Package | nw-gmsa.github.io |
Resource Type | Questionnaire |
Id | GenomicTestOrderFuture |
FHIR Version | R4 |
Source | https://nw-gmsa.github.io/https://build.fhir.org/ig/nw-gmsa/R4/Questionnaire-GenomicTestOrderFuture.html |
URL | https://nw-gmsa.github.io/Questionnaire/GenomicTestOrderFuture |
Version | 0.0.7 |
Status | draft |
Date | 2025-08-10T08:12:52+00:00 |
Title | North West Genomics Test Order |
Realm | uk |
Description | THIS IS FOR ANALYSIS, and is not to be used for implementation at present. The aim of this is to support conversion of multiple Genomic Order Forms HL7 v2 and FHIR. |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire GenomicTestOrderFuture
StructureLinkID | Text | Cardinality | Type | Description & Constraints |
---|---|---|---|---|
![]() ![]() | THIS IS FOR ANALYSIS, and is not to be used for implementation at present. The aim of this is to support conversion of multiple Genomic Order Forms HL7 v2 and FHIR. | Questionnaire | https://nw-gmsa.github.io/Questionnaire/GenomicTestOrderFuture#0.0.7 | |
![]() ![]() ![]() | Patient | 0..1 | group | Definition: Patient |
![]() ![]() ![]() ![]() | Patient surname | 1..1 | string | Definition: Patient.name.family |
![]() ![]() ![]() ![]() | Patient first name | 1..1 | string | Definition: Patient.name.given |
![]() ![]() ![]() ![]() | Date of birth | 1..1 | date | Definition: Patient.birthDate |
![]() ![]() ![]() ![]() | Date of death | 0..1 | date | Definition: Patient.deceasedDateTime |
![]() ![]() ![]() ![]() | Address | 0..1 | group | Definition: Patient.address |
![]() ![]() ![]() ![]() ![]() | Address Line | 0..* | string | Definition: Patient.address.line |
![]() ![]() ![]() ![]() ![]() | City | 0..1 | string | Definition: Patient.address.city |
![]() ![]() ![]() ![]() ![]() | Postcode | 0..1 | string | Definition: Patient.address.postalCode |
![]() ![]() ![]() ![]() | Sex registered at birth | 0..1 | choice | Definition: Patient.gender Value Set: AdministrativeGender |
![]() ![]() ![]() ![]() | Ethnic Category | 0..1 | choice | Definition: Patient.extension:ethnicCategory Value Set: Ethnicity |
![]() ![]() ![]() ![]() | NHS Number | 0..1 | string | Definition: Patient.identifier:nhsNumber |
![]() ![]() ![]() ![]() | Hospital Number (Medical Record Number) | 1..1 | string | Definition: Patient.identifier:MedicalRecordNumber |
![]() ![]() ![]() ![]() | Account Number (Episode or Stay Number) | 0..1 | string | Definition: ServiceRequest.encounter.identifier.value |
![]() ![]() ![]() ![]() ![]() | PV1-19 (also known as stay number) | 0..1 | display | |
![]() ![]() ![]() ![]() | Age at collection | 0..1 | decimal | |
![]() ![]() ![]() ![]() | Location | 0..1 | string | |
![]() ![]() ![]() ![]() | GP Surgery (ODS Code) | 0..1 | choice | Definition: Patient.generalPractitioner |
![]() ![]() ![]() | Healthcare Professional | 0..1 | group | Definition: PractitionerRole |
![]() ![]() ![]() ![]() | Referring Clinician Name | 1..1 | string | Definition: PractitionerRole.practitioner.display |
![]() ![]() ![]() ![]() | Referring Clinician Current Speciality | 1..1 | choice | Definition: PractitionerRole.specialty.coding.code Value Set: UK Core Practice Setting Code |
![]() ![]() ![]() ![]() | Referring Clinician Professional Identifier | 1..1 | string | Definition: PractitionerRole.practitioner.identifier.value |
![]() ![]() ![]() ![]() | 0..1 | string | Definition: PractitionerRole.telecom.value | |
![]() ![]() ![]() ![]() | Phone | 0..1 | string | Definition: PractitionerRole.telecom.value |
![]() ![]() ![]() ![]() | Referring Organisation ODS Code | 0..1 | string | Definition: PractitionerRole.organization.identifier.value |
![]() ![]() ![]() | Test Request | 0..1 | group | Definition: ServiceRequest |
![]() ![]() ![]() ![]() | Test Category | 0..1 | choice | Definition: ServiceRequest.category Value Set: Order Category |
![]() ![]() ![]() ![]() | Test Code (Rare and inherited diseases) | 1..* | choice | Definition: ServiceRequest.code Enable When: SNM/15220000 = Value Set: Genomic Rare and Inherited Disease Test Directory |
