| Package | hl7.fhir.uv.ichom-breast-cancer |
| Type | Questionnaire |
| Id | ClinicalResponseAnnualUpdate |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/ichom-breast-cancer/https://build.fhir.org/ig/HL7/fhir-ichom-breast-cancer-ig/Questionnaire-ClinicalResponseAnnualUpdate.html |
| URL | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseAnnualUpdate |
| Version | 1.0.0 |
| Status | draft |
| Date | 2023-08-21T16:37:24+00:00 |
| Name | AnnualClinicalResponse |
| Title | Annual follow-up of clinical questionnaire response |
| Realm | uv |
| Authority | hl7 |
| Description | Clinical response questionnaire at annual post-treatment follow-up |
No resources found
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Note: links and images are rebased to the (stated) source
| LinkId | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  AnnualClinicalResponse | Clinical response questionnaire at annual post-treatment follow-up | Questionnaire | http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseAnnualUpdate#1.0.0 | |
  General-Information-Clinical | General information | 1..1 | group | |
  NA-Clinical | What is the patient's medical record number? | 1..1 | string | |
 LastName-Clinical | What is the patient's last name? | 1..1 | string | |
| Tumor-Factors | Tumor factors | 1..1 | group | |
 MUTBC | Indicate if the patient carries a genetic mutation predisposing breast cancer | 1..* | choice | Value Set: Germline Mutation ValueSet |
| Treatment-Variables | Treatment Variables | 1..1 | group | |
| TREATMENT_BREAST | Indicate whether the patient received one of the following treatment during the last year (select all that apply) | 1..* | choice | Value Set: Type of treatments ValueSet |
| SURGERY_BREAST | Indicate whether the patient received surgery during the last year | 1..1 | choice | Enable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003) Value Set: Types of breast surgery ValueSet |
 SurgeryDateKnown | Is the date of surgery known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Surgical procedure (procedure) (SNOMED CT#387713003) |
 SurgeryDate | Please provide the date of surgery | 1..1 | date | Enable When: SurgeryDateKnown = true |
| SURGERYAX | Indicate whether the patient received surgery to the axilla | 1..1 | choice | Enable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008) Value Set: Axilla surgery ValueSet |
| SURGERYAXDATE-Known | Is the date of surgery to the axilla known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Operative procedure on axilla (SNOMED CT#699455008) |
| SURGERYAXDATE | Please provide the date of surgery to the axilla | 1..1 | date | Enable When: SURGERYAXDATE-Known = true |
| SURGERYAX2 | Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year | 1..1 | choice | Enable When:
Value Set: Yes, No and Unknown Valueset |
| SURGERYAX2DATE-Known | Is the date of axillary clearance known? | 1..1 | boolean | Enable When: SURGERYAX2 = Yes (expandedYes-NoIndicator#Y) |
| SURGERYAX2DATE | Please provide the date of axillary clearance | 1..1 | date | Enable When: SURGERYAX2DATE-Known = true |
| RECONSTRUCTION_DELAY | Indicate whether the patient received a delayed reconstruction | 1..1 | choice | Enable When: SURGERY_BREAST = Mastectomy without immediate reconstruction (Breast surgery types CodeSystem#mastectomy-without-immediate-reconstruction) Value Set: Yes, No and Unknown Valueset |
| SURGERY_RECONSTRUCTION | Indicate what type of reconstruction the patient received | 1..1 | choice | Enable When:
Value Set: Type of reconstruction surgery ValueSet |
| ImplantReconstruction | Indicate the location of the implant | 1..1 | choice | Enable When:
Value Set: Location of the implant ValueSet |
| RECONSTRUCTDATE-Known | Is the date of the delayed reconstruction known? | 1..1 | boolean | Enable When: RECONSTRUCTION_DELAY = Yes (expandedYes-NoIndicator#Y) |
| RECONSTRUCTDATE | Please provide the date of delayed reconstruction | 1..1 | date | Enable When: RECONSTRUCTDATE-Known = true |
| RADIOTX_BREAST | What was the intent of radiotherapy | 1..* | choice | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) Value Set: Intent of therapy ValueSet |
