| Package | hl7.fhir.uv.ichom-breast-cancer |
| Resource Type | Questionnaire |
| Id | ClinicalResponseBaseline |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/ichom-breast-cancer/https://build.fhir.org/ig/HL7/fhir-ichom-breast-cancer-ig/Questionnaire-ClinicalResponseBaseline.html |
| URL | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseBaseline |
| Version | 1.0.0 |
| Status | draft |
| Date | 2023-08-21T16:37:24+00:00 |
| Name | ClinicalResponseBaseline |
| Title | Clinical response questionnaire at baseline |
| Realm | uv |
| Authority | hl7 |
| Description | Clinical response questionnaire at baseline (first doctors' visit) |
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Note: links and images are rebased to the (stated) source
| LinkId | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  ClinicalResponseBaseline | Clinical response questionnaire at baseline (first doctors' visit) | Questionnaire | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseBaseline#1.0.0 | ||
  General-Information-Clinical | General information | 1..1 | group | ||
  NA-Clinical | What is the patient's medical record number? | 1..1 | string | Expressions:
| |
 LastName-Clinical | What is the patient's last name? | 1..1 | string | Expressions:
| |
| Demographics | Demographic factors | 1..1 | group | ||
 Sex | Indicate the sex of the patient at birth: | 1..1 | choice | Value Set: AdministrativeGender Expressions:
| |
 YearOfBirth | In what year was the patient born? | 1..1 | integer | Max Length: 4 Expressions:
| |
| Clinical-Factors | Clinical factors | 1..1 | group | ||
 Height | Indicate the patient's body height | 1..1 | quantity |  | |
| Weight | Indicate the patient's weight. | 1..1 | quantity | | |
| LATERAL | Indicate the laterality of breast cancer | 1..1 | choice | Value Set: Laterality of breast cancer ValueSet | |
| FIRSTBC | Indicate if this is the first breast cancer | 1..1 | choice | Value Set: Yes, No and Unknown Valueset | |
| NewBC | Indicate if this is a new cancer on contralateral or ipsilateral breast | 1..1 | choice | Enable When: FIRSTBC = No (expandedYes-NoIndicator#N) Value Set: Laterality of new cancer ValueSet | |
| Tumor-Factors | Tumor factors | 1..1 | group | ||
 HistologicalDateKnown | Is the date of histological diagnosis known? | 1..1 | boolean | ||
 HistologicalDiagnosisDate | Indicate the initial date of histological diagnosis: | 1..1 | date | Enable When: HistologicalDateKnown = true | |
| HISTOTYPE | Indicate the histologic type of the tumor (select all that apply) | 1..* | choice | Value Set: Histological type of the tumor ValueSet | |
| MUTBC | Indicate if the patient carries a germline mutation predisposing breast cancer | 1..* | choice | Value Set: Germline Mutation ValueSet | |
| GRADEINV | Indicate the grade of the invasive component of tumor | 1..1 | choice | Value Set: Grading of tumor ValueSet | |
| GRADEDCIS | Indicate the tumor grade of DCIS component of tumor | 1..1 | choice | Value Set: Grading of tumor ValueSet | |
| TNMCT_BREAST | Indicate the clinical tumor stage (per AJCC 8th Ed.): | 1..1 | choice | Value Set: TNM Primary Tumor ValueSet | |
| TNMCN_BREAST | Indicate the clinical nodal stage (per AJCC 8th Ed.): | 1..1 | choice | Value Set: TNM Regional Nodes ValueSet | |
| TNMCM_BREAST | Indicate the clinical distant metastasis (per AJCC 8th Ed.): | 1..1 | choice | Value Set: TNM Distant Metastases ValueSet | |
| ERSTATUS | Indicate if the estrogen receptor status is positive: | 1..1 | choice | Value Set: Estrogen receptor status ValueSet | |
| PRSTATUS | Indicate if the progesterone receptor status is positive: | 1..1 | choice | Value Set: Progesterone receptor status ValueSet | |
| HER2STATUS | Indicate if the HER2 receptor status is positive: | 1..1 | choice | Value Set: HER2 receptor status ValueSet | |
| MolecularProfiling | Indicate if a molecular profiling tool was used. If so, which one? | 1..1 | choice | Value Set: Molecular profiling | |
 Mammaprint | Indicate the mammaprint score on a scale of 0.000 to 1.000 | 1..1 | decimal | Enable When: MolecularProfiling = Mammaprint Score (Molecular Profiling CodeSystem#mammaprint) | |
| Oncotype | Indicate the oncotype score on a scale of 0 to 100 | 1..1 | decimal | Enable When: MolecularProfiling = Oncotype Score (Molecular Profiling CodeSystem#oncotype) | |
| Endopredict | Indicate the endopredict score on a scale of 1.1 to 6.2 | 1..1 | decimal | Enable When: MolecularProfiling = Endopredict Score (Molecular Profiling CodeSystem#endopredict) | |
| Treatment-Variables | Treatment variables | 1..1 | group | ||
 MultMeet | Indicate if a multidisciplinary meeting was conducted | 1..1 | choice | Value Set: Yes, No and Unknown Valueset | |
