{ "resourceType" : "Questionnaire", "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire PrivateColposcopyReferralQuestionnaire

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\"\"\"\" PrivateColposcopyReferralQuestionnaireQuestionnairehttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PrivateColposcopyReferralQuestionnaire#0.1.1
\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p01-ClinicInformationpage 01. Clinic Information0..1group
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p01-ClinicInformation / p01-q01-FacilityIDpage 01 question 1. Colposcopy HPI facility ID1..1reference
\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformationpage 02. Referral Information0..1group
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q01-SelfReferralpage 02 question 1. Self Referral?1..1boolean
\"\"\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q01-SelfReferral / p02-q02.1-SelfReferralpage 02 question 2.1. If your patient has self-referred enter in their GP’s HPI-CPN and HPI Health Facility ID0..1display
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q02-ReferredByNamepage 02 question 2. Referred by health worker name1..1reference
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q03-ReferredByFacilityIDpage 02 question 3. Referred by health facility ID1..1reference
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q04-ReferralDateReceivedpage 02 question 5. Referral received date0..1date
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q05-ReferralDateAcceptedpage 02 question 6. Referral accepted date1..1date
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q06-AppointmentDatepage 02 question 7. Appointment date0..1date
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q07-FirstVisitpage 02 question 8. First colposcopy visit?1..1boolean
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q8-FollowUpTypepage 02 question 9. Follow-up Colposcopy Visit1..1choiceEnable When: p02-q07-FirstVisit = false
Options: 4 options
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p02-ReferralInformation / p02-q9-FollowUpTimeFramepage 02 question 9. Follow-up timeframe1..1choiceEnable When: p02-q07-FirstVisit = false
Options: 15 options
\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p03-RefferalReasonpage 03. Reason for Referral1..1group
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p03-RefferalReason / p03-q01-AssessmentReasonpage 03 question 1. Assessment for the reason for referral1..1choiceOptions: 12 options
\"\"\"\"\"\"\"\" PrivateColposcopyReferralQuestionnaire / p03-RefferalReason / p03-q02-OtherReasonpage 03 question 2. Other Reason (if Any)0..1stringEnable When: p03-q01-AssessmentReason = Other