![]() ![]() ![]() ![]() | Test Code (Haemoglobinopathy) | 1..* | choice | Definition: ServiceRequest.code Enable When: SNM/15220000 = Options: 5 options |
![]() ![]() ![]() ![]() | Test Code (Cancer) | 1..* | choice | Definition: ServiceRequest.code Enable When: SNM/15220000 = Value Set: Genomic Cancer Test Directory |
![]() ![]() ![]() ![]() | G Number (Pedigree Number) - Order Group Number | 0..1 | string | Definition: ServiceRequest.requisition |
![]() ![]() ![]() ![]() | Test request ID/Order ID | 0..1 | string | Definition: ServiceRequest.identifier:placerOrderNumber |
![]() ![]() ![]() ![]() | Priority | 0..1 | choice | Definition: ServiceRequest.priority Value Set: Request Priority |
![]() ![]() ![]() ![]() | Consent | 0..1 | group | |
![]() ![]() ![]() ![]() ![]() | Has consent has been obtained for tests (Y/N) | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 2 options |
![]() ![]() ![]() ![]() ![]() | Has consent has been obtained for DNA storage (Y/N) | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 2 options |
![]() ![]() ![]() ![]() ![]() | ROD attached or to follow | 0..1 | choice | Options: 3 options |
![]() ![]() ![]() ![]() | Patient Clinical Information | 0..1 | group | |
![]() ![]() ![]() ![]() ![]() | CITT code (Specific disease suspected/reason for testing) | 0..* | choice | Definition: ServiceRequest.reasonCode Value Set: Genomic Condition Codes |
![]() ![]() ![]() ![]() ![]() | Relevant clinical information and family history | 0..1 | string | Definition: ServiceRequest.note |
![]() ![]() ![]() | Specimen/Biopsy | 0..1 | group | Definition: Specimen |
![]() ![]() ![]() ![]() | Specimen ID Number / Lab DNA Number (If Known) | 0..1 | string | Definition: Specimen.identifier.value |
![]() ![]() ![]() ![]() ![]() | ORM v2.4 - OBX-3 = LOINC 80398-1 and OBX-2 = CE. OML v2.5.1 SPM-2 | 0..1 | display | |
![]() ![]() ![]() ![]() | Pathology Laboratory Hospital/Trust ID | 0..1 | string | Definition: Specimen.identifier.assigner.identifier.value |
![]() ![]() ![]() ![]() | Specimen Collection Date | 0..1 | dateTime | Definition: Specimen.collection.collectedDateTime |
![]() ![]() ![]() ![]() ![]() | ORM v2.4 - OBX-3 = LOINC 33882-2 and OBX-2 = TS . OML v2.5.1 SPM-17 | 0..1 | display | |
![]() ![]() ![]() ![]() | Specimen Type | 0..1 | choice | Definition: Specimen.type.coding.code Value Set: Specimen Type |
![]() ![]() ![]() ![]() ![]() | ORM v2.4 - OBX-3 = LOINC 66746-9 and OBX-2 = CE. OML v2.5.1 SPM-4 | 0..1 | display | |
![]() ![]() ![]() ![]() | High Infection Risk? | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 2 options |
![]() ![]() ![]() ![]() | Anticoagulant/preservative? | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 2 options |
![]() ![]() ![]() ![]() | Tissue source/organ of origin | 0..1 | choice | Definition: Specimen.collection.bodySite |
![]() ![]() ![]() ![]() | Specimen Volume/number of slides or scrolls | 0..1 | string | Definition: Specimen.collection.quantity |
![]() ![]() ![]() ![]() | Audit (Specimen Tracking) | 0..1 | group | Definition: Specimen.collection |
![]() ![]() ![]() ![]() ![]() | Date and time sample received in lab | 0..1 | date | Definition: Specimen.receivedTime |
![]() ![]() ![]() ![]() ![]() | Date and time sample sent | 0..1 | date | |
![]() ![]() ![]() ![]() ![]() | Transport used | 0..1 | string | |
![]() ![]() ![]() ![]() ![]() | Tracking number | 0..1 | string | |
![]() ![]() ![]() ![]() ![]() | Sample sent to | 0..1 | string | |
![]() ![]() ![]() ![]() ![]() | Name of person who sent sample | 0..1 | string | |
![]() ![]() ![]() | Ask At Order Entry Questions | 0..1 | group | |
![]() ![]() ![]() ![]() | Patient is from consanguineous union? | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 3 options |
![]() ![]() ![]() ![]() | Confirm that a pathology report will be provided alongside the sample. | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 3 options |
![]() ![]() ![]() ![]() | Reason for variant re-interpretation request | 0..1 | string | Definition: Observation.valueCodeableConcept |