| RADIOTXTYPE_BREAST | Indicate location/type of radiotherapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) Value Set: The location of radiotherapy ValueSet |
| RadioTxStartDate-Known | Is the start date of radiotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) |
| RadioTxStartDate | Please provide the start date of radiotherapy | 1..1 | date | Enable When: RadioTxStartDate-Known = true |
| RadioTxStopDate-Known | Is the stop date of radiotherapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Radiation oncology AND/OR radiotherapy (SNOMED CT#108290001) |
| RadioTxStopDate | Please provide the stop date of radiotherapy | 1..1 | date | Enable When: RadioTxStopDate-Known = true |
| CHEMOTXINTENT | Indicate the intent of chemotherapy | 1..1 | choice | Enable When:
Value Set: Intent of therapy ValueSet |
| CHEMOTXTYPE_BREAST | Indicate the type of chemotherapy (select all that apply) | 1..* | choice | Enable When:
Value Set: Type of chemotherapy ValueSet |
| ChemoTxStartDate-Known | Is the start date of chemotherapy known? | 1..1 | boolean | Enable When:
|
| ChemoTxStartDate | Please provide the start date of chemotherapy | 1..1 | date | Enable When: ChemoTxStartDate-Known = true |
| ChemoTxStopdate-Known | Is the stop date of chemotherapy known? | 1..1 | boolean | Enable When:
|
| ChemoTxStopdate | Please provide the stop date of chemotherapy | 1..1 | date | Enable When: ChemoTxStopdate-Known = true |
| HORMONTX_BREAST | Indicate the intent of hormonal therapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) Value Set: Intent of therapy ValueSet |
| HORMONTXTYPE | Indicate the type of hormonal therapy (select all that apply) | 1..* | choice | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) Value Set: Type of hormonal therapy ValueSet |
| HORMONTXSTARTDATE-Known | Is the start date of hormonal therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) |
| HORMONTXSTARTDATE | Please provide the start date of hormonal therapy | 1..1 | date | Enable When: HORMONTXSTARTDATE-Known = true |
| HORMONTXSTOPDATE-Known | Is the stop date of hormonal therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Hormone therapy (SNOMED CT#169413002) |
| HORMONTXSTOPDATE | Please provide the stop date of hormonal therapy, if applicable | 1..1 | date | Enable When: HORMONTXSTOPDATE-Known = true |
| TARGETTX_BREAST | Indicate the type of targeted therapy | 1..1 | choice | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) Value Set: Type of targeted therapy ValueSet |
| TargetTxStartDate-Known | Is the start date of targeted therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) |
| TargetTxStartDate | Please provide the start date of targeted therapy | 1..1 | date | Enable When: TargetTxStartDate-Known = true |
| TargetTxStopDate-Known | Is the stop date of targeted therapy known? | 1..1 | boolean | Enable When: TREATMENT_BREAST = Targeted therapy (Treatment variables CodeSytem#targeted-therapy) |
| TargetTxStopDate | Please provide the stop date of targeted therapy | 1..1 | date | Enable When: TargetTxStopDate-Known = true |
| SURGERYPATIENT | Indicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply) | 1..* | choice | Value Set: Type of re-operation |
| SURGERYDATEPATIENT-Known | Is the date of the reoperation known? | 1..1 | boolean | Enable When:
|
| SURGERYDATEPATIENT | Please provide the date of the reoperation | 1..1 | date | Enable When: SURGERYDATEPATIENT-Known = true |
| Survival-and-Disease-control | Survival and disease control | 1..1 | group | |
 Survival-Q0 | Was the intent of the treatment curative? | 1..1 | boolean | |
| MalignancyRecur | Is there evidence of local, regional or distant recurrence of neoplasm? | 1..1 | choice | Enable When: Survival-Q0 = true Value Set: Recurrence of neoplasm ValueSet |
| RecurMethod | What was the method of confirming recurrence of neoplasm? | 1..1 | choice | Enable When:
Value Set: Recurrence method ValueSet |
| RecurDateCancer-Known | Is the date of cancer recurrence known? | 1..1 | boolean | Enable When:
|
| RecurDateCancer | What is the date of cancer recurrence? | 1..1 | date | Enable When: RecurDateCancer-Known = true |
| VitalStatus | Indicate if the person has deceased, regardless of cause | 1..1 | choice | Value Set: Yes, No and Unknown Valueset |
