FHIR IG analytics| Package | uk.nhsengland.genomics.r4 |
| Resource Type | QuestionnaireResponse |
| Id | QuestionnaireResponse-RoD-Example.json |
| FHIR Version | R4 |
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FHIR
FHIRsmith{
"resourceType": "QuestionnaireResponse",
"id": "QuestionnaireResponse-RoD-Example",
"questionnaire": "https://fhir.nhs.uk/Questionnaire/NHSDigital-Questionnaire-Genomics-Example",
"status": "completed",
"subject": {
"reference": "Patient/Patient-LindsaySorrell-Example",
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9449307946"
}
},
"authored": "2023-08-21",
"author": {
"identifier": {
"system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
"value": "9999999996"
},
"display": "Test AHP"
},
"source": {
"reference": "Patient/Patient-LindsaySorrell-Example",
"identifier": {
"system": "https://fhir.nhs.uk/Id/nhs-number",
"value": "9449307946"
}
},
"item": [
{
"linkId": "patientDetails",
"text": "Patient Details",
"item": [
{
"linkId": "givenName",
"text": "First Name",
"answer": [
{
"valueString": "Lindsay"
}
]
},
{
"linkId": "familyName",
"text": "Last Name",
"answer": [
{
"valueString": "Sorrell"
}
]
},
{
"linkId": "nhs_Number",
"text": "NHS number (or postcode if not not known)",
"answer": [
{
"valueString": "944 9307 946"
}
]
},
{
"linkId": "birthDate",
"text": "Date of Birth",
"answer": [
{
"valueDate": "2011-04-12"
}
]
}
]
},
{
"linkId": "declaration4",
"text": "Confirmation of Your Genomic Test and Research Choices",
"item": [
{
"linkId": "confirmation",
"text": "I confirm that I have had the opportunity to discuss information about genomic testing, I agree to the genomic test, and my research choice is indicated below.",
"item": [
{
"linkId": "researchConfirmation1",
"text": "I have discussed taking part in the National Genomic Research Library. If your answer to A is NO then please ignore B and sign directly below",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "researchConfirmation2",
"text": "I agree that my data and remainder sample may contribute to the National Genomic Research Library",
"answer": [
{
"valueBoolean": true
}
]
}
]
}
]
},
{
"linkId": "isRespondentAttorney",
"text": "Are you completing this form on behalf of someone?",
"answer": [
{
"valueBoolean": false
}
]
},
{
"linkId": "patientValidation",
"text": "Patient Validation",
"item": [
{
"linkId": "patientNamecombined",
"text": "Patient Name",
"answer": [
{
"valueString": "Mr. Lindsay Sorrell"
}
]
},
{
"linkId": "patientSignature",
"text": "Signature",
"answer": [
{
"valueString": "NA"
}
]
},
{
"linkId": "datePatientCompletedForm",
"text": "Date",
"answer": [
{
"valueDateTime": "2023-08-21"
}
]
}
]
},
{
"linkId": "declaration5",
"text": "Healthcare professional use only",
"item": [
{
"linkId": "healthcareProfessional",
"text": "To be completed by the healthcare professional recording the patient’s choices.",
"item": [
{
"linkId": "patientCategory",
"text": "Patient category",
"answer": [
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/patient-choice-category-genomics",
"code": "adult-own-choice",
"display": "Adult(made their own choice)"
}
}
]
},
{
"linkId": "testType",
"text": "Test type",
"answer": [
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/test-type-genomics",
"code": "RID-WGS",
"display": "Rare and Inherited Diseases - WGS"
}
}
]
},
{
"linkId": "remoteConsent",
"text": "Remote consent, recorded remotely by clinician, no patient signature",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "responsibleClinician",
"text": "Responsible clinician",
"answer": [
{
"valueString": "Dr Hazel Smith"
}
]
},
{
"linkId": "patientMRN",
"text": "Hospital number",
"answer": [
{
"valueString": "RWT14789"
}
]
},
{
"linkId": "healthcareProfessionalName",
"text": "Healthcare professional name",
"answer": [
{
"valueString": "Test AHP"
}
]
},
{
"linkId": "healthcareProfessionalSignature",
"text": "Signature",
"answer": [
{
"valueString": "Dr. Hazel Smith"
}
]
},
{
"linkId": "datehealthcareProfessionalCompletedForm",
"text": "Date",
"answer": [
{
"valueDateTime": "2023-08-21"
}
]
}
]
}
]
}
]
}