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Source1

{
  "resourceType": "Questionnaire",
  "id": "chr-on-west-Questionnaire-1001-AllTypes",
  "meta": {
    "lastUpdated": "2024-12-08T10:00:00Z",
    "source": "urn:telus:emr:chr:on-west",
    "profile": [
      "https://www.telus.com/health/fhir/dwemrextract/StructureDefinition/DwQuestionnaire"
    ]
  },
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "url": "https://www.telus.com/health/fhir/dwemrextract/Questionnaire/chr-on-west-1001",
  "identifier": [
    {
      "system": "urn:telus:emr:chr:on-west:questionnaireid",
      "value": "1001"
    }
  ],
  "version": "1.0",
  "name": "AllSupportedItemTypes",
  "title": "CHR Questionnaire - All Supported Item Types",
  "status": "active",
  "date": "2024-12-08",
  "publisher": "TELUS Health",
  "contact": [
    {
      "name": "TELUS Health",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.telus.com/health"
        }
      ]
    },
    {
      "name": "TELUS Health",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.telus.com/health"
        }
      ]
    }
  ],
  "description": "This questionnaire demonstrates all FHIR R4 item types that are supported by CHR",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "CA",
          "display": "Canada"
        }
      ]
    }
  ],
  "purpose": "To demonstrate and document all FHIR R4 item types supported by CHR FormTemplates and Questionnaires for integration with external FHIR-compliant systems",
  "copyright": "Copyright © 2026 TELUS Health. All rights reserved.",
  "item": [
    {
      "linkId": "section_header",
      "text": "Patient Demographics Section",
      "type": "display",
      "required": false
    },
    {
      "linkId": "patient_name",
      "text": "Patient Full Name",
      "type": "string",
      "required": true
    },
    {
      "linkId": "medical_history",
      "text": "Please describe your medical history",
      "type": "text",
      "required": false
    },
    {
      "linkId": "date_of_birth",
      "text": "Date of Birth",
      "type": "date",
      "required": true
    },
    {
      "linkId": "appointment_time",
      "text": "Preferred appointment time",
      "type": "time",
      "required": false
    },
    {
      "linkId": "has_insurance",
      "text": "Do you have health insurance?",
      "type": "boolean",
      "required": true
    },
    {
      "linkId": "age_years",
      "text": "Age (years)",
      "type": "integer",
      "required": true
    },
    {
      "linkId": "weight_kg",
      "text": "Weight (kg)",
      "type": "decimal",
      "required": false
    },
    {
      "linkId": "gender",
      "text": "Gender",
      "type": "choice",
      "required": true,
      "repeats": false,
      "answerOption": [
        {
          "valueString": "Male"
        },
        {
          "valueString": "Female"
        },
        {
          "valueString": "Other"
        },
        {
          "valueString": "Prefer not to say"
        }
      ]
    },
    {
      "linkId": "symptoms",
      "text": "Select all symptoms you are experiencing",
      "type": "choice",
      "required": false,
      "repeats": true,
      "answerOption": [
        {
          "valueString": "Fever"
        },
        {
          "valueString": "Cough"
        },
        {
          "valueString": "Shortness of breath"
        },
        {
          "valueString": "Fatigue"
        },
        {
          "valueString": "Headache"
        }
      ]
    },
    {
      "linkId": "pain_scale",
      "text": "Rate your pain level (0 = no pain, 10 = worst pain)",
      "type": "choice",
      "required": false,
      "repeats": false,
      "answerOption": [
        {
          "valueString": "0 - No pain"
        },
        {
          "valueString": "1"
        },
        {
          "valueString": "2"
        },
        {
          "valueString": "3"
        },
        {
          "valueString": "4"
        },
        {
          "valueString": "5 - Moderate pain"
        },
        {
          "valueString": "6"
        },
        {
          "valueString": "7"
        },
        {
          "valueString": "8"
        },
        {
          "valueString": "9"
        },
        {
          "valueString": "10 - Worst pain"
        }
      ]
    },
    {
      "linkId": "insurance_details",
      "text": "Please provide insurance details",
      "type": "text",
      "enableWhen": [
        {
          "question": "has_insurance",
          "operator": "=",
          "answerBoolean": true
        }
      ],
      "enableBehavior": "any",
      "required": false
    },
    {
      "linkId": "medications_table",
      "text": "Current Medications",
      "type": "group",
      "required": false,
      "item": [
        {
          "linkId": "medication_name",
          "text": "Medication Name",
          "type": "string",
          "required": false,
          "repeats": true
        },
        {
          "linkId": "dosage",
          "text": "Dosage",
          "type": "string",
          "required": false,
          "repeats": true
        },
        {
          "linkId": "frequency",
          "text": "Frequency",
          "type": "string",
          "required": false,
          "repeats": true
        }
      ]
    },
    {
      "linkId": "patient_signature",
      "text": "Patient Signature",
      "type": "attachment",
      "required": true
    },
    {
      "linkId": "signature_date",
      "text": "Signature Date",
      "type": "date",
      "required": true
    }
  ]
}