| DeceasedDate-Known | Is the date of death of the patient known? | 1..1 | boolean | Enable When: VitalStatus = Yes (expandedYes-NoIndicator#Y) |
| DeceasedDate | Please provide the date of death of the patient | 1..1 | date | Enable When: DeceasedDate-Known = true |
| DEATHBC | Is the death attributable to breast cancer? | 1..1 | choice | Enable When: VitalStatus = Yes (expandedYes-NoIndicator#Y) Value Set: Yes, No and Unknown Valueset |
| Documentation for this format | ||||
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"id": "ClinicalResponseAnnualUpdate",
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"required": true,
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"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/BreastSurgeryTypeVS"
},
{
"linkId": "SurgeryDateKnown",
"text": "Is the date of surgery known?",
"type": "boolean",
"enableWhen": [
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{
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"operator": "=",
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"required": true
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{
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"text": "Indicate whether the patient received surgery to the axilla",
"type": "choice",
"enableWhen": [
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"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/AxillaSurgeryVS"
},
{
"linkId": "SURGERYAXDATE-Known",
"text": "Is the date of surgery to the axilla known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "699455008"
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}
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"required": true
},
{
"linkId": "SURGERYAXDATE",
"text": "Please provide the date of surgery to the axilla",
"type": "date",
"enableWhen": [
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"question": "SURGERYAXDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "SURGERYAX2",
"text": "Indicate whether the patient received axillary clearance due to lymph node involvement after sentinel lymph node biopsy during the last year",
"type": "choice",
"enableWhen": [
{
"question": "SURGERYAX",
"operator": "=",
"answerCoding": {
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"enableBehavior": "any",
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"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
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{
"linkId": "SURGERYAX2DATE-Known",
"text": "Is the date of axillary clearance known?",
"type": "boolean",
"enableWhen": [
{
"question": "SURGERYAX2",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
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}
],
"required": true
},
{
"linkId": "SURGERYAX2DATE",
"text": "Please provide the date of axillary clearance",
"type": "date",
"enableWhen": [
{
"question": "SURGERYAX2DATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "RECONSTRUCTION_DELAY",
"text": "Indicate whether the patient received a delayed reconstruction",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-without-immediate-reconstruction"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "SURGERY_RECONSTRUCTION",
"text": "Indicate what type of reconstruction the patient received",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-without-immediate-reconstruction"
}
},
{
"question": "SURGERY_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/BreastSurgeryTypesCodeSystem",
"code": "mastectomy-with-immediate-reconstruction"
}
}
],
"enableBehavior": "any",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ReconstructionTypeVS"
},
{
"linkId": "ImplantReconstruction",
"text": "Indicate the location of the implant",
"type": "choice",
"enableWhen": [
{
"question": "SURGERY_RECONSTRUCTION",
"operator": "!=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/ReconstructionTypeCodeSystem",
"code": "autologous"
}
},
{
"question": "SURGERY_RECONSTRUCTION",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK"
}
}
],
"enableBehavior": "all",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ImplantLocationVS"
},
{
"linkId": "RECONSTRUCTDATE-Known",
"text": "Is the date of the delayed reconstruction known?",
"type": "boolean",
"enableWhen": [