![]() ![]() ![]() ![]() | Specimen Source (Blood Restrictions) | 0..1 | string | Definition: Observation.valueCodeableConcept |
![]() ![]() ![]() ![]() | Clinical Indication | 0..1 | choice | Definition: Observation.valueCodeableConcept Value Set: http://snomed.info/sct/900000000000207008?fhir_vs=ecl/<782964007 |
![]() ![]() ![]() ![]() | Please enter the trisomy screening risk (including the chromosome of interest if appropriate). | 0..1 | string | Definition: Observation.valueCodeableConcept |
![]() ![]() ![]() ![]() | Transplant? | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 3 options |
![]() ![]() ![]() ![]() ![]() | Transplant Type | 0..1 | choice | Enable When: SNM/782902008 = Value Set: http://snomed.info/sct/900000000000207008?fhir_vs=ecl/<737294004 |
![]() ![]() ![]() ![]() | Advanced Lung Cancer Stage | 0..1 | choice | Value Set: http://snomed.info/sct/900000000000207008?fhir_vs=ecl/<1222594003 |
![]() ![]() ![]() ![]() | Extra Testing Form Completed? | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 3 options |
![]() ![]() ![]() ![]() ![]() | Please Note That An Additional Test Order Form 'Whole Genome Sequencing Rare Disease Order Form (Link at Top of Form)' is Required To Activate Testing. If This is Not Received, The DNA Will Be Extracted and Stored | 0..1 | display | |
![]() ![]() ![]() ![]() | Does this test relate to an ongoing pregnancy? | 0..1 | choice | Definition: Observation.valueCodeableConcept Options: 3 options |
![]() ![]() ![]() ![]() ![]() | Pregnant | 0..1 | group | Enable When: SNM/77386006 = |
![]() ![]() ![]() ![]() ![]() ![]() | Does this test relate to a pregnancy with > 1 fetus? | 0..1 | string | Definition: Observation.valueCodeableConcept Options: 3 options |
![]() ![]() ![]() ![]() ![]() ![]() | Patient expected delivery date | 0..1 | date | Definition: Observation.valueDateTime |
![]() ![]() ![]() ![]() ![]() ![]() | Patient gestation | 0..1 | integer | Definition: Observation.valueQuantity |
![]() ![]() ![]() ![]() ![]() ![]() | What were the Abnormal Scan Findings | 0..1 | string | Definition: Observation.valueQuantity |
![]() ![]() ![]() | Prior Results | 0..1 | group | |
![]() ![]() ![]() ![]() | Haemoglobinopathy Testing Prior Results | 0..1 | group | Enable When: SNM/15220000 = |
![]() ![]() ![]() ![]() ![]() | CBC panel - Blood by Automated count | 0..1 | reference | |
![]() ![]() ![]() ![]() ![]() ![]() | See Questionnaire [CBC panel - Blood by Automated count](https://nw-gmsa.github.io/R4/Questionnaire-58410-2.html) | 0..1 | display | |
![]() ![]() ![]() ![]() | Rare and Inherited Disease Prior Results | 0..1 | group | Enable When: SNM/15220000 = |
![]() ![]() ![]() ![]() | Cancer Testing Prior Results | 0..1 | group | Enable When: SNM/15220000 = |
![]() ![]() ![]() ![]() ![]() | Unknown Results Panel | 0..1 | group | |
![]() ![]() ![]() ![]() ![]() ![]() | Neoplastic Cell Content Level | 0..1 | quantity | Definition: Observation.valueQuantity |
![]() ![]() ![]() ![]() ![]() ![]() | Neoplastic Cell Content Level % | 0..1 | quantity | Definition: Observation.valueQuantity |
![]() ![]() ![]() ![]() ![]() | Macrodissection Requirements | 0..1 | string | |
![]() ![]() ![]() ![]() ![]() | Blast Cell Count | 0..1 | quantity | Definition: Observation.valueQuantity |
Options Sets
Answer options for HL7/OBR-4-h
Answer options for LN/19826-7
Answer options for LN/75520-7
Answer options for consent-3
Answer options for SNM/281269004
Answer options for LN/74384-9
Answer options for SNM/842009
Answer options for SNM/74996004-pathology-report
Answer options for SNM/782902008
Answer options for SNM/74996004
Answer options for SNM/77386006
Answer options for SNM/370386005
