FHIR IG Statistics: Questionnaire/Questionnaire-RoD-YoungPersonAssentForm-Example

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{
  "resourceType": "Questionnaire",
  "id": "Questionnaire-RoD-YoungPersonAssentForm-Example",
  "url": "https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-YoungPersonAssentForm-Example",
  "version": "0.1.0",
  "name": "QuestionnaireRoDYoungPersonAssentFormExample",
  "title": "National Genomic Research Library Young Person Assent Form (ages 6 – 15)",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "date": "2024-01-18T09:00:00Z",
  "publisher": "NHS England",
  "contact": [
    {
      "name": "NHS England",
      "telecom": [
        {
          "system": "email",
          "value": "interoperabilityteam@nhs.net",
          "use": "work",
          "rank": 1
        }
      ]
    }
  ],
  "description": "This questionnaire is to be used to document the patient consent for young person(ages 6 – 15) before undergoing Genomic testing and their choice of participation in the National Genomic Research Library programme",
  "purpose": "Young Person Assent Form (ages 6 – 15) Regarding Genomic Testing",
  "item": [
    {
      "linkId": "declaration",
      "text": "Feel free to ask any questions before answering the questions below.",
      "type": "display"
    },
    {
      "linkId": "patientDetails",
      "text": "Patient Details",
      "type": "group",
      "item": [
        {
          "linkId": "givenName",
          "text": "First Name",
          "type": "string",
          "required": true
        },
        {
          "linkId": "familyName",
          "text": "Last Name",
          "type": "string",
          "required": true
        },
        {
          "linkId": "nhs_Number",
          "text": "NHS number (or postcode if not not known)",
          "type": "string",
          "required": true
        },
        {
          "linkId": "birthDate",
          "text": "Date of Birth",
          "type": "date",
          "required": true
        }
      ]
    },
    {
      "linkId": "declarationResponse",
      "text": "Please indicate your choices below by ticking the appropriate box:",
      "type": "group",
      "readOnly": true,
      "item": [
        {
          "linkId": "consentQuestion1",
          "text": "1. Have you read information or has someone explained the research to you?",
          "type": "boolean",
          "required": true
        },
        {
          "linkId": "consentQuestion2",
          "text": "2. Have you asked all the questions you want?",
          "type": "boolean",
          "required": true
        },
        {
          "linkId": "consentQuestion3",
          "text": "3. Have you had your questions answered in a way you understand?",
          "type": "boolean",
          "required": true
        },
        {
          "linkId": "consentQuestion4",
          "text": "4. Do you understand it’s OK to say you don’t want to take part – but that your parent(s), or guardian who look after you, will make the final choice?",
          "type": "boolean",
          "required": true
        },
        {
          "linkId": "consentQuestion5",
          "text": "5. Are you happy to take part?",
          "type": "boolean",
          "required": true
        }
      ]
    },
    {
      "linkId": "guidanceNonWillingToConsent",
      "text": "If ANY of your answers are ‘NO’, or you don’t want to take part:",
      "type": "group",
      "item": [
        {
          "linkId": "NonWillingToConsent1",
          "text": "• Don’t sign your name on this form",
          "type": "display"
        },
        {
          "linkId": "NonWillingToConsent2",
          "text": "• Tell your parents and healthcare team how you feel, so they know",
          "type": "display"
        }
      ]
    },
    {
      "linkId": "guidanceWillingToConsent",
      "text": "If ALL of your answers are ‘YES’:",
      "type": "group",
      "item": [
        {
          "linkId": "WillingToConsent",
          "text": "• Please write your name, signature, and today’s date here:",
          "type": "display"
        }
      ]
    },
    {
      "linkId": "isRemoteConsentTrue",
      "text": "Assent obtained remotely, no participant signature",
      "type": "boolean",
      "required": true
    },
    {
      "linkId": "patientValidation",
      "text": "Patient Validation",
      "type": "group",
      "enableWhen": [
        {
          "question": "consentQuestion1",
          "operator": "=",
          "answerBoolean": true
        },
        {
          "question": "consentQuestion2",
          "operator": "=",
          "answerBoolean": true
        },
        {
          "question": "consentQuestion3",
          "operator": "=",
          "answerBoolean": true
        },
        {
          "question": "consentQuestion4",
          "operator": "=",
          "answerBoolean": true
        },
        {
          "question": "consentQuestion5",
          "operator": "=",
          "answerBoolean": true
        },
        {
          "question": "isRemoteConsentTrue",
          "operator": "=",
          "answerBoolean": false
        }
      ],
      "enableBehavior": "all",
      "item": [
        {
          "linkId": "patientNamecombined",
          "text": "Patient Name",
          "type": "string",
          "required": true
        },
        {
          "linkId": "patientSignature",
          "text": "Signature",
          "type": "string",
          "required": true
        },
        {
          "linkId": "datePatientCompletedForm",
          "text": "Date",
          "type": "dateTime",
          "required": true
        }
      ]
    }
  ]
}