CardiologyForm
type: Questionnaire
node role: treeRoot
id:
  v: CardiologyForm
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire CardiologyForm Language: en Structure LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Questionnaire urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d#4.0.0-ci-build #xD; patient_header Patient Information 0..1 group #xD; patient_surname Surname: 1..1 string #xD; patient_firstname First Name: 1..1 string #xD; patient_date_of_birth DOB: 1..1 date #xD; patient_gender Gender: 1..1 choice Options: 3 options #xD; patient_hc_pc HN PC: 0..1 string Max Length: 2 #xD; patient_hc_number HN: 0..1 string Max Length: 10 #xD; patient_hc_vc HN VC: 0..1 string #xD; patient_address_line1 Address (Line 1): 1..1 string #xD; patient_address_line2 Address (Line 2): 0..1 string #xD; patient_address_city City: 1..1 string #xD; patient_address_province Province: 1..1 string Max Length: 2 #xD; patient_address_postalcode Postal Code: 1..1 string #xD; patient_phone_mobile Mobile #: 0..1 string #xD; patient_phone_home Home #: 0..1 string #xD; patient_phone_business Business #: 0..1 string #xD; patient_email Email: 0..1 string #xD; additionalinfo_header [Optional] Additional Patient Information 0..1 group #xD; additionalinfo_sexassignedatbirth Sex assigned at birth: 0..1 choice Options: 4 options #xD; additionalinfo_pronouns Pronouns: 0..1 choice Options: 4 options #xD; additionalinfo_pronouns_other Other pronouns: 1..1 string Enable When: additionalinfo_pronouns = other (v3 Code System NullFlavor#OTH) #xD; additionalinfo_preferredlanguage Preferred language: 0..1 choice Options: 3 options #xD; additionalinfo_preferredlanguage_specify Specify: 1..1 string Enable When: additionalinfo_preferredlanguage = other (v3 Code System NullFlavor#OTH) #xD; additionalinfo_preferredlanguage_translatorrequired Translator required 0..* string Enable When: additionalinfo_preferredlanguage = other (v3 Code System NullFlavor#OTH) Options: 1 option #xD; additionalinfo_bestmethodofcontact Best method of cont…
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm
    l: artifact-versionAlgorithm
  value: Coding
    system:
      v: http://hl7.org/fhir/version-algorithm
      l: version-algorithm
    code:
      v: semver
extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode
    l: sdc-questionnaire-entryMode
  value: Code
    v: random
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fhir
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 4
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc
        l: hl7.fhir.uv.sdc
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status
    l: structuredefinition-standards-status
  value: Code
    v: trial-use
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom
        l: structuredefinition-conformance-derivedFrom
      value: Canonical
        v: http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc
        l: hl7.fhir.uv.sdc
identifier:
  system:
    v: urn:ietf:rfc:3986
    l: 3986
  value:
    v: urn:oid:2.16.840.1.113883.4.642.40.17.35.43
version:
  v: 4.0.0-ci-build
title:
  v: Cardiology Form
status:
  v: active
experimental:
  v: false
subject type:
  v: Patient
date:
  v: 2026-01-20T15:05:51.993+00:00
publisher:
  v: HL7 International / FHIR Infrastructure
contact:
  name:
    v: HL7 International / FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
contact:
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
      l: m49.htm
    code:
      v: 001
    display:
      v: World
effective period:
  start:
    v: 2025-02-03
code: http://snomed.info/id/789718008
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 789718008
  display:
    v: Cardiology service
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:grey;border-style:solid;
  link id:
    v: patient_header
  text:
    v: Patient Information
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: font-weight:bold;
  type:
    v: group
  item:
    link id:
      v: patient_surname
    text:
      v: Surname:
    type:
      v: string
    required:
      v: true
  item:
    link id:
      v: patient_firstname
    text:
      v: First Name:
    type:
      v: string
    required:
      v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/entryFormat
        l: entryFormat
      value: String
        v: yyyy/MM/dd
    link id:
      v: patient_date_of_birth
    text:
      v: DOB:
    type:
      v: date
    required:
      v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
        l: questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: patient_gender
    text:
      v: Gender:
    type:
      v: choice
    required:
      v: true
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
  item:
    link id:
      v: patient_hc_pc
    text:
      v: HN PC:
    type:
      v: string
    max length:
      v: 2
    item:
      link id:
        v: patient_hc_number
      text:
        v: HN:

