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Packageuk.nhsdigital.r4
Resource TypeQuestionnaire
IdQuestionnaire-Patient-Registration.json
FHIR VersionR4

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Source1

{
  "resourceType": "Questionnaire",
  "id": "0300f7e6-3a1c-4931-b7b7-e5099a883248",
  "title": "Patient Registration",
  "url": "https://example.nhs.uk/Questionnaire/Patient-Registration",
  "subjectType": [
    "Patient"
  ],
  "name": "PatientRegistration",
  "status": "draft",
  "item": [
    {
      "text": "Title",
      "type": "string",
      "linkId": "prefix",
      "required": true
    },
    {
      "text": "First Name",
      "linkId": "forename",
      "type": "string",
      "required": true
    },
    {
      "text": "Middle Name(s)",
      "linkId": "middlenames",
      "type": "string",
      "required": false
    },
    {
      "text": "Last name",
      "linkId": "surname",
      "type": "string",
      "required": true
    },
    {
      "text": "Previous last name",
      "linkId": "previous_surname",
      "type": "string"
    },
    {
      "text": "Date of Birth",
      "linkId": "date_of_birth",
      "type": "date",
      "required": true
    },
    {
      "text": "NHS Number (if known)",
      "linkId": "nhs_number",
      "type": "string",
      "maxLength": 10
    },
    {
      "text": "Your postcode used when you last registered with a UK GP",
      "linkId": "previous_postcode",
      "type": "string"
    },
    {
      "text": "Your current address",
      "linkId": "current_address",
      "type": "string"
    },
    {
      "text": "Contact Preference",
      "linkId": "contact_group",
      "type": "group",
      "repeats": true,
      "item": [
        {
          "text": "Contact Type",
          "linkId": "contact_type",
          "type": "choice",
          "required": false,
          "answerValueSet": "http://hl7.org/fhir/ValueSet/contact-point-system"
        },
        {
          "text": "Contact Number or email",
          "linkId": "contact_value",
          "type": "string"
        }
      ]
    },
    {
      "text": "Gender assigned at Birth",
      "linkId": "gender_birth",
      "type": "choice",
      "answerOption": [
        {
          "valueCoding": {
            "system": "http://hl7.org/fhir/administrative-gender",
            "code": "female",
            "display": "Female"
          }
        },
        {
          "valueCoding": {
            "system": "http://hl7.org/fhir/administrative-gender",
            "code": "male",
            "display": "Male"
          }
        },
        {
          "valueCoding": {
            "system": "http://hl7.org/fhir/administrative-gender",
            "code": "other",
            "display": "Non Binary"
          }
        },
        {
          "valueCoding": {
            "system": "http://hl7.org/fhir/administrative-gender",
            "code": "unknown",
            "display": "Prefer to self describe"
          }
        }
      ]
    },
    {
      "text": "Ethnic Category",
      "linkId": "ethnic",
      "type": "choice",
      "required": false,
      "answerValueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-DeathNotificationStatus"
    },
    {
      "text": "Have you ever been a member of the UK Armed Forces or are a family member registered with the Defence Medical Services?",
      "linkId": "armed_forces",
      "type": "boolean"
    }
  ],
  "description": "A form to be used in conjunction with patient registration workflows"
}