6 | NHS no | 0..1 | string | Definition: Patient.identifier:nhsNumber |
| HealthcareProfessional | Referring Clinician | 0..1 | group | Definition: PractitionerRole |
| LN/18705-4 | Referring clinician | 0..1 | string | Definition: PractitionerRole.practitioner.display |
| NOS/DepartmentAddress | Address | 0..1 | string | Definition: PractitionerRole.organization.display |
| LN/89058-2 | 0..1 | string | Definition: PractitionerRole.telecom.value | |
| AskAtOrderEntry | Ask At Order Entry Questions | 0..1 | group | |
 NOS/FamilyHistoryPedigree | Family history/pedigree: other affected individuals, parental consanguinity, ethnicity | 0..1 | string | Definition: ServiceRequest.note |
| Audiogram | Audiogram | 0..1 | group | |
| NOS/AudiogramFindings | Audiogram findings (serial if relevant) | 0..1 | string | Definition: Observation.valueString |
 NOS/AudiogramSeverityRight | Severity - right ear | 0..1 | integer | Definition: Observation.valueQuantity |
| NOS/AudiogramSeverityLeft | Severity - left ear | 0..1 | integer | Definition: Observation.valueQuantity |
| NOS/AudiogramProgression | Progression | 0..1 | string | Definition: Observation.valueString |
| NOS/SuspectedSyndromicDiagnosis | Clinically suspected syndromic diagnosis | 0..* | choice | Definition: ServiceRequest.reasonCode Options: 6 options |
| NOS/DeafnessRiskFactors | Risk factors | 0..* | choice | Definition: Observation.valueCodeableConcept Options: 4 options |
 SNM/113091000-mri | MRI performed? | 0..1 | boolean | Definition: Observation.valueBoolean |
| NOS/MRIFindings | MRI findings | 0..1 | string | Definition: Observation.valueString Enable When: SNM/113091000-mri = true |
| Documentation for this format | ||||
Options Sets
Answer options for NOS/SuspectedSyndromicDiagnosis
Answer options for NOS/DeafnessRiskFactors
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "DeafnessR67AskAtOrderEntry",
"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/DeafnessR67AskAtOrderEntry",
"version": "2.2.0",
"title": "Deafness (R67) Ask At Order Entry Questions",
"status": "unknown",
"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": "**For analysis purposes only - not an active or planned project.**\n\n**Ask At Order Entry Questions** for the **Deafness Testing Proforma\n(R67 Non-Syndromic Hearing Loss)**, used alongside the [common core order\nform](Questionnaire-GenomicTestOrder.html) - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions). The\ntest code (R67) is fixed by the choice of form rather than entered - the\nproforma instead exists to capture the clinical detail (audiogram, syndromic\nfeatures, risk factors) that supports the R67 eligibility criteria.",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "GB",
"display": "United Kingdom of Great Britain and Northern Ireland"
}
]
}
],
"item": [
{
"linkId": "Patient",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient",
"text": "Patient Details",
"type": "group",
"item": [
{
"linkId": "NOS/PatientName",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.name",
"text": "Name",
"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/PatientName-designNote",
"text": "Single free-text Name field on this form, unlike the Surname/Forename split most other paper forms use.",
"type": "display"
}
]
},
{
"linkId": "LN/21112-8",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.birthDate",
"code": [
{
"system": "http://loinc.org",
"code": "21112-8"
}
],
"text": "Date of birth",
"type": "date"
},
{
"linkId": "LN/46098-0",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.gender",
"code": [
{
"system": "http://loinc.org",
"code": "46098-0"
}
],
"text": "Gender",
"type": "choice",
"answerValueSet": "http://hl7.org/fhir/ValueSet/administrative-gender"
},
{
"linkId": "LN/56799-0",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.line",
"code": [
{
"system": "http://loinc.org",
"code": "56799-0"
}
],
"text": "Address",
"type": "string"
},
{
"linkId": "LN/45401-7",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.postalCode",
"code": [
{
"system": "http://loinc.org",
"code": "45401-7"
}
],
"text": "Postcode",
"type": "string"
},
{
"linkId": "LN/76435-7",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.identifier:MedicalRecordNumber",
"code": [
{
"system": "http://loinc.org",
"code": "76435-7"
}
],
"text": "Hospital Number",
"type": "string"
},
{
"linkId": "LN/89061-6",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#Patient.identifier:nhsNumber",
"code": [
{
"system": "http://loinc.org",
"code": "89061-6"
}
],
"text": "NHS no",
"type": "string"
}
]
},
{
"linkId": "HealthcareProfessional",
"definition": "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole",
"text": "Referring Clinician",
"type": "group",
"item": [
{
"linkId": "LN/18705-4",
"definition": "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.practitioner.display",
"code": [
{
"system": "http://loinc.org",
"code": "18705-4"
}
],
"text": "Referring clinician",
"type": "string"
},
{
"linkId": "NOS/DepartmentAddress",
"definition": "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.organization.display",
"text": "Address",
"type": "string"
},
{
"linkId": "LN/89058-2",
"definition": "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value",
"code": [
{
"system": "http://loinc.org",
"code": "89058-2",
"display": "Contact email address"
}
],
"text": "Email",
"type": "string"
}
]
},
{
"linkId": "AskAtOrderEntry",
"text": "Ask At Order Entry Questions",
"type": "group",
"item": [
{
"linkId": "NOS/FamilyHistoryPedigree",
"definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.note",
"text": "Family history/pedigree: other affected individuals, parental consanguinity, ethnicity",
"type": "string"
},
{
"linkId": "Audiogram",
"text": "Audiogram",
"type": "group",
"item": [
{
"linkId": "NOS/AudiogramFindings",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"text": "Audiogram findings (serial if relevant)",
"type": "string"
},
{
"linkId": "NOS/AudiogramSeverityRight",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity",
"code": [
{
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "AudiogramSeverityRight"
}
],
"text": "Severity - right ear",
"type": "integer"
},
{
"linkId": "NOS/AudiogramSeverityLeft",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity",
"code": [
{
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "AudiogramSeverityLeft"
}
],
"text": "Severity - left ear",
"type": "integer"
},
{
"linkId": "NOS/AudiogramProgression",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"code": [
{
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "AudiogramProgression"
}
],
"text": "Progression",
"type": "string"
}
]
},
{
"linkId": "NOS/SuspectedSyndromicDiagnosis",
"definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.reasonCode",
"text": "Clinically suspected syndromic diagnosis",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessSyndromePendred"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessSyndromeUsher"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessSyndromeJervellLangeNielsen"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessSyndromeWaardenburg"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessSyndromeBranchioOtoRenal"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessSyndromeWolfram"
}
}
]
},
{
"linkId": "NOS/DeafnessRiskFactors",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept",
"text": "Risk factors",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessRiskFactorPrematurity"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessRiskFactorHyperbilirubinemia"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessRiskFactorProlongedNNUStay"
}
},
{
"valueCoding": {
"system": "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA",
"code": "DeafnessRiskFactorOtotoxicMedication"
}
}
]
},
{
"linkId": "SNM/113091000-mri",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueBoolean",
"code": [
{
"system": "http://snomed.info/sct",
"code": "113091000",
"display": "Magnetic resonance imaging (procedure)"
}
],
"text": "MRI performed?",
"type": "boolean"
},
{
"linkId": "NOS/MRIFindings",
"definition": "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString",
"text": "MRI findings",
"type": "string",
"enableWhen": [
{
"question": "SNM/113091000-mri",
"operator": "=",
"answerBoolean": true
}
]
}
]
}
]
}