v: list

v: List

system:
  v: http://hl7.org/fhir/questionnaire-item-control
  l: questionnaire-item-control
code:
  v: radio-button
display:
  v: Radio Button

v: male

v: Male

v: female

v: Female

v: other

v: Other

v: string

v: 10

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/minLength
    l: minLength
  value: Integer
    v: 2
link id:
  v: patient_hc_vc
text:
  v: HN VC:
type:
  v: string

link id:
  v: patient_address_line1
text:
  v: Address (Line 1):
type:
  v: string
required:
  v: true
item:
  link id:
    v: patient_address_line2
  text:
    v: Address (Line 2):
  type:
    v: string
item:
  link id:
    v: patient_address_city
  text:
    v: City:
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: patient_address_province
  text:
    v: Province:
  type:
    v: string
  required:
    v: true
  max length:
    v: 2
item:
  extension:
    extension:
      url:
        v: key
        l: key
      value: Id
        v: pat-pcode
    extension:
      url:
        v: severity
        l: severity
      value: Code
        v: error
    extension:
      url:
        v: expression
        l: expression
      value: Expression
    extension:
      url:
        v: human
        l: human
      value: String
        v: Must be a valid Canadian postal-code
    url:
      v: http://hl7.org/fhir/StructureDefinition/targetConstraint
      l: targetConstraint
  link id:
    v: patient_address_postalcode
  text:
    v: Postal Code:
  type:
    v: string
  required:
    v: true

v: text/fhirpath

v: %resource.repeat(item).where(linkId='patient_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))

extension:
  extension:
    url:
      v: key
      l: key
    value: Id
      v: mobilephone
  extension:
    url:
      v: severity
      l: severity
    value: Code
      v: error
  extension:
    url:
      v: expression
      l: expression
    value: Expression
      language:
        v: text/fhirpath
      expression:
        v: %resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))
  extension:
    url:
      v: human
      l: human
    value: String
      v: Must be a valid phone number
  url:
    v: http://hl7.org/fhir/StructureDefinition/targetConstraint
    l: targetConstraint
link id:
  v: patient_phone_mobile
text:
  v: Mobile #:
type:
  v: string

extension:
  extension:
    url:
      v: key
      l: key
    value: Id
      v: homephone
  extension:
    url:
      v: severity
      l: severity
    value: Code
      v: error
  extension:
    url:
      v: expression
      l: expression
    value: Expression
      language:
        v: text/fhirpath
      expression:
        v: %resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))
  extension:
    url:
      v: human
      l: human
    value: String
      v: Must be a valid phone number
  url:
    v: http://hl7.org/fhir/StructureDefinition/targetConstraint
    l: targetConstraint
link id:
  v: patient_phone_home
text:
  v: Home #:
type:
  v: string

extension:
  extension:
    url:
      v: key
      l: key
    value: Id
      v: busphone
  extension:
    url:
      v: severity
      l: severity
    value: Code
      v: error
  extension:
    url:
      v: expression
      l: expression
    value: Expression
      language:
        v: text/fhirpath
      expression:
        v: %resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))
  extension:
    url:
      v: human
      l: human
    value: String
      v: Must be a valid phone number
  url:
    v: http://hl7.org/fhir/StructureDefinition/targetConstraint
    l: targetConstraint
link id:
  v: patient_phone_business
text:
  v: Business #:
type:
  v: string