| MultRecTreatments | Which treatments did the multidisciplinary team recommend (select all that apply)? | 1..* | choice | Enable When: MultMeet = Yes (expandedYes-NoIndicator#Y) Value Set: Recommended treatment types ValueSet | |
| Documentation for this format | |||||
FHIR{
"resourceType": "Questionnaire",
"id": "ClinicalResponseBaseline",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "patient",
"display": "Patient"
}
},
{
"url": "type",
"valueCode": "Patient"
},
{
"url": "description",
"valueString": "Patient information to pre-populate the form with"
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "informative",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/ichom-breast-cancer/ImplementationGuide/hl7.fhir.uv.ichom-breast-cancer"
}
]
}
}
],
"url": "http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseBaseline",
"version": "1.0.0",
"name": "ClinicalResponseBaseline",
"title": "Clinical response questionnaire at baseline",
"status": "draft",
"experimental": true,
"date": "2023-08-21T16:37:24+00:00",
"publisher": "HL7 International - Clinical Interoperability Council Group",
"contact": [
{
"name": "HL7 International - Clinical Interoperability Council Group",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/cic"
}
]
}
],
"description": "Clinical response questionnaire at baseline (first doctors' visit)",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"item": [
{
"linkId": "General-Information-Clinical",
"text": "General information",
"type": "group",
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%patient.id"
}
}
],
"linkId": "NA-Clinical",
"text": "What is the patient's medical record number?",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%patient.name.first().family.first()"
}
}
],
"linkId": "LastName-Clinical",
"text": "What is the patient's last name?",
"type": "string",
"required": true
}
]
},
{
"linkId": "Demographics",
"text": "Demographic factors",
"type": "group",
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "expandedGender",
"language": "application/x-fhir-query",
"expression": "ValueSet/$expand?url=http://hl7.org/fhir/ValueSet/administrative-gender"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%expandedGender.expansion.contains.where(code=%patient.gender)"
}
}
],
"linkId": "Sex",
"text": "Indicate the sex of the patient at birth:",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/ValueSet/administrative-gender"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%patient.birthDate.substring(0,4)"
}
}
],
"linkId": "YearOfBirth",
"text": "In what year was the patient born?",
"type": "integer",
"required": true,
"maxLength": 4
}
]
},
{
"linkId": "Clinical-Factors",
"text": "Clinical factors",
"type": "group",
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod",
"valueDuration": {
"value": 300,
"system": "http://unitsofmeasure.org",
"code": "a"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationExtract",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "cm",
"display": "cm"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-minQuantity",
"valueQuantity": {
"value": 10,
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-maxQuantity",
"valueQuantity": {
"value": 320,
"system": "http://unitsofmeasure.org",
"code": "cm"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "[in_i]",
"display": "[in_i]"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-minQuantity",
"valueQuantity": {
"value": 3.94,
"system": "http://unitsofmeasure.org",
"code": "[in_i]"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-maxQuantity",
"valueQuantity": {
"value": 126,
"system": "http://unitsofmeasure.org",
"code": "[in_i]"
}
}
],
"linkId": "Height",
"code": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Body height"
}
],
"text": "Indicate the patient's body height",
"type": "quantity",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod",
"valueDuration": {
"value": 300,
"system": "http://unitsofmeasure.org",
"code": "a"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationExtract",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "kg",
"display": "kg"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-minQuantity",
"valueQuantity": {
"value": 0.1,
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-maxQuantity",
"valueQuantity": {
"value": 750,
"system": "http://unitsofmeasure.org",
"code": "kg"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"system": "http://unitsofmeasure.org",
"code": "[lb_av]",
"display": "[lb_av]"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-minQuantity",
"valueQuantity": {
"value": 0.22,
"system": "http://unitsofmeasure.org",
"code": "[lb_av]"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-maxQuantity",
"valueQuantity": {
"value": 1653.47,
"system": "http://unitsofmeasure.org",
"code": "[lb_av]"
