Package | virtually.healthcare |
Type | Questionnaire |
Id | eRS-Referral-Request |
FHIR Version | R4 |
Source | https://fhir.virtually.healthcare/https://build.fhir.org/ig/Virtually-Healthcare/HL7-FHIR-Implementation-Guide/Questionnaire-eRS-Referral-Request.html |
URL | https://fhir.virtually.healthcare/Questionnaire/eRS-Referral-Request |
Version | 0.1.1-current |
Status | draft |
Date | 2025-04-28T07:12:35+00:00 |
Title | eRS Referral Form |
Realm | uk |
Description | Representation of eRS Referral Request as a Questionnaire [A011: Create Referral (Deprecated)](https://developer.nhs.uk/apis/e-Referrals/explore_endpoint_a011.html) |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire eRS-Referral-Request
Profile: Questionnaire
LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
---|---|---|---|---|---|
![]() ![]() | Representation of eRS Referral Request as a Questionnaire [A011: Create Referral (Deprecated)](https://developer.nhs.uk/apis/e-Referrals/explore_endpoint_a011.html) | Questionnaire | https://fhir.virtually.healthcare/Questionnaire/eRS-Referral-Request#0.1.1-current | ||
![]() ![]() ![]() | Patient Details | 0..1 | group | ||
![]() ![]() ![]() ![]() | NHS Number | 1..1 | string | Definition: ServiceRequest.subject.identifier:NHSNumber.value | |
![]() ![]() ![]() | Referring Clinician | 0..1 | string | ||
![]() ![]() ![]() ![]() | SDS User Id (from SmartCard) | 1..1 | string | Definition: ServiceRequest.requester.identifier.value | |
![]() ![]() ![]() | Referral Details | 0..1 | group | Definition: ServiceRequest | |
![]() ![]() ![]() ![]() | Clinic/Service Type | 0..1 | choice | Definition: ServiceRequest.code Options: 2 options | |
![]() ![]() ![]() ![]() | Priority | 0..1 | choice | Definition: ServiceRequest.priority Options: 3 options | |
![]() ![]() ![]() ![]() | Selected Services (eRS Service Id) | 0..* | choice | Definition: ServiceRequest.performer.identifier.value Options: 2 options | |
![]() ![]() ![]() ![]() | Request Type | 1..1 | choice | Definition: ServiceRequest.code Options: 2 options | |
![]() ![]() ![]() ![]() | Referral Pathway Start | 0..1 | date | Definition: ServiceRequest.authoredOn | |
![]() ![]() ![]() ![]() | Organisation or clinician providing the service | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | SDS User Id (from SmartCard) | 0..1 | string | Definition: ServiceRequest.performer.identifier.value | |
![]() ![]() ![]() | Supporting Information | 0..1 | group | ||
![]() ![]() ![]() ![]() | Attachments | 0..* | group | Definition: ServiceRequest.supportingInfo:ReferralLetter | |
![]() ![]() ![]() ![]() ![]() | Attachment Location | 1..1 | url | ||
![]() ![]() ![]() ![]() ![]() | Attachment Type | 1..1 | choice | Options: 4 options | |
![]() ![]() ![]() ![]() | Service Selection Criteria | 0..1 | group | Definition: ServiceRequest.supportingInfo | |
![]() ![]() ![]() ![]() ![]() | Specialty | 0..1 | choice | Options: 1 option | |
![]() ![]() ![]() ![]() ![]() | Services near postcode | 0..1 | string | ![]() ![]() | Definition: ServiceRequest.supportingInfo |
![]() ![]() ![]() ![]() ![]() | Distance Limit | 0..1 | integer | Definition: ServiceRequest.supportingInfo | |
![]() ![]() ![]() ![]() | Age and Gender Appropriate | 0..1 | boolean | Definition: ServiceRequest.supportingInfo | |
![]() ![]() ![]() ![]() | Maximum wait time for appointment | 0..1 | integer | Definition: ServiceRequest.supportingInfo | |
![]() ![]() ![]() ![]() | First Patient Reminder Letter Follow Up | 1..1 | integer | Definition: ServiceRequest.supportingInfo | |
![]() ![]() ![]() ![]() | Commissioning Provisioning | 0..1 | choice | Definition: ServiceRequest.supportingInfo Options: 4 options | |
![]() ![]() ![]() ![]() | Intention to add referral letter | 1..1 | choice | Definition: ServiceRequest.supportingInfo Options: 2 options | |
Options Sets
Answer options for 3.1
Answer options for 3.2
Answer options for 3.3
Answer options for 3.4
Answer options for 4.1.2
Answer options for 4.2.1
Answer options for 4.6
Answer options for 4.7
{ "resourceType": "Questionnaire", "id": "eRS-Referral-Request", "meta": { "profile": [ "https://fhir.virtually.healthcare/StructureDefinition/Questionnaire" ] }, "text": { "status": "extensions", "div": "<!-- snip (see above) -->" }, "url": "https://fhir.virtually.healthcare/Questionnaire/eRS-Referral-Request", "version": "0.1.1-current", "title": "eRS Referral Form", "status": "draft", "date": "2025-04-28T07:12:35+00:00", "publisher": "Virtually Healthcare", "contact": [ { "name": "Virtually Healthcare", "telecom": [ { "system": "url", "value": "https://virtually.healthcare" } ] } ], "description": "Representation of eRS Referral Request as a Questionnaire [A011: Create Referral (Deprecated)](https://developer.nhs.uk/apis/e-Referrals/explore_endpoint_a011.html)", "jurisdiction": [ { "coding": [ { "system": "urn:iso:std:iso:3166", "code": "GB", "display": "United Kingdom of Great Britain and Northern Ireland" } ] } ], "code": [ { "system": "http://snomed.info/sct", "code": "3457005", "display": "Patient referral" } ], "item": [ { "linkId": "1", "text": "Patient Details", "type": "group", "item": [ { "linkId": "1.1", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.subject.identifier:NHSNumber.value", "text": "NHS Number", "type": "string", "required": true } ] }, { "linkId": "2", "text": "Referring Clinician", "type": "string", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "2.1", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.requester.identifier.value", "text": "SDS User Id (from SmartCard)", "type": "string", "required": true } ] }, { "linkId": "3", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest", "text": "Referral