{
"question": "RECONSTRUCTION_DELAY",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y"
}
}
],
"required": true
},
{
"linkId": "RECONSTRUCTDATE",
"text": "Please provide the date of delayed reconstruction",
"type": "date",
"enableWhen": [
{
"question": "RECONSTRUCTDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "RADIOTX_BREAST",
"text": "What was the intent of radiotherapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TherapyIntentVS"
},
{
"linkId": "RADIOTXTYPE_BREAST",
"text": "Indicate location/type of radiotherapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/LocationRadiotherapyVS"
},
{
"linkId": "RadioTxStartDate-Known",
"text": "Is the start date of radiotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true
},
{
"linkId": "RadioTxStartDate",
"text": "Please provide the start date of radiotherapy",
"type": "date",
"enableWhen": [
{
"question": "RadioTxStartDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "RadioTxStopDate-Known",
"text": "Is the stop date of radiotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "108290001"
}
}
],
"required": true
},
{
"linkId": "RadioTxStopDate",
"text": "Please provide the stop date of radiotherapy",
"type": "date",
"enableWhen": [
{
"question": "RadioTxStopDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "CHEMOTXINTENT",
"text": "Indicate the intent of chemotherapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TherapyIntentVS"
},
{
"linkId": "CHEMOTXTYPE_BREAST",
"text": "Indicate the type of chemotherapy (select all that apply)",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ChemoTherapyTypeVS"
},
{
"linkId": "ChemoTxStartDate-Known",
"text": "Is the start date of chemotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true
},
{
"linkId": "ChemoTxStartDate",
"text": "Please provide the start date of chemotherapy",
"type": "date",
"enableWhen": [
{
"question": "ChemoTxStartDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "ChemoTxStopdate-Known",
"text": "Is the stop date of chemotherapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "adjuvant-chemotherapy"
}
},
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "neoadjuvant-chemotherapy"
}
}
],
"enableBehavior": "any",
"required": true
},
{
"linkId": "ChemoTxStopdate",
"text": "Please provide the stop date of chemotherapy",
"type": "date",
"enableWhen": [
{
"question": "ChemoTxStopdate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "HORMONTX_BREAST",
"text": "Indicate the intent of hormonal therapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TherapyIntentVS"
},
{
"linkId": "HORMONTXTYPE",
"text": "Indicate the type of hormonal therapy (select all that apply)",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/HormonalTherapyTypeVS"
},
{
"linkId": "HORMONTXSTARTDATE-Known",
"text": "Is the start date of hormonal therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true
},
{
"linkId": "HORMONTXSTARTDATE",
"text": "Please provide the start date of hormonal therapy",
"type": "date",
"enableWhen": [
{
"question": "HORMONTXSTARTDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "HORMONTXSTOPDATE-Known",
"text": "Is the stop date of hormonal therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "169413002"
}
}
],
"required": true
},
{
"linkId": "HORMONTXSTOPDATE",
"text": "Please provide the stop date of hormonal therapy, if applicable",
"type": "date",
"enableWhen": [
{
"question": "HORMONTXSTOPDATE-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "TARGETTX_BREAST",
"text": "Indicate the type of targeted therapy",
"type": "choice",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "targeted-therapy"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/TargetedTherapyVS"
},
{
"linkId": "TargetTxStartDate-Known",
"text": "Is the start date of targeted therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "targeted-therapy"
}
}
],
"required": true
},
{
"linkId": "TargetTxStartDate",
"text": "Please provide the start date of targeted therapy",
"type": "date",
"enableWhen": [
{
"question": "TargetTxStartDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "TargetTxStopDate-Known",
"text": "Is the stop date of targeted therapy known?",
"type": "boolean",
"enableWhen": [
{