extension:
  extension:
    url:
      v: key
      l: key
    value: Id
      v: patemail
  extension:
    url:
      v: severity
      l: severity
    value: Code
      v: error
  extension:
    url:
      v: expression
      l: expression
    value: Expression
      language:
        v: text/fhirpath
      expression:
        v: %resource.repeat(item).where(linkId='patient_email').answer.all(value.matches('(?:[a-z0-9!#$%&'*+/=?^_`{|}~-]+(?:\.[a-z0-9!#$%&'*+/=?^_`{|}~-]+)*|"(?:[\x01-\x08\x0b\x0c\x0e-\x1f\x21\x23-\x5b\x5d-\x7f]|\\[\x01-\x09\x0b\x0c\x0e-\x7f])*")@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\x01-\x08\x0b\x0c\x0e-\x1f\x21-\x5a\x53-\x7f]|\\[\x01-\x09\x0b\x0c\x0e-\x7f])+)\])'))
  extension:
    url:
      v: human
      l: human
    value: String
      v: Must be a valid email address
  url:
    v: http://hl7.org/fhir/StructureDefinition/targetConstraint
    l: targetConstraint
link id:
  v: patient_email
text:
  v: Email:
type:
  v: string

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: additionalinfo_header
text:
  v: [Optional] Additional Patient Information
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: [Optional] Additional Patient Information
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: font-weight:bold;
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: additionalinfo_sexassignedatbirth
  text:
    v: Sex assigned at birth:
  type:
    v: choice
  answer option:
    value: Coding
      type: LA3-6
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: LA3-6
      display:
        v: Female
  answer option:
    value: Coding
      type: LA2-8
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: LA2-8
      display:
        v: Male
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/exampleCS
        l: exampleCS
      code:
        v: Intersex
      display:
        v: Intersex
  answer option:
    value: Coding
      type: LA4489-6
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: LA4489-6
      display:
        v: Unknown
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: additionalinfo_pronouns
  text:
    v: Pronouns:
  type:
    v: choice
  answer option:
    value: Coding
      type: LA29519-8
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: LA29519-8
      display:
        v: She/Her
  answer option:
    value: Coding
      type: LA29518-0
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: LA29518-0
      display:
        v: He/Him
  answer option:
    value: Coding
      type: LA29519-8
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: LA29519-8
      display:
        v: They/Them
  answer option:
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
        l: v3-NullFlavor
      code:
        v: OTH
      display:
        v: other
  item:
    link id:
      v: additionalinfo_pronouns_other
    text:
      v: Other pronouns:
    type:
      v: string
    enable when:
      question:
        v: additionalinfo_pronouns
      operator:
        v: =
      answer: Coding
    enable behavior:
      v: all
    required:
      v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: additionalinfo_preferredlanguage
  text:
    v: Preferred language:
  type:
    v: choice
  required:
    v: false
  answer option:
    value: Coding
      system:
        v: urn:ietf:bcp:47
        l: 47
      code:
        v: en
      display:
        v: English
  answer option:
    value: Coding
      system:
        v: urn:ietf:bcp:47
        l: 47
      code:
        v: fr
      display:
        v: French
  answer option:
    value: Coding
      system:
        v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
        l: v3-NullFlavor
      code:
        v: OTH
      display:
        v: other
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: background-color:white;border-style:solid;

v: push-button

v: Push Button

v: push-button

v: Push Button

v: OTH

v: other

v: push-button

v: Push Button

v: additionalinfo_preferredlanguage_specify

v: Specify:

v: string

question:
  v: additionalinfo_preferredlanguage
operator:
  v: =
answer: Coding
  system:
    v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
    l: v3-NullFlavor
  code:
    v: OTH
  display:
    v: other

v: all

v: true

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_preferredlanguage_translatorrequired
text:
  v: Translator required
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
enable when:
  question:
    v: additionalinfo_preferredlanguage
  operator:
    v: =
  answer: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
      l: v3-NullFlavor
    code:
      v: OTH
    display:
      v: other
repeats:
  v: true
answer option:
  value: String
    v: Translator Required

