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Packagehl7.fhir.uv.ichom-breast-cancer
Resource TypeQuestionnaire
IdQuestionnaire-ClinicalResponseBaseline.json
FHIR VersionR4

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Narrative

Note: links and images are rebased to the (stated) source

LinkIdTextCardinalityTypeFlagsDescription & Constraintsdoco
.. ClinicalResponseBaselineClinical response questionnaire at baseline (first doctors' visit)Questionnairehttp://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseBaseline#1.0.0
... General-Information-ClinicalGeneral information1..1group
.... NA-ClinicalWhat is the patient's medical record number?1..1stringExpressions:
.... LastName-ClinicalWhat is the patient's last name?1..1stringExpressions:
... DemographicsDemographic factors1..1group
.... SexIndicate the sex of the patient at birth:1..1choiceValue Set: AdministrativeGender
Expressions:
  • Initial Value: %expandedGender.expansion.contains.where(code=%patient.gender)
.... YearOfBirthIn what year was the patient born?1..1integerMax Length: 4
Expressions:
... Clinical-FactorsClinical factors1..1group
.... HeightIndicate the patient's body height1..1quantityicon
.... WeightIndicate the patient's weight.1..1quantityicon
.... LATERALIndicate the laterality of breast cancer1..1choiceValue Set: Laterality of breast cancer ValueSet
.... FIRSTBCIndicate if this is the first breast cancer1..1choiceValue Set: Yes, No and Unknown Valueset
.... NewBCIndicate if this is a new cancer on contralateral or ipsilateral breast1..1choiceEnable When: FIRSTBC = No (expandedYes-NoIndicator#N)
Value Set: Laterality of new cancer ValueSet
... Tumor-FactorsTumor factors1..1group
.... HistologicalDateKnownIs the date of histological diagnosis known?1..1boolean
.... HistologicalDiagnosisDateIndicate the initial date of histological diagnosis:1..1dateEnable When: HistologicalDateKnown = true
.... HISTOTYPEIndicate the histologic type of the tumor (select all that apply)1..*choiceValue Set: Histological type of the tumor ValueSet
.... MUTBCIndicate if the patient carries a germline mutation predisposing breast cancer1..*choiceValue Set: Germline Mutation ValueSet
.... GRADEINVIndicate the grade of the invasive component of tumor1..1choiceValue Set: Grading of tumor ValueSet
.... GRADEDCISIndicate the tumor grade of DCIS component of tumor1..1choiceValue Set: Grading of tumor ValueSet
.... TNMCT_BREASTIndicate the clinical tumor stage (per AJCC 8th Ed.):1..1choiceValue Set: TNM Primary Tumor ValueSet
.... TNMCN_BREASTIndicate the clinical nodal stage (per AJCC 8th Ed.):1..1choiceValue Set: TNM Regional Nodes ValueSet
.... TNMCM_BREASTIndicate the clinical distant metastasis (per AJCC 8th Ed.):1..1choiceValue Set: TNM Distant Metastases ValueSet
.... ERSTATUSIndicate if the estrogen receptor status is positive:1..1choiceValue Set: Estrogen receptor status ValueSet
.... PRSTATUSIndicate if the progesterone receptor status is positive:1..1choiceValue Set: Progesterone receptor status ValueSet
.... HER2STATUSIndicate if the HER2 receptor status is positive:1..1choiceValue Set: HER2 receptor status ValueSet
.... MolecularProfilingIndicate if a molecular profiling tool was used. If so, which one?1..1choiceValue Set: Molecular profiling
.... MammaprintIndicate the mammaprint score on a scale of 0.000 to 1.0001..1decimalEnable When: MolecularProfiling = Mammaprint Score (Molecular Profiling CodeSystem#mammaprint)
.... OncotypeIndicate the oncotype score on a scale of 0 to 1001..1decimalEnable When: MolecularProfiling = Oncotype Score (Molecular Profiling CodeSystem#oncotype)
.... EndopredictIndicate the endopredict score on a scale of 1.1 to 6.21..1decimalEnable When: MolecularProfiling = Endopredict Score (Molecular Profiling CodeSystem#endopredict)
... Treatment-VariablesTreatment variables1..1group
.... MultMeetIndicate if a multidisciplinary meeting was conducted1..1choiceValue Set: Yes, No and Unknown Valueset
.... MultRecTreatmentsWhich treatments did the multidisciplinary team recommend (select all that apply)?1..*choiceEnable When: MultMeet = Yes (expandedYes-NoIndicator#Y)
Value Set: Recommended treatment types ValueSet

doco Documentation for this format

Source1

{
  "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"
        }
      ]
    }
  ]
}