\"doco\" Documentation for this format

Options Sets

Answer options for p02-q8-FollowUpType

Answer options for p02-q9-FollowUpTimeFrame

Answer options for p03-q01-AssessmentReason

" }, "url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PrivateColposcopyReferralQuestionnaire", "identifier" : [{ "use" : "official", "value" : "PrivateColposcopyReferralQuestionnaire" }], "version" : "0.1.1", "name" : "PrivateColposcopyReferralQuestionnaire", "title" : "Private Colposcopy Referral Summary Questionnaire", "status" : "draft", "experimental" : false, "subjectType" : ["Patient"], "date" : "2026-10-13T01:26:02+00:00", "publisher" : "Te Whatu Ora", "contact" : [{ "name" : "Te Whatu Ora", "telecom" : [{ "system" : "url", "value" : "https://www.tewhatuora.govt.nz/" }] }, { "name" : "Te Whatu Ora Integration Team", "telecom" : [{ "system" : "email", "value" : "integration@tewhatuora.govt.nz", "use" : "work" }] }], "useContext" : [{ "code" : { "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type", "code" : "workflow", "display" : "Workflow Setting" }, "valueCodeableConcept" : { "text" : "Private Colposcopy Visit Summary" } }], "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "NZ", "display" : "New Zealand" }] }], "purpose" : "To gather the referral details of Private colposcopy procedure.", "item" : [{ "linkId" : "p01-ClinicInformation", "prefix" : "page 01", "text" : "Clinic Information", "type" : "group", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource", "valueCode" : "Location" }], "linkId" : "p01-q01-FacilityID", "prefix" : "page 01 question 1", "text" : "Colposcopy HPI facility ID", "type" : "reference", "required" : true }] }, { "linkId" : "p02-ReferralInformation", "prefix" : "page 02", "text" : "Referral Information", "type" : "group", "item" : [{ "linkId" : "p02-q01-SelfReferral", "prefix" : "page 02 question 1", "text" : "Self Referral?", "type" : "boolean", "required" : true, "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help", "display" : "Help-Button" }], "text" : "Help-Button" } }], "linkId" : "p02-q02.1-SelfReferral", "prefix" : "page 02 question 2.1", "text" : "If your patient has self-referred enter in their GP’s HPI-CPN and HPI Health Facility ID", "type" : "display" }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource", "valueCode" : "Practitioner" }], "linkId" : "p02-q02-ReferredByName", "prefix" : "page 02 question 2", "text" : "Referred by health worker name", "type" : "reference", "required" : true }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource", "valueCode" : "Location" }], "linkId" : "p02-q03-ReferredByFacilityID", "prefix" : "page 02 question 3", "text" : "Referred by health facility ID", "type" : "reference", "required" : true }, { "linkId" : "p02-q04-ReferralDateReceived", "prefix" : "page 02 question 5", "text" : "Referral received date", "type" : "date", "required" : false }, { "linkId" : "p02-q05-ReferralDateAccepted", "prefix" : "page 02 question 6", "text" : "Referral accepted date", "type" : "date", "required" : true }, { "linkId" : "p02-q06-AppointmentDate", "prefix" : "page 02 question 7", "text" : "Appointment date", "type" : "date", "required" : false }, { "linkId" : "p02-q07-FirstVisit", "prefix" : "page 02 question 8", "text" : "First colposcopy visit?", "type" : "boolean", "required" : true, "repeats" : false }, { "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" : "p02-q8-FollowUpType", "prefix" : "page 02 question 9", "text" : "Follow-up Colposcopy Visit", "type" : "choice", "enableWhen" : [{ "question" : "p02-q07-FirstVisit", "operator" : "=", "answerBoolean" : false }], "enableBehavior" : "all", "required" : true, "repeats" : false, "answerOption" : [{ "valueCoding" : { "display" : "1st Follow Up Visit" } }, { "valueCoding" : { "display" : "2nd Follow Up Visit" } }, { "valueCoding" : { "display" : "3rd Follow Up Visit" } }, { "valueCoding" : { "display" : "4th or more Follow up Visit" } }] }, { "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" : "p02-q9-FollowUpTimeFrame", "prefix" : "page 02 question 9", "text" : "Follow-up timeframe", "type" : "choice", "enableWhen" : [{ "question" : "p02-q07-FirstVisit", "operator" : "=", "answerBoolean" : false }], "enableBehavior" : "all", "required" : true, "repeats" : false, "answerOption" : [{ "valueCoding" : { "code" : "7D", "display" : "7 Days" } }, { "valueCoding" : { "code" : "2W", "display" : "2 Weeks" } }, { "valueCoding" : { "code" : "6W", "display" : "6 Weeks" } }, { "valueCoding" : { "code" : "1M", "display" : "1 Month" } }, { "valueCoding" : { "code" : "2M", "display" : "2 Months" } }, { "valueCoding" : { "code" : "3M", "display" : "3 Months" } }, { "valueCoding" : { "code" : "4M", "display" : "4 Months" } }, { "valueCoding" : { "code" : "5M", "display" : "5 Months" } }, { "valueCoding" : { "code" : "6M", "display" : "6 Months" } }, { "valueCoding" : { "code" : "7M", "display" : "7 Months" } }, { "valueCoding" : { "code" : "9M", "display" : "9 Months" } }, { "valueCoding" : { "code" : "12M", "display" : "12 Months" } }, { "valueCoding" : { "code" : "18M", "display" : "18 Months" } }, { "valueCoding" : { "code" : "36M", "display" : "36 Months" } }, { "valueCoding" : { "code" : "60M", "display" : "60 Months" } }] }] }, { "linkId" : "p03-RefferalReason", "prefix" : "page 03", "text" : "Reason for Referral", "type" : "group", "required" : true, "repeats" : false, "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" : "p03-q01-AssessmentReason", "prefix" : "page 03 question 1", "text" : "Assessment for the reason for referral", "type" : "choice", "required" : true, "repeats" : false, "answerOption" : [{ "valueCoding" : { "display" : "Any cytological evidence or suspicion of invasion" } }, { "valueCoding" : { "display" : "Any cytological glandular abnormality" } }, { "valueCoding" : { "display" : "HPV 16/18 with or without cytology" } }, { "valueCoding" : { "display" : "HPV other where the participant is immune compromised" } }, { "valueCoding" : { "display" : "HPV other with LSIL on two occasions if over 50 and 3 occasions if under 50" } }, { "valueCoding" : { "display" : "Positive test of cure" } }, { "valueCoding" : { "display" : "Low-grade clinical assessment" } }, { "valueCoding" : { "display" : "High-grade clinical assessment" } }, { "valueCoding" : { "display" : "Suspicion of an invasive cancer clinical assessment" } }, { "valueCoding" : { "display" : "HPV not detected with high-grade cytology" } }, { "valueCoding" : { "display" : "HPV not detected with suspicion or evidence of cancer on cytology" } }, { "valueCoding" : { "display" : "Other" } }] }, { "linkId" : "p03-q02-OtherReason", "prefix" : "page 03 question 2", "text" : "Other Reason (if Any)", "type" : "string", "enableWhen" : [{ "question" : "p03-q01-AssessmentReason", "operator" : "=", "answerCoding" : { "display" : "Other" } }], "enableBehavior" : "all" }] }] }