"question": "TREATMENT_BREAST",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/TreatmentTypesCodeSystem",
"code": "targeted-therapy"
}
}
],
"required": true
},
{
"linkId": "TargetTxStopDate",
"text": "Please provide the stop date of targeted therapy",
"type": "date",
"enableWhen": [
{
"question": "TargetTxStopDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "SURGERYPATIENT",
"text": "Indicate if the patient has had one of the following re-operations since their surgery for breast cancer (select all that apply)",
"type": "choice",
"required": true,
"repeats": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/ReoperationTypeVS"
},
{
"linkId": "SURGERYDATEPATIENT-Known",
"text": "Is the date of the reoperation known?",
"type": "boolean",
"enableWhen": [
{
"question": "SURGERYPATIENT",
"operator": "!=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "unknown"
}
},
{
"question": "SURGERYPATIENT",
"operator": "!=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373572006",
"display": "Clinical finding absent"
}
}
],
"enableBehavior": "all",
"required": true
},
{
"linkId": "SURGERYDATEPATIENT",
"text": "Please provide the date of the reoperation",
"type": "date",
"enableWhen": [
{
"question": "SURGERYDATEPATIENT-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
}
]
},
{
"linkId": "Survival-and-Disease-control",
"text": "Survival and disease control",
"type": "group",
"required": true,
"item": [
{
"linkId": "Survival-Q0",
"text": "Was the intent of the treatment curative?",
"type": "boolean",
"required": true
},
{
"linkId": "MalignancyRecur",
"text": "Is there evidence of local, regional or distant recurrence of neoplasm?",
"type": "choice",
"enableWhen": [
{
"question": "Survival-Q0",
"operator": "=",
"answerBoolean": true
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/RecurrenceVS"
},
{
"linkId": "RecurMethod",
"text": "What was the method of confirming recurrence of neoplasm?",
"type": "choice",
"enableWhen": [
{
"question": "MalignancyRecur",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/RecurrenceCodeSystem",
"code": "local-recurrence"
}
},
{
"question": "MalignancyRecur",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/RecurrenceCodeSystem",
"code": "regional-recurrence"
}
},
{
"question": "MalignancyRecur",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/RecurrenceCodeSystem",
"code": "distant-recurrence"
}
}
],
"enableBehavior": "any",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/RecurrenceMethodVS"
},
{
"linkId": "RecurDateCancer-Known",
"text": "Is the date of cancer recurrence known?",
"type": "boolean",
"enableWhen": [
{
"question": "MalignancyRecur",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/RecurrenceCodeSystem",
"code": "local-recurrence"
}
},
{
"question": "MalignancyRecur",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/RecurrenceCodeSystem",
"code": "regional-recurrence"
}
},
{
"question": "MalignancyRecur",
"operator": "=",
"answerCoding": {
"system": "http://hl7.org/fhir/uv/ichom-breast-cancer/CodeSystem/RecurrenceCodeSystem",
"code": "distant-recurrence"
}
}
],
"enableBehavior": "any",
"required": true
},
{
"linkId": "RecurDateCancer",
"text": "What is the date of cancer recurrence?",
"type": "date",
"enableWhen": [
{
"question": "RecurDateCancer-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "VitalStatus",
"text": "Indicate if the person has deceased, regardless of cause",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
},
{
"linkId": "DeceasedDate-Known",
"text": "Is the date of death of the patient known?",
"type": "boolean",
"enableWhen": [
{
"question": "VitalStatus",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
],
"required": true
},
{
"linkId": "DeceasedDate",
"text": "Please provide the date of death of the patient",
"type": "date",
"enableWhen": [
{
"question": "DeceasedDate-Known",
"operator": "=",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "DEATHBC",
"text": "Is the death attributable to breast cancer?",
"type": "choice",
"enableWhen": [
{
"question": "VitalStatus",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
}
}
],
"required": true,
"answerValueSet": "http://hl7.org/fhir/uv/ichom-breast-cancer/ValueSet/NoYesUnknownVS"
}
]
}
]
}