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://example.com/CodeSystem/item-controls
        l: item-controls
      code:
        v: push-button
      display:
        v: Push Button
link id:
  v: additionalinfo_bestmethodofcontact
text:
  v: Best method of contact:
type:
  v: choice
answer option:
  value: Coding
    system:
      v: http://hl7.org/fhir/contact-point-use
      l: contact-point-use
    code:
      v: mobile
    display:
      v: Mobile
answer option:
  value: Coding
    system:
      v: http://hl7.org/fhir/contact-point-use
      l: contact-point-use
    code:
      v: home
    display:
      v: Home
answer option:
  value: Coding
    system:
      v: http://hl7.org/fhir/contact-point-use
      l: contact-point-use
    code:
      v: work
    display:
      v: Work
answer option:
  value: Coding
    system:
      v: http://hl7.org/fhir/contact-point-system
      l: contact-point-system
    code:
      v: email
    display:
      v: Email
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: additionalinfo_bestmethodofcontact_voicemails
  text:
    v: Voicemails acceptable
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: string
  enable when:
    question:
      v: additionalinfo_bestmethodofcontact
    operator:
      v: =
    answer: Coding
      system:
        v: http://hl7.org/fhir/contact-point-use
        l: contact-point-use
      code:
        v: mobile
      display:
        v: Mobile
  enable behavior:
    v: any
  repeats:
    v: true
  answer option:
    value: String
      v: Voicemails acceptable

v: check-box

v: Check-box

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_preferredname_select
text:
  v: Preferred name
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Preferred Name

link id:
  v: additionalinfo_preferredname
text:
  v: Prefered name String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
enable when:
  question:
    v: additionalinfo_preferredname_select
  operator:
    v: =
  answer: String
    v: Preferred Name
enable behavior:
  v: all

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: additionalinfo_alternatecontact_select
text:
  v: Alternate contact
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Alternate contact

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_alternatecontact_name
text:
  v: Name:
type:
  v: string
enable when:
  question:
    v: additionalinfo_alternatecontact_select
  operator:
    v: =
  answer: String
    v: Alternate contact
enable behavior:
  v: all
required:
  v: true

extension:
  extension:
    url:
      v: key
      l: key
    value: Id
      v: altphone
  extension:
    url:
      v: severity
      l: severity
    value: Code
      v: error
  extension:
    url:
      v: expression
      l: expression
    value: Expression
      language:
        v: text/fhirpath
      expression:
        v: %resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))
  extension:
    url:
      v: human
      l: human
    value: String
      v: Must be a valid phone number
  url:
    v: http://hl7.org/fhir/StructureDefinition/targetConstraint
    l: targetConstraint
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_alternatecontact_phone
text:
  v: Alternate contact phone #:
type:
  v: string
enable when:
  question:
    v: additionalinfo_alternatecontact_select
  operator:
    v: =
  answer: String
    v: Alternate contact
enable behavior:
  v: all

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_alternatecontact_relationship
text:
  v: Relationship:
type:
  v: string
enable when:
  question:
    v: additionalinfo_alternatecontact_select
  operator:
    v: =
  answer: String
    v: Alternate contact
enable behavior:
  v: all

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: radio-button
      display:
        v: Radio Button
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_alternatecontact_bookingcontact
text:
  v: Is Alternate contact the appointment booking contact?:
type:
  v: choice
enable when:
  question:
    v: additionalinfo_alternatecontact_select
  operator:
    v: =
  answer: String
    v: Alternate contact
enable behavior:
  v: all
answer option:
  value: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v2-0532
      l: v2-0532
    code:
      v: Y
    display:
      v: Yes
answer option:
  value: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v2-0532
      l: v2-0532
    code:
      v: N
    display:
      v: No

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: additionalinfo_unsafecontacts_select
text:
  v: Unsafe contact persons (do not speak with)
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Unsafe contact persons (do not speak with)

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_unsafecontacts_speakwithpatientdirectly
text:
  v: Only speak with patient directly
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
enable when:
  question:
    v: additionalinfo_unsafecontacts_select
  operator:
    v: =
  answer: String
    v: Unsafe contact persons (do not speak with)
enable behavior:
  v: all
repeats:
  v: true
answer option:
  value: String
    v: Only speak with patient directly

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_unsafecontacts_donotspeakwith
text:
  v: Do not speak with:
type:
  v: string
enable when:
  question:
    v: additionalinfo_unsafecontacts_select
  operator:
    v: =
  answer: String
    v: Unsafe contact persons (do not speak with)
enable behavior:
  v: all

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: additionalinfo_accessibilityconcernsordisability_selectt
text:
  v: Accessibility concerns or disability
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Accessibility concerns or disability