{ "resourceType": "Questionnaire", "id": "GenomicTestOrderFuture", "text": { "status": "extensions", "div": "<!-- snip (see above) -->" }, "url": "https://nw-gmsa.github.io/Questionnaire/GenomicTestOrderFuture", "version": "0.0.7", "title": "North West Genomics Test Order", "status": "draft", "date": "2025-08-10T08:12:52+00:00", "publisher": "NHS North West GMSA", "contact": [ { "telecom": [ { "system": "url", "value": "https://www.nw-gmsa.nhs.uk/contact-us" } ] } ], "description": "THIS IS FOR ANALYSIS, and is not to be used for implementation at present.\n\nThe aim of this is to support conversion of multiple Genomic Order Forms HL7 v2 and FHIR.", "jurisdiction": [ { "coding": [ { "system": "urn:iso:std:iso:3166", "code": "GB", "display": "United Kingdom of Great Britain and Northern Ireland" } ] } ], "item": [ { "linkId": "Patient", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient", "text": "Patient", "type": "group", "item": [ { "linkId": "LN/45394-4", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.name.family", "code": [ { "system": "http://loinc.org", "code": "45394-4" } ], "text": "Patient surname", "type": "string", "required": true }, { "linkId": "LN/45392-8", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.name.given", "code": [ { "system": "http://loinc.org", "code": "45392-8" } ], "text": "Patient first name", "type": "string", "required": true }, { "linkId": "LN/21112-8", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.birthDate", "code": [ { "system": "http://loinc.org", "code": "21112-8" } ], "text": "Date of birth", "type": "date", "required": true }, { "linkId": "LN/81954-0", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.deceasedDateTime", "code": [ { "system": "http://loinc.org", "code": "81954-0" } ], "text": "Date of death", "type": "date", "required": false }, { "linkId": "LN/56799-0", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.address", "code": [ { "system": "http://loinc.org", "code": "56799-0" } ], "text": "Address", "type": "group", "item": [ { "linkId": "HL7/PID-11-1", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.address.line", "text": "Address Line", "type": "string", "repeats": true }, { "linkId": "HL7/PID-11-3", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.address.city", "text": "City", "type": "string" }, { "linkId": "LN/45401-7", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.address.postalCode", "code": [ { "system": "http://loinc.org", "code": "45401-7" } ], "text": "Postcode", "type": "string" } ] }, { "linkId": "LN/46098-0", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.gender", "code": [ { "system": "http://loinc.org", "code": "46098-0" } ], "text": "Sex registered at birth", "type": "choice", "answerValueSet": "http://hl7.org/fhir/ValueSet/administrative-gender" }, { "linkId": "LN/32624-9", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.extension:ethnicCategory", "code": [ { "system": "http://loinc.org", "code": "32624-9" } ], "text": "Ethnic Category", "type": "choice", "answerValueSet": "https://nw-gmsa.github.io/ValueSet/ethnicity" }, { "linkId": "LN/89061-6", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.identifier:nhsNumber", "code": [ { "system": "http://loinc.org", "code": "89061-6" } ], "text": "NHS Number", "type": "string" }, { "linkId": "LN/76435-7", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.identifier:MedicalRecordNumber", "code": [ { "system": "http://loinc.org", "code": "76435-7" } ], "text": "Hospital Number (Medical Record Number)", "type": "string", "required": true }, { "linkId": "LN/56797-4", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.encounter.identifier.value", "code": [ { "system": "http://loinc.org", "code": "56797-4" } ], "text": "Account Number (Episode or Stay Number)", "type": "string", "required": false, "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "help" } ] } } ], "linkId": "LN/56797-4-designNote", "text": "PV1-19 (also known as stay number)", "type": "display" } ] }, { "linkId": "ageAtCollection", "text": "Age at collection", "type": "decimal" }, { "linkId": "location", "text": "Location", "type": "string" }, { "linkId": "HL7/PD1-3", "definition": "https://nw-gmsa.github.io/StructureDefinition/Patient#Patient.generalPractitioner", "text": "GP Surgery (ODS Code)", "type": "choice" } ] }, { "linkId": "HealthcareProfessional", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole", "text": "Healthcare Professional", "type": "group", "item": [ { "linkId": "LN/18705-4", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole.practitioner.display", "code": [ { "system": "http://loinc.org", "code": "18705-4" } ], "text": "Referring Clinician Name", "type": "string", "required": true }, { "linkId": "LN/18707-0", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole.specialty.coding.code", "code": [ { "system": "http://loinc.org", "code": "18707-0" } ], "text": "Referring Clinician Current Speciality", "type": "choice", "required": true, "answerValueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode" }, { "linkId": "LN/46608-6", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole.practitioner.identifier.value", "code": [ { "system": "http://loinc.org", "code": "46608-6" } ], "text": "Referring Clinician Professional Identifier", "type": "string", "required": true }, { "linkId": "LN/89058-2", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value", "code": [ { "system": "http://loinc.org", "code": "89058-2", "display": "Contact email address" } ], "text": "Email", "type": "string" }, { "linkId": "LN/81230-5", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value", "code": [ { "system": "http://loinc.org", "code": "81230-5" } ], "text": "Phone", "type": "string" }, { "linkId": "HL7/ORC-21", "definition": "https://nw-gmsa.github.io/StructureDefinition/PractitionerRole#PractitionerRole.organization.identifier.value", "text": "Referring Organisation ODS Code", "type": "string" } ] }, { "linkId": "TestRequest", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest", "text": "Test Request", "type": "group", "item": [ { "linkId": "SNM/15220000", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.category", "code": [ { "system": "http://snomed.info/sct", "code": "15220000", "display": "Laboratory test" } ], "text": "Test Category", "type": "choice", "answerValueSet": "https://nw-gmsa.github.io/ValueSet/order-category" }, { "linkId": "HL7/OBR-4-r", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.code", "code": [ { "system": "http://loinc.org", "code": "29300-1" } ], "text": "Test Code (Rare and inherited diseases)", "type": "choice", "enableWhen": [ { "question": "SNM/15220000", "operator": "=", "answerCoding": { "system": "https://nw-gmsa.github.io/CodeSystem/NWGMSA", "code": "RareAndInheritedDiseasesGeneticTesting" } } ], "required": true, "repeats": true, "answerValueSet": "https://nw-gmsa.github.io/ValueSet/GenomicRareAndInheritedDisease" }, { "linkId": "HL7/OBR-4-h", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.code", "code": [ { "system": "http://loinc.org", "code": "29300-1" } ], "text": "Test Code (Haemoglobinopathy)", "type": "choice", "enableWhen": [ { "question": "SNM/15220000", "operator": "=", "answerCoding": { "system": "https://nw-gmsa.github.io/CodeSystem/NWGMSA", "code": "HaemoglobinopathyGeneticTesting" } } ], "required": true, "repeats": true, "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code": "R361.1", "display": "Sickle cell, thalassaemia and other haemoglobinopathies trait or carrier testing" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code": "R361.2", "display": "Sickle cell, thalassaemia and other haemoglobinopathies trait or carrier testing" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code": "R372.1", "display": "Newborn screening for sickle cell disease in a transfused baby" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code": "R93.1", "display": "Sickle cell, thalassaemia and other haemoglobinopathies" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code": "R93.2", "display": "Sickle cell, thalassaemia and other haemoglobinopathies" } } ] }, { "linkId": "HL7/OBR-4-c", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.code", "code": [ { "system": "http://loinc.org", "code": "29300-1" } ], "text": "Test Code (Cancer)", "type": "choice", "enableWhen": [ { "question": "SNM/15220000", "operator": "=", "answerCoding": { "system": "https://nw-gmsa.github.io/CodeSystem/NWGMSA", "code": "CancerGeneticTesting" } } ], "required": true, "repeats": true, "answerValueSet": "https://nw-gmsa.github.io/ValueSet/GenomicCancer" }, { "linkId": "pedigreeNumber", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.requisition", "text": "G