}
}
],
"linkId": "Weight",
"code": [
{
"system": "http://loinc.org",
"code": "29463-7",
"display": "Body weight"
},
{
"system": "http://loinc.org",
"code": "3141-9",
"display": "Body weight Measured"
},
{
"system": "http://snomed.info/sct",
"code": "27113001",
"display": "Body weight"
}
],
"text": "Indicate the patient's weight.",
"type": "quantity",
"required": true
},
{
"linkId": "LATERAL",
"text": "Indicate the laterality of breast cancer",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/LateralityVS"
},
{
"linkId": "FIRSTBC",
"text": "Indicate if this is the first breast cancer",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "NewBC",
"text": "Indicate if this is a new cancer on contralateral or ipsilateral breast",
"type": "choice",
"enableWhen": [
{
"question": "FIRSTBC",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "N"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/LateralityNewCancerVS"
}
]
},
{
"linkId": "Tumor-Factors",
"text": "Tumor factors",
"type": "group",
"required": true,
"item": [
{
"linkId": "HistologicalDateKnown",
"text": "Is the date of histological diagnosis known?",
"type": "boolean",
"required": true
},
{
"linkId": "HistologicalDiagnosisDate",
"text": "Indicate the initial date of histological diagnosis:",
"type": "date",
"enableWhen": [
{
"question": "HistologicalDateKnown",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "HISTOTYPE",
"text": "Indicate the histologic type of the tumor (select all that apply)",
"type": "choice",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/HistologicalTypeVS"
},
{
"linkId": "MUTBC",
"text": "Indicate if the patient carries a germline mutation predisposing breast cancer",
"type": "choice",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/GermlineMutationVS"
},
{
"linkId": "GRADEINV",
"text": "Indicate the grade of the invasive component of tumor",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/GradingVS"
},
{
"linkId": "GRADEDCIS",
"text": "Indicate the tumor grade of DCIS component of tumor",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/GradingVS"
},
{
"linkId": "TNMCT_BREAST",
"text": "Indicate the clinical tumor stage (per AJCC 8th Ed.):",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TNMPrimaryTumorVS"
},
{
"linkId": "TNMCN_BREAST",
"text": "Indicate the clinical nodal stage (per AJCC 8th Ed.):",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TNMRegionalNodesVS"
},
{
"linkId": "TNMCM_BREAST",
"text": "Indicate the clinical distant metastasis (per AJCC 8th Ed.):",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TNMDistantMetastasesVS"
},
{
"linkId": "ERSTATUS",
"text": "Indicate if the estrogen receptor status is positive:",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/EstrogenStatusVS"
},
{
"linkId": "PRSTATUS",
"text": "Indicate if the progesterone receptor status is positive:",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ProgesteroneStatusVS"
},
{
"linkId": "HER2STATUS",
"text": "Indicate if the HER2 receptor status is positive:",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/HER2ReceptorStatusVS"
},
{
"linkId": "MolecularProfiling",
"text": "Indicate if a molecular profiling tool was used. If so, which one?",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/MolecularProfilingStatusVS"
},
{
"linkId": "Mammaprint",
"text": "Indicate the mammaprint score on a scale of 0.000 to 1.000",
"type": "decimal",
"enableWhen": [
{
"question": "MolecularProfiling",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/MolecularProfilingCodeSystem",
"code": "mammaprint"
}
}
],
"required": true
},
{
"linkId": "Oncotype",
"text": "Indicate the oncotype score on a scale of 0 to 100",
"type": "decimal",
"enableWhen": [
{
"question": "MolecularProfiling",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/MolecularProfilingCodeSystem",
"code": "oncotype"
}
}
],
"required": true
},
{
"linkId": "Endopredict",
"text": "Indicate the endopredict score on a scale of 1.1 to 6.2",
"type": "decimal",
"enableWhen": [
{
"question": "MolecularProfiling",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/MolecularProfilingCodeSystem",
"code": "endopredict"
}
}
],
"required": true
}
]
},
{
"linkId": "Treatment-Variables",
"text": "Treatment variables",
"type": "group",
"required": true,
"item": [
{
"linkId": "MultMeet",
"text": "Indicate if a multidisciplinary meeting was conducted",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "MultRecTreatments",
"text": "Which treatments did the multidisciplinary team recommend (select all that apply)?",
"type": "choice",
"enableWhen": [
{
"question": "MultMeet",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y"
}
}
],
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/RecommendedTreatmentTypeVS"
}
]
}
]
}