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://example.com/CodeSystem/item-controls
        l: item-controls
      code:
        v: push-button
      display:
        v: Push Button
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_accessibilityconcernsordisability
text:
  v: Accessibility concerns Options
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
type:
  v: choice
enable when:
  question:
    v: additionalinfo_accessibilityconcernsordisability_selectt
  operator:
    v: =
  answer: String
    v: Accessibility concerns or disability
repeats:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/129839007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 129839007
    display:
      v: Falls risk
answer option:
  value: Coding
    type: http://snomed.info/id/301621006
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 301621006
    display:
      v: Patient requires lift
answer option:
  value: Coding
    type: http://snomed.info/id/105503008
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 105503008
    display:
      v: Wheelchair
answer option:
  value: Coding
    type: http://snomed.info/id/15188001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 15188001
    display:
      v: Hearing impaired

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: additionalinfo_specialconsiderations_select
text:
  v: Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: additionalinfo_specialconsiderations
text:
  v: Details of special considerations:
type:
  v: text
enable when:
  question:
    v: additionalinfo_specialconsiderations_select
  operator:
    v: =
  answer: String
    v: Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)
required:
  v: true

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: additionalinfo_sendcopiestoadditionalproviders
text:
  v: Send copies of reports to additional providers
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Send copies of reports to additional providers

link id:
  v: additionalinfo_sendcopiestoadditionalproviders_names
text:
  v: Name(s):
type:
  v: string
enable when:
  question:
    v: additionalinfo_sendcopiestoadditionalproviders
  operator:
    v: =
  answer: String
    v: Send copies of reports to additional providers
enable behavior:
  v: all
required:
  v: true
item:
  link id:
    v: additionalinfo_sendcopiestoadditionalproviders_contactinfo
  text:
    v: Contact information:
  type:
    v: string
  enable when:
    question:
      v: additionalinfo_sendcopiestoadditionalproviders
    operator:
      v: =
    answer: String
      v: Send copies of reports to additional providers
  enable behavior:
    v: all
  required:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: additionalinfo_sendcopiestoadditionalproviders_ispcp
  text:
    v: This is the Primary Care Provider
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: string
  enable when:
    question:
      v: additionalinfo_sendcopiestoadditionalproviders
    operator:
      v: =
    answer: String
      v: Send copies of reports to additional providers
  enable behavior:
    v: all
  repeats:
    v: true
  answer option:
    value: String
      v: This is the Primary Care Provider

v: check-box

v: Check-box

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
extension:
  extension:
    url:
      v: sortIndex
      l: sortIndex
    value: PositiveInt
      v: 1
  extension:
    url:
      v: text
      l: text
    value: String
      v: Referral Details
      extension:
        value: String
  extension:
    url:
      v: style
      l: style
    value: String
      v: font-weight:bold;text-decoration:underline;
  extension:
    url:
      v: groupItems
      l: groupItems
    value: Boolean
      v: false
  url:
    v: http://example.com/StructureDefinition/group-note-info
    l: group-note-info
link id:
  v: 102173268919
text:
  v: Referral Details
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Referral Details
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: font-weight:bold;color:#202035;
type:
  v: group
item:
  extension:
    extension:
      url:
        v: enableWhenExpression
        l: enableWhenExpression
      value: Expression
    extension:
      url:
        v: sortIndex
        l: sortIndex
      value: PositiveInt
        v: 1
    extension:
      url:
        v: text
        l: text
      value: String
        v: Triage Considerations
    extension:
      url:
        v: style
        l: style
      value: String
        v: font-weight:bold;
    url:
      v: http://example.com/StructureDefinition/group-note-info
      l: group-note-info
  link id:
    v: cardio_triagecons
  text:
    v: Triage Considerations
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
        v: Triage Considerations
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: font-weight:bold;
  type:
    v: group
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
        l: questionnaire-choiceOrientation
      value: Code
        v: horizontal
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
        l: questionnaire-itemControl
      value: CodeableConcept
    extension:
      extension:
        value: PositiveInt
      extension:
        value: String
      extension:
        value: Boolean
      extension:
        value: String
      url:
        v: http://example.com/StructureDefinition/question-note-info
        l: question-note-info
    link id:
      v: referral_requestedpriority
    text:
      v: Requested Priority:
    type:
      v: choice
    required:
      v: true
    answer option:
      value: Coding
      initial selected:
        v: true
    answer option:
      value: Coding
    item:
      link id:
        v: referral_requestedpriority_urgentreason
      text:
        v: Reason for urgent triage
      type:
        v: string
      enable when:
        answer: Coding
      required:
        v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
        l: questionnaire-choiceOrientation
      value: Code
        v: horizontal
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
        l: questionnaire-itemControl
      value: CodeableConcept
    extension:
      extension:
        value: PositiveInt
      extension:
        value: String
      url:
        v: http://example.com/StructureDefinition/question-note-info
        l: question-note-info
    link id:
      v: referral_secondopinion
    text:
      v: Second Opinion
      extension:
        value: String
      extension:
        value: String
    type:
      v: choice
    repeats:
      v: true
    answer option:
      value: Coding
        type: http://snomed.info/id/77406008
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: background-color:white;border-style:solid;
    link id:
      v: referral_secondopinion_reason
    text:
      v: Reason for second opinion:
    type:
      v: text
    enable when:
      question:
        v: referral_secondopinion
      operator:
        v: =
      answer: Coding
        type: http://snomed.info/id/77406008