Number (Pedigree Number) - Order Group Number", "type": "string" }, { "linkId": "LN/106194-4", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.identifier:placerOrderNumber", "code": [ { "system": "http://loinc.org", "code": "106194-4" } ], "text": "Test request ID/Order ID", "type": "string", "required": false }, { "linkId": "LN/82768-3", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.priority", "code": [ { "system": "http://loinc.org", "code": "82768-3" } ], "text": "Priority", "type": "choice", "required": false, "answerValueSet": "https://nw-gmsa.github.io/ValueSet/RequestPriority" }, { "linkId": "Consent", "text": "Consent", "type": "group", "item": [ { "linkId": "LN/19826-7", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "309370004", "display": "Consent status" }, { "system": "http://loinc.org", "code": "19826-7", "display": "Informed consent obtained" }, { "system": "http://loinc.org", "code": "59284-0", "display": "Consent Document" } ], "text": "Has consent has been obtained for tests (Y/N)", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } } ] }, { "linkId": "LN/75520-7", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://loinc.org", "code": "75520-7", "display": "Biobank specimens are stored and available for research" } ], "text": "Has consent has been obtained for DNA storage (Y/N)", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } } ] }, { "linkId": "consent-3", "text": "ROD attached or to follow", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA4489-6", "display": "Unknown" } } ] } ] }, { "linkId": "PatientClinicalInformation", "text": "Patient Clinical Information", "type": "group", "item": [ { "linkId": "LN/51967-8", "definition": "https://nw-gmsa.github.io/StructureDefinition/ServiceRequest#ServiceRequest.reasonCode", "code": [ { "system": "http://loinc.org", "code": "51967-8" }, { "system": "http://snomed.info/sct", "code": "782964007", "display": "Genetic disease" } ], "text": "CITT code (Specific disease suspected/reason for testing)", "type": "choice", "repeats": true, "answerValueSet": 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"LN/80398-1-designNote", "text": "ORM v2.4 - OBX-3 = LOINC 80398-1 and OBX-2 = CE. 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v2.5.1 SPM-17", "type": "display" } ] }, { "linkId": "LN/66746-9", "definition": "https://nw-gmsa.github.io/StructureDefinition/Specimen#Specimen.type.coding.code", "code": [ { "system": "http://loinc.org", "code": "66746-9", "display": "Specimen Type" }, { "system": "http://snomed.info/sct", "code": "123038009", "display": "Specimen" } ], "text": "Specimen Type", "type": "choice", "answerValueSet": "https://nw-gmsa.github.io/ValueSet/specimen-type", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "help" } ] } } ], "linkId": "LN/66746-9-designNote", "text": "ORM v2.4 - OBX-3 = LOINC 66746-9 and OBX-2 = CE.\nOML v2.5.1 SPM-4", "type": "display" } ] }, { "linkId": "SNM/281269004", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "281269004", "display": "High infection risk sample" } ], "text": "High Infection Risk?", "type": "choice", "required": false, "repeats": false, "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } } ] }, { "linkId": "LN/74384-9", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "434711009", "display": "Specimen container" }, { "system": "http://loinc.org", "code": "74384-9" } ], "text": "Anticoagulant/preservative?", "type": "choice", "required": false, "repeats": false, "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } } ] }, { "linkId": "LN/39111-0", "definition": "https://nw-gmsa.github.io/StructureDefinition/Specimen#Specimen.collection.bodySite", "code": [ { "system": "http://loinc.org", "code": "39111-0" }, { "system": "http://loinc.org", "code": "31208-2", "display": "Specimen source identified" } ], "text": "Tissue source/organ of