FHIR IG analytics| Package | lt.hl7.fhir.prostate |
| Resource Type | Questionnaire |
| Id | Questionnaire-questionnaire-prostate-pathologist-referral.json |
| FHIR Version | R5 |
| Source | https://build.fhir.org/ig/HL7LT/ig-lt-prostate/Questionnaire-questionnaire-prostate-pathologist-referral.html |
| URL | https://hl7.lt/fhir/prostate/Questionnaire/prostate-pathologist-referral |
| Version | 0.1.0 |
| Status | draft |
| Date | 2025-06-01 |
| Name | ProstatePathologistReferral |
| Title | Referral to pathologist (E014, form 014-1-1/a) |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
English
Generated Narrative: Questionnaire questionnaire-prostate-pathologist-referral
Language: en
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  ProstatePathologistReferral | Questionnaire | https://hl7.lt/fhir/prostate/Questionnaire/prostate-pathologist-referral#0.1.0 | ||
  grp-referral-info | Referral information | 0..1 | group | |
  sending-institution | Sending institution | 1..1 | string | |
| sending-section | Section / department | 0..1 | string | |
| treating-physician-name | Treating physician (full name) | 1..1 | string | |
| treating-physician-email | Treating physician e-mail | 0..1 | string | |
| treating-physician-phone | Treating physician phone | 0..1 | string | |
| referring-doctor-name | Referring doctor (full name) | 1..1 | string | |
| referring-doctor-email | Referring doctor e-mail | 0..1 | string | |
 referring-doctor-phone | Referring doctor phone | 0..1 | string | |
| grp-biopsy-type | Biopsy type | 0..1 | group | |
 biopsy-type | Biopsy type | 1..1 | coding | Options: 2 options |
| grp-tissue-fixing | Tissue fixing | 0..1 | group | |
| tissue-fixing-material | Tissue-fixing material | 1..1 | coding | Options: 2 options |
| grp-clinical-diagnosis | Clinical diagnosis | 0..1 | group | |
| clinical-diagnosis | Clinical diagnosis | 1..1 | coding | Options: 2 options |
| clinical-t-stage | Clinical T stage (if C61) | 0..1 | coding | Options: 4 options |
| grp-procedure | Procedure | 0..1 | group | |
| operation-name | Operation name | 1..1 | coding | Options: 2 options |
| procedure-type | Procedure type | 1..1 | coding | Options: 4 options |
| grp-specimens | Description of histological object (number of biopsies per location) | 0..1 | group | |
 specimens-right-pz | Right peripheral zone (number of biopsies) | 0..1 | integer | |
| specimens-left-pz | Left peripheral zone (number of biopsies) | 0..1 | integer | |
| specimens-focus-1 | Focus 1 (number of biopsies) | 0..1 | integer | |
| specimens-focus-2 | Focus 2 (number of biopsies) | 0..1 | integer | |
| specimens-focus-3 | Focus 3 (number of biopsies) | 0..1 | integer | |
| grp-clinical-data | Clinical data | 0..1 | group | |
 psa-ngml | PSA (ng/ml) | 0..1 | quantity | |
| psat-ngml-ml | PSAT (ng/ml/ml) | 0..1 | quantity | |
| prostate-volume-ml | Prostate volume (ml) | 0..1 | quantity | |
| mpmri-pirads | mpMRI PI-RADS assessment | 0..1 | coding | Options: 4 options |
| grp-additional | Additional information | 0..1 | group | |
  additional-info | Additional information | 0..1 | text | |
| Documentation for this format | ||||
Options Sets
Answer options for biopsy-type
Answer options for tissue-fixing-material
Answer options for clinical-diagnosis
Answer options for clinical-t-stage
Answer options for operation-name
Answer options for procedure-type
Answer options for mpmri-pirads
Lithuanian
Generated Narrative: Questionnaire questionnaire-prostate-pathologist-referral
Language: en
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
| ProstatePathologistReferral | Questionnaire | https://hl7.lt/fhir/prostate/Questionnaire/prostate-pathologist-referral#0.1.0 | ||
| grp-referral-info | Referral information | 0..1 | group | |
| sending-institution | Sending institution | 1..1 | string | |
| sending-section | Section / department | 0..1 | string | |
| treating-physician-name | Treating physician (full name) | 1..1 | string | |
| treating-physician-email | Treating physician e-mail | 0..1 | string | |