String
v: Referral Details

v: text/fhirpath

v: true

system:
  v: http://example.com/CodeSystem/item-controls
  l: item-controls
code:
  v: push-button
display:
  v: Push Button

v: sortIndex
l: sortIndex

PositiveInt
v: 1

v: text
l: text

String
v: Requested Priority:

v: sameLine
l: sameLine

Boolean
v: true

v: answerStyle
l: answerStyle

String
v: font-weight:bold;color:#EE6B00;

url:
  v: text
  l: text
value: String
  v: Routine

url:
  v: style
  l: style
value: String
  v: font-weight:bold;color:#EE6B00;

v: routine

v: Routine

v: urgent

v: Urgent

v: referral_requestedpriority

v: =

Coding
system:
  v: http://hl7.org/fhir/request-priority
  l: request-priority
code:
  v: urgent
display:
  v: Urgent

system:
  v: http://hl7.org/fhir/questionnaire-item-control
  l: questionnaire-item-control
code:
  v: check-box
display:
  v: Check-box

v: sortIndex
l: sortIndex

PositiveInt
v: 2

v: text
l: text

String
v: Second Opinion

String
v: display:none;

v: 77406008

v: Second or third medical opinion

v: 77406008

v: Second or third medical opinion

extension:
  extension:
    url:
      v: sortIndex
      l: sortIndex
    value: PositiveInt
      v: 2
  extension:
    url:
      v: text
      l: text
    value: String
      v: Service(s) Requested
  extension:
    url:
      v: style
      l: style
    value: String
      v: font-weight:bold;
  url:
    v: http://example.com/StructureDefinition/group-note-info
    l: group-note-info
link id:
  v: 695991571585
text:
  v: Service(s) Requested Select all that apply:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Service(s) Requested Select all that apply:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: color:Gray20;
type:
  v: group
required:
  v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression
      l: sdc-questionnaire-calculatedExpression
    value: Expression
      description:
        v: Calculates HSC services based on selected checkboxes for cardiac testing and cardiology consult
      language:
        v: text/fhirpath
      expression:
        v: iif(%resource.item.where(linkId='223886162384').answer.value.exists(), 'CARDIOLOGY_SERVICES', '') + iif(%resource.item.where(linkId='223886162384').answer.value.exists() and %resource.item.where(linkId='785727177547').answer.value.exists(), '|', '') + iif(%resource.item.where(linkId='785727177547').answer.value.exists(), 'CARDIOLOGY', '')
  extension:
    extension:
      url:
        v: text
        l: text
      value: String
        v: HSCs Assigned:
    extension:
      url:
        v: style
        l: style
      value: String
        v: font-weight:bold;
    url:
      v: http://example.com/StructureDefinition/question-note-info
      l: question-note-info
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-hidden
      l: questionnaire-hidden
    value: Boolean
      v: true
  link id:
    v: referralService
  text:
    v: HSCs Assigned:
  type:
    v: string
  read only:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 223886162384
  text:
    v: Cardiac Testing
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20001
      display:
        v: Cardiac Testing
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: 660331267409
  text:
    v: Exam(s) Requested
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
        v: Exam(s) Requested
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: color:Gray20;font-weight:bold;
  type:
    v: group
  enable when:
    question:
      v: 223886162384
    operator:
      v: =
    answer: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20001
      display:
        v: Cardiac Testing
  enable behavior:
    v: all
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
        l: questionnaire-choiceOrientation
      value: Code
        v: horizontal
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
        l: questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: 720409326878
    text:
      v: 24 Hour Ambulatory Blood Pressure Monitoring
      extension:
        value: String
      extension:
        value: String
    type:
      v: choice
    repeats:
      v: true
    answer option:
      value: Coding
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
        l: questionnaire-choiceOrientation
      value: Code
        v: horizontal
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
        l: questionnaire-itemControl
      value: CodeableConcept