Details", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "3.1", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.code", "text": "Clinic/Service Type", "type": "choice", "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-ClinicType-1", "code": "GENERAL_SURGERY", "display": "General Surgery" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-ClinicType-1", "code": "HEART_FAILURE", "display": "Heart Failure" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "3.2", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.priority", "text": "Priority", "type": "choice", "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-Priority-1", "code": "ROUTINE", "display": "Routine" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-Priority-1", "code": "TWO_WEEK_WAIT", "display": "2 Week Wait" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-Priority-1", "code": "URGENT", "display": "Urgent" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "3.3", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.performer.identifier.value", "text": "Selected Services (eRS Service Id)", "type": "choice", "repeats": true, "readOnly": false, "answerOption": [ { "valueCoding": { "system": "http://fhir.nhs.net/Id/ers-service", "code": "12000" } }, { "valueCoding": { "system": "http://fhir.nhs.net/Id/ers-service", "code": "12001" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "3.4", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.code", "text": "Request Type", "type": "choice", "required": true, "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-RequestType-1", "code": "ADVICE_AND_GUIDANCE_REQUEST", "display": "Advice and Guidance Request" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-RequestType-1", "code": "APPOINTMENT_REQUEST", "display": "Appointment Request" } } ] }, { "linkId": "3.5", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.authoredOn", "text": "Referral Pathway Start", "type": "date" }, { "linkId": "3.6", "text": "Organisation or clinician providing the service", "type": "group", "item": [ { "linkId": "3.6.1", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.performer.identifier.value", "text": "SDS User Id (from SmartCard)", "type": "string" } ] } ] }, { "linkId": "4", "text": "Supporting Information", "type": "group", "item": [ { "linkId": "4.1", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo:ReferralLetter", "text": "Attachments", "type": "group", "repeats": true, "item": [ { "linkId": "4.1.1", "text": "Attachment Location", "type": "url", "required": true }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "4.1.2", "text": "Attachment Type", "type": "choice", "required": true, "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-AttachmentType-1", "code": "REFERRER", "display": "Referrer" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-AttachmentType-1", "code": "PROVIDER", "display": "Provider" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-AttachmentType-1", "code": "ADVICE_REQUEST", "display": "Advice Request" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-AttachmentType-1", "code": "GUIDANCE_RESPONSE", "display": "Guidance Response" } } ] } ] }, { "linkId": "4.2", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Service Selection Criteria", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "4.2.1", "text": "Specialty", "type": "choice", "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-Specialty", "code": "CARDIOLOGY", "display": "Cardiology" } } ] }, { "linkId": "4.2.2", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Services near postcode", "type": "string", "readOnly": true }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding": { "system": "http://unitsofmeasure.org", "code": "[mi_br]", "display": "[mi_br]" } } ], "linkId": "4.2.3", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Distance Limit", "type": "integer" } ] }, { "linkId": "4.3", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Age and Gender Appropriate", "type": "boolean" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding": { "system": "http://unitsofmeasure.org", "code": "d", "display": "d" } } ], "linkId": "4.4", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Maximum wait time for appointment", "type": "integer" }, { "linkId": "4.5", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "First Patient Reminder Letter Follow Up", "type": "integer", "required": true }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "4.6", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Commissioning Provisioning", "type": "choice", "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-CommissioningProvisioning-1", "code": "ALL_AVAILABLE_FOR_BOOKING", "display": "All available for Booking" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-CommissioningProvisioning-1", "code": "ALL_SERVICES", "display": "All Services" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-CommissioningProvisioning-1", "code": "LOCALLY_COMMISSIONABLE", "display": "Locally Commissionable" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-CommissioningProvisioning-1", "code": "NATIONALLY_AVAILABLE", "display": "Nationally Available" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/questionnaire-item-control", "code": "drop-down", "display": "Drop down" } ] } } ], "linkId": "4.7", "definition": "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.supportingInfo", "text": "Intention to add referral letter", "type": "choice", "required": true, "answerOption": [ { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-ReferralLetterIntention-1", "code": "NEED_TO_ADD_LATER", "display": "Need to add later" } }, { "valueCoding": { "system": "https://fhir.nhs.uk/STU3/CodeSystem/eRS-ReferralLetterIntention-1", "code": "NOT_INTENDING_TO_ADD", "display": "Not intending to add" } } ] } ] } ] }