| treating-physician-phone | Treating physician phone | 0..1 | string | |
| referring-doctor-name | Referring doctor (full name) | 1..1 | string | |
| referring-doctor-email | Referring doctor e-mail | 0..1 | string | |
| referring-doctor-phone | Referring doctor phone | 0..1 | string | |
| grp-biopsy-type | Biopsy type | 0..1 | group | |
| biopsy-type | Biopsy type | 1..1 | coding | Options: 2 options |
| grp-tissue-fixing | Tissue fixing | 0..1 | group | |
| tissue-fixing-material | Tissue-fixing material | 1..1 | coding | Options: 2 options |
| grp-clinical-diagnosis | Clinical diagnosis | 0..1 | group | |
| clinical-diagnosis | Clinical diagnosis | 1..1 | coding | Options: 2 options |
| clinical-t-stage | Clinical T stage (if C61) | 0..1 | coding | Options: 4 options |
| grp-procedure | Procedure | 0..1 | group | |
| operation-name | Operation name | 1..1 | coding | Options: 2 options |
| procedure-type | Procedure type | 1..1 | coding | Options: 4 options |
| grp-specimens | Description of histological object (number of biopsies per location) | 0..1 | group | |
| specimens-right-pz | Right peripheral zone (number of biopsies) | 0..1 | integer | |
| specimens-left-pz | Left peripheral zone (number of biopsies) | 0..1 | integer | |
| specimens-focus-1 | Focus 1 (number of biopsies) | 0..1 | integer | |
| specimens-focus-2 | Focus 2 (number of biopsies) | 0..1 | integer | |
| specimens-focus-3 | Focus 3 (number of biopsies) | 0..1 | integer | |
| grp-clinical-data | Clinical data | 0..1 | group | |
| psa-ngml | PSA (ng/ml) | 0..1 | quantity | |
| psat-ngml-ml | PSAT (ng/ml/ml) | 0..1 | quantity | |
| prostate-volume-ml | Prostate volume (ml) | 0..1 | quantity | |
| mpmri-pirads | mpMRI PI-RADS assessment | 0..1 | coding | Options: 4 options |
| grp-additional | Additional information | 0..1 | group | |
| additional-info | Additional information | 0..1 | text | |
| Documentation for this format | ||||
Options Sets
Answer options for biopsy-type
Answer options for tissue-fixing-material
Answer options for clinical-diagnosis
Answer options for clinical-t-stage
Answer options for operation-name
Answer options for procedure-type
Answer options for mpmri-pirads
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "questionnaire-prostate-pathologist-referral",
"language": "en",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"url": "https://hl7.lt/fhir/prostate/Questionnaire/prostate-pathologist-referral",
"version": "0.1.0",
"name": "ProstatePathologistReferral",
"title": "Referral to pathologist (E014, form 014-1-1/a)",
"status": "draft",
"subjectType": [
"Patient"
],
"date": "2025-06-01",
"publisher": "Lithuanian Medical Library",
"contact": [
{
"name": "Lithuanian Medical Library",
"telecom": [
{
"system": "url",
"value": "https://medicinosnk.lt"
},
{
"system": "email",
"value": "info@medicinosnk.lt"
}
]
}
],
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "LT"
}
]
}
],
"item": [
{
"linkId": "grp-referral-info",
"text": "Referral information",
"type": "group",
"item": [
{
"linkId": "sending-institution",
"text": "Sending institution",
"type": "string",
"required": true
},
{
"linkId": "sending-section",
"text": "Section / department",
"type": "string"
},
{
"linkId": "treating-physician-name",
"text": "Treating physician (full name)",
"type": "string",
"required": true
},
{
"linkId": "treating-physician-email",
"text": "Treating physician e-mail",
"type": "string"
},
{
"linkId": "treating-physician-phone",
"text": "Treating physician phone",
"type": "string"
},
{
"linkId": "referring-doctor-name",
"text": "Referring doctor (full name)",
"type": "string",
"required": true
},
{
"linkId": "referring-doctor-email",
"text": "Referring doctor e-mail",
"type": "string"
},
{
"linkId": "referring-doctor-phone",
"text": "Referring doctor phone",
"type": "string"
}
]
},
{
"linkId": "grp-biopsy-type",
"text": "Biopsy type",
"type": "group",
"item": [
{
"linkId": "biopsy-type",
"text": "Biopsy type",