origin", "type": "choice" }, { "linkId": "LN/3169-0", "definition": "https://nw-gmsa.github.io/StructureDefinition/Specimen#Specimen.collection.quantity", "code": [ { "system": "http://loinc.org", "code": "3169-0", "display": "Volume of Specimen" }, { "system": "http://loinc.org", "code": "42185-9", "display": "Number of specimens obtained" } ], "text": "Specimen Volume/number of slides or scrolls", "type": "string" }, { "linkId": "OrderTracking", "definition": "https://nw-gmsa.github.io/StructureDefinition/Specimen#Specimen.collection", "text": "Audit (Specimen Tracking)", "type": "group", "item": [ { "linkId": "NOS/xxxx1", "definition": "https://nw-gmsa.github.io/StructureDefinition/Specimen#Specimen.receivedTime", "text": "Date and time sample received in lab", "type": "date" }, { "linkId": "NOS/xxxx2", "text": "Date and time sample sent", "type": "date" }, { "linkId": "NOS/xxxx3", "text": "Transport used", "type": "string" }, { "linkId": "LN/97209-1", "code": [ { "system": "http://loinc.org", "code": "97209-1" } ], "text": "Tracking number", "type": "string" }, { "linkId": "NOS/xxxx5", "text": "Sample sent to", "type": "string" }, { "linkId": "NOS/xxxx6", "text": "Name of person who sent sample", "type": "string" } ] } ] }, { "linkId": "AskAtOrderEntry", "text": "Ask At Order Entry Questions", "type": "group", "item": [ { "linkId": "SNM/842009", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "842009", "display": "Consanguinity" } ], "text": "Patient is from consanguineous union?", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA4489-6", "display": "Unknown" } } ] }, { "linkId": "SNM/74996004-pathology-report", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "74996004", "display": "Confirmation of" } ], "text": "Confirm that a pathology report will be provided alongside the sample.", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA4489-6", "display": "Unknown" } } ] }, { "linkId": "SNM/385675009", "definition": 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"url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer", "valueUrl": "https://snowstorm.ihtsdotools.org/fhir" } ], "linkId": "SNM/782964007", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "782964007", "display": "Genetic disease" }, { "system": "http://loinc.org", "code": "51967-8", "display": "Genetic disease assessed [ID]" } ], "text": "Clinical Indication", "type": "choice", "answerValueSet": "http://snomed.info/sct/900000000000207008?fhir_vs=ecl/<782964007" }, { "linkId": "SNM/78989007", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "78989007", "display": "Trisomy" }, { "system": "http://loinc.org", "code": "75560-3", "display": "Fetal Trisomy 21 prior risk [Likelihood] Based on maternal age" } ], "text": "Please enter the trisomy screening risk (including the chromosome of interest if appropriate).", "type": "string" }, { "linkId": "SNM/782902008", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "782902008", "display": "Implantation procedure" } ], "text": "Transplant?", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA4489-6", "display": "Unknown" } } ], "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "autocomplete" } ] } }, { "url": "http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer", "valueUrl": 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If This is Not Received, The DNA Will Be Extracted and Stored", "type": "display" } ] }, { "linkId": "SNM/77386006", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "77386006", "display": "Pregnancy" } ], "text": "Does this test relate to an ongoing pregnancy?", "type": "choice", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA4489-6", "display": "Unknown" } } ], "item": [ { "linkId": "pregnant", "text": "Pregnant", "type": "group", "enableWhen": [ { "question": "SNM/77386006", "operator": "=", "answerCoding": { "system": "http://loinc.org", "code": "LA33-6" } } ], "item": [ { "linkId": "SNM/370386005", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueCodeableConcept", "code": [ { "system": "http://snomed.info/sct", "code": "370386005", "display": "Ultrasound