v: check-box

v: Check-box

system:
  v: http://hl7.org/fhir/questionnaire-item-control
  l: questionnaire-item-control
code:
  v: check-box
display:
  v: Check-box

String
v: display:none;

v: 20003

v: 24 Hour Ambulatory Blood Pressure Monitoring

system:
  v: http://hl7.org/fhir/questionnaire-item-control
  l: questionnaire-item-control
code:
  v: check-box
display:
  v: Check-box

v: 960455115596

v: Coronary Angiogram
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
    l: rendering-xhtml
  value: String
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: display:none;

v: choice

v: true

value: Coding
  system:
    v: http://example.com/CodeSystem/standardized-referral-form-codes
    l: standardized-referral-form-codes
  code:
    v: 20004
  display:
    v: Coronary Angiogram

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 297634898828
text:
  v: Echocardiogram - Resting
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20005
    display:
      v: Echocardiogram - Resting

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: 443484577720
text:
  v: sub Echocardiogram - Resting
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: group
enable when:
  question:
    v: 297634898828
  operator:
    v: =
  answer: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20005
    display:
      v: Echocardiogram - Resting
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 165530569567
  text:
    v: Echocardiogram (2D)
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20012
      display:
        v: Echocardiogram (2D)
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 286552421895
  text:
    v: Echocardiogram with Contrast
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20013
      display:
        v: Echocardiogram with Contrast
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 910527687300
  text:
    v: Echocardiogram with Saline (Bubble)
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20014
      display:
        v: Echocardiogram with Saline (Bubble)
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 657824763133
  text:
    v: Pediatric Echocardiogram
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20015
      display:
        v: Pediatric Echocardiogram
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: 992743200182

v: Transesophageal Echocardiogram (TEE)
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
    l: rendering-xhtml
  value: String
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: display:none;

v: choice

v: true

value: Coding
  system:
    v: http://example.com/CodeSystem/standardized-referral-form-codes
    l: standardized-referral-form-codes
  code:
    v: 20016
  display:
    v: Transesophageal Echocardiogram (TEE)

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 894277763438
text:
  v: Electrocardiogram (ECG)
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20006
    display:
      v: Electrocardiogram (ECG)

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 279226023495
text:
  v: Holter Monitoring
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20007
    display:
      v: Holter Monitoring

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: 440449731882
text:
  v: sub holter monitoring
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: group
enable when:
  question:
    v: 279226023495
  operator:
    v: =
  answer: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20007
    display:
      v: Holter Monitoring
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 671328703851
  text:
    v: 24 Hours
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20017
      display:
        v: 24 Hours
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 423992261841
  text:
    v: 48 Hours
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20018
      display:
        v: 48 Hours
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 419924239187
  text:
    v: 72 Hours
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20019
      display:
        v: 72 Hours
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 731054417270
  text:
    v: 7 Days
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20020
      display:
        v: 7 Days
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

url:
  v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
  l: questionnaire-choiceOrientation
value: Code
  v: horizontal

v: 235876421044

v: 14 Days
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
    l: rendering-xhtml
  value: String
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: display:none;

v: choice

v: true

value: Coding
  system:
    v: http://example.com/CodeSystem/standardized-referral-form-codes
    l: standardized-referral-form-codes
  code:
    v: 20021
  display:
    v: 14 Days