"type": "coding",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "biopsy-initial",
"display": "Initial biopsy"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "biopsy-repeat",
"display": "Repeat biopsy"
}
}
]
}
]
},
{
"linkId": "grp-tissue-fixing",
"text": "Tissue fixing",
"type": "group",
"item": [
{
"linkId": "tissue-fixing-material",
"text": "Tissue-fixing material",
"type": "coding",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "fixative-buffered-formalin",
"display": "10% buffered formalin"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "fixative-unfixed",
"display": "Unfixed (no fixative)"
}
}
]
}
]
},
{
"linkId": "grp-clinical-diagnosis",
"text": "Clinical diagnosis",
"type": "group",
"item": [
{
"linkId": "clinical-diagnosis",
"text": "Clinical diagnosis",
"type": "coding",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "dx-n40-gph",
"display": "N40 Glandular prostatic hyperplasia"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "dx-c61",
"display": "C61 Malignant neoplasm of prostate"
}
}
]
},
{
"linkId": "clinical-t-stage",
"text": "Clinical T stage (if C61)",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "ct-1c",
"display": "cT1c"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "ct-2",
"display": "cT2"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "ct-3a",
"display": "cT3a"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "ct-3b",
"display": "cT3b"
}
}
]
}
]
},
{
"linkId": "grp-procedure",
"text": "Procedure",
"type": "group",
"item": [
{
"linkId": "operation-name",
"text": "Operation name",
"type": "coding",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "op-transperineal",
"display": "Transperineal biopsy"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "op-transrectal",
"display": "Transrectal biopsy"
}
}
]
},
{
"linkId": "procedure-type",
"text": "Procedure type",
"type": "coding",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "proc-systematic",
"display": "Systematic biopsy"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "proc-adaptive",
"display": "Adaptive biopsy"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "proc-systematic-targeted",
"display": "Systematic + targeted biopsy"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "proc-applicative-perifocal",
"display": "Applicative + perifocal biopsy"
}
}
]
}
]
},
{
"linkId": "grp-specimens",
"text": "Description of histological object (number of biopsies per location)",
"type": "group",
"item": [
{
"linkId": "specimens-right-pz",
"text": "Right peripheral zone (number of biopsies)",
"type": "integer"
},
{
"linkId": "specimens-left-pz",
"text": "Left peripheral zone (number of biopsies)",
"type": "integer"
},
{
"linkId": "specimens-focus-1",
"text": "Focus 1 (number of biopsies)",
"type": "integer"
},
{
"linkId": "specimens-focus-2",
"text": "Focus 2 (number of biopsies)",
"type": "integer"
},
{
"linkId": "specimens-focus-3",
"text": "Focus 3 (number of biopsies)",
"type": "integer"
}
]
},
{
"linkId": "grp-clinical-data",
"text": "Clinical data",
"type": "group",
"item": [
{
"linkId": "psa-ngml",
"text": "PSA (ng/ml)",
"type": "quantity"
},
{
"linkId": "psat-ngml-ml",
"text": "PSAT (ng/ml/ml)",
"type": "quantity"
},
{
"linkId": "prostate-volume-ml",
"text": "Prostate volume (ml)",
"type": "quantity"
},
{
"linkId": "mpmri-pirads",
"text": "mpMRI PI-RADS assessment",
"type": "coding",
"answerOption": [
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "pirads-cat-1-2",
"display": "PI-RADS 1-2"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "pirads-cat-3",
"display": "PI-RADS 3"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "pirads-cat-4",
"display": "PI-RADS 4"
}
},
{
"valueCoding": {
"system": "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options",
"code": "pirads-cat-5",
"display": "PI-RADS 5"
}
}
]
}
]
},
{
"linkId": "grp-additional",
"text": "Additional information",
"type": "group",
"item": [
{
"linkId": "additional-info",
"text": "Additional information",
"type": "text"
}
]
}
]
}