scan - multiple fetus" } ], "text": "Does this test relate to a pregnancy with > 1 fetus?", "type": "string", "answerOption": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA33-6", "display": "Yes" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "valueCoding": { "system": "http://loinc.org", "code": "LA4489-6", "display": "Unknown" } } ] }, { "linkId": "SNM/161714006", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueDateTime", "code": [ { "system": "http://snomed.info/sct", "code": "161714006", "display": "Estimated date of delivery" } ], "text": "Patient expected delivery date", "type": "date" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding": { "system": "http://unitsofmeasure.org", "code": "wk", "display": "Wk" } } ], "linkId": "SNM/598151000005105", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueQuantity", "code": [ { "system": "http://snomed.info/sct", "code": "598151000005105", "display": "Gestational age" } ], "text": "Patient gestation", "type": "integer" }, { "linkId": "SNM/169222003", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueQuantity", "code": [ { "system": "http://snomed.info/sct", "code": "169222003", "display": "US obstetric scan abnormal" } ], "text": "What were the Abnormal Scan Findings", "type": "string" } ] } ] } ] }, { "linkId": "PriorResults", "text": "Prior Results", "type": "group", "item": [ { "linkId": "HaemoglobinopathyTestResults", "text": "Haemoglobinopathy Testing Prior Results", "type": "group", "enableWhen": [ { "question": "SNM/15220000", "operator": "=", "answerCoding": { "system": "https://nw-gmsa.github.io/CodeSystem/NWGMSA", "code": "HaemoglobinopathyGeneticTesting" } } ], "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile", "valueCanonical": "https://nw-gmsa.github.io/StructureDefinition/Observation-Panel" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource", "valueCode": "Observation" } ], "linkId": "LN/58410-2", "text": "CBC panel - Blood by Automated count", "type": "reference", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "help" } ] } } ], "linkId": "LN/58410-2-designNote", "text": "See Questionnaire [CBC panel - Blood by Automated count](https://nw-gmsa.github.io/R4/Questionnaire-58410-2.html)", "type": "display" } ] } ] }, { "linkId": "RareAndInheritedDiseasesGeneticTesting", "text": "Rare and Inherited Disease Prior Results", "type": "group", "enableWhen": [ { "question": "SNM/15220000", "operator": "=", "answerCoding": { "system": "https://nw-gmsa.github.io/CodeSystem/NWGMSA", "code": "RareAndInheritedDiseasesGeneticTesting" } } ] }, { "linkId": "CancerGeneticTesting", "text": "Cancer Testing Prior Results", "type": "group", "enableWhen": [ { "question": "SNM/15220000", "operator": "=", "answerCoding": { "system": "https://nw-gmsa.github.io/CodeSystem/NWGMSA", "code": "CancerGeneticTesting" } } ], "item": [ { "linkId": "UnknownResultsPanel", "text": "Unknown Results Panel", "type": "group", "item": [ { "linkId": "SNM/250537006", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueQuantity", "code": [ { "system": "http://snomed.info/sct", "code": "250537006", "display": "Histopathology finding (finding)" } ], "text": "Neoplastic Cell Content Level", "type": "quantity" }, { "linkId": "NOS/230031", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueQuantity", "code": [ { "system": "http://snomed.info/sct", "code": "250537006", "display": "Histopathology finding (finding)" } ], "text": "Neoplastic Cell Content Level %", "type": "quantity" } ] }, { "linkId": "SNM/252416005", "code": [ { "system": "http://snomed.info/sct", "code": "252416005", "display": "Histopathology test (procedure)" } ], "text": "Macrodissection Requirements", "type": "string" }, { "linkId": "NOS/230033", "definition": "https://nw-gmsa.github.io/StructureDefinition/Observation#Observation.valueQuantity", "code": [ { "system": "https://nw-gmsa.github.io/CodeSystem/MFTQuestionIds", "code": "230033", "display": "BLAST CELL COUNT" } ], "text": "Blast Cell Count", "type": "quantity" } ] } ] } ] }