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Packageuk.nhsengland.genomics.r4
Resource TypeQuestionnaireResponse
IdQuestionnaireResponse-RoD-PheobeSmithamYPAForm-Example.json
FHIR VersionR4

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Source1

{
  "resourceType": "QuestionnaireResponse",
  "id": "QuestionnaireResponse-RoD-PheobeSmithamYPAForm-Example",
  "questionnaire": "https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-YoungPersonAssentForm-Example",
  "status": "completed",
  "basedOn": [
    {
      "reference": "ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example"
    }
  ],
  "subject": {
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/nhs-number",
      "value": "9449307539"
    },
    "display": "A Patient"
  },
  "authored": "2024-01-25",
  "author": {
    "type": "PractitionerRole",
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
      "value": "999999999999"
    }
  },
  "source": {
    "type": "PractitionerRole",
    "identifier": {
      "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
      "value": "999999999999"
    }
  },
  "item": [
    {
      "linkId": "patientDetails",
      "text": "Patient Details",
      "item": [
        {
          "linkId": "givenName",
          "text": "First Name",
          "answer": [
            {
              "valueString": "Phoebe"
            }
          ]
        },
        {
          "linkId": "familyName",
          "text": "Last Name",
          "answer": [
            {
              "valueString": "Smitham"
            }
          ]
        },
        {
          "linkId": "nhs_Number",
          "text": "NHS number (or postcode if not not known)",
          "answer": [
            {
              "valueString": "9449307539"
            }
          ]
        },
        {
          "linkId": "birthDate",
          "text": "Date of Birth",
          "answer": [
            {
              "valueDate": "2013-09-27"
            }
          ]
        }
      ]
    },
    {
      "linkId": "declarationResponse",
      "text": "Please indicate your choices below by ticking the appropriate box:",
      "item": [
        {
          "linkId": "consentQuestion1",
          "text": "1. Have you read information or has someone explained the research to you?",
          "answer": [
            {
              "valueBoolean": true
            }
          ]
        },
        {
          "linkId": "consentQuestion2",
          "text": "2. Have you asked all the questions you want?",
          "answer": [
            {
              "valueBoolean": true
            }
          ]
        },
        {
          "linkId": "consentQuestion3",
          "text": "3. Have you had your questions answered in a way you understand?",
          "answer": [
            {
              "valueBoolean": 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?",
          "answer": [
            {
              "valueBoolean": true
            }
          ]
        },
        {
          "linkId": "consentQuestion5",
          "text": "5. Are you happy to take part?",
          "answer": [
            {
              "valueBoolean": true
            }
          ]
        }
      ]
    },
    {
      "linkId": "isRemoteConsentTrue",
      "text": "Assent obtained remotely, no participant signature",
      "answer": [
        {
          "valueBoolean": true
        }
      ]
    }
  ]
}