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 374742834400
text:
  v: Loop / Event Monitor
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20008
    display:
      v: Loop / Event Monitor

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 159161544747
text:
  v: Cardiovascular stress testing
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20009
    display:
      v: Stress Testing

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: 370275060390
text:
  v: Sub Stress Testing
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: group
enable when:
  question:
    v: 159161544747
  operator:
    v: =
  answer: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20009
    display:
      v: Stress Testing
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 814218498309
  text:
    v: ECG - Exercise Stress Test
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20022
      display:
        v: ECG - Exercise Stress Test
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 307107493993
  text:
    v: ECG - Dobutamine/Persantine Stress Test
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20023
      display:
        v: ECG - Dobutamine/Persantine Stress Test
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 805303414102
  text:
    v: Echocardiogram - Exercise Stress Test
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20024
      display:
        v: Echocardiogram - Exercise Stress Test
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 193586908489
  text:
    v: Echocardiogram - Dobutamine/Persantine Stress Test
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20025
      display:
        v: Echocardiogram - Dobutamine/Persantine Stress Test

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 918517139023
text:
  v: Nuclear Medicine
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20010
    display:
      v: Nuclear Medicine

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: 222686221935
text:
  v: sub Nuclear Medicine
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: group
enable when:
  question:
    v: 918517139023
  operator:
    v: =
  answer: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20010
    display:
      v: Nuclear Medicine
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 924189648184
  text:
    v: MUGA - Resting
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20026
      display:
        v: MUGA - Resting
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 857163514910
  text:
    v: Cardiac Pyrophosphate
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20027
      display:
        v: Cardiac Pyrophosphate
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 892165959617
  text:
    v: Myocardial perfusion scan
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20028
      display:
        v: MIBI Scans / Myocardial Perfusion Imaging (MPI):
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: 538288549138
  text:
    v: sub MIBI
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: group
  enable when:
    question:
      v: 892165959617
    operator:
      v: =
    answer: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20028
      display:
        v: MIBI Scans / Myocardial Perfusion Imaging (MPI):
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
        l: questionnaire-itemControl
      value: CodeableConcept

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: radio-button

v: Radio Button

CodeableConcept
coding:
  system:
    v: http://hl7.org/fhir/questionnaire-item-control
    l: questionnaire-item-control
  code:
    v: check-box
  display:
    v: Check-box

v: 373435981917

v: MIBI Scan - Exercise Stress Test
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
    l: rendering-xhtml
  value: String
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: display:none;

v: string

v: true

value: String
  v: MIBI Scan - Exercise Stress Test

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 434394942688
text:
  v: MIBI Scan - Dobutamine/Persantine Stress Test
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: MIBI Scan - Dobutamine/Persantine Stress Test

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 913594478162
text:
  v: Thallium Viability Test
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: string
repeats:
  v: true
answer option:
  value: String
    v: Thallium Viability Test

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 992682216482
text:
  v: Tilt Table Testing
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20011
    display:
      v: Tilt Table Testing

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: cardiology_referral_services_cardiactesting_other
text:
  v: Other
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
      l: v3-NullFlavor
    code:
      v: OTH
    display:
      v: other

link id:
  v: cardiology_referral_services_cardiactesting_other_specify
text:
  v: Specify
type:
  v: text
enable when:
  question:
    v: cardiology_referral_services_cardiactesting_other
  operator:
    v: =
  answer: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
      l: v3-NullFlavor
    code:
      v: OTH
    display:
      v: other
enable behavior:
  v: all
required:
  v: true

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 785727177547
text:
  v: Cardiology Consultation
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20002
    display:
      v: Cardiology Consultation

link id:
  v: 186952778859
text:
  v: Concern(s) / Indication(s) Triggering Referral Select all that apply:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Concern(s) / Indication(s) Triggering Referral Select all that apply:
type:
  v: group
required:
  v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 219569805461
  text:
    v: Arrhythmias or Palpitations
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      type: http://snomed.info/id/698247007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 698247007
      display:
        v: Arrhythmias or Palpitations
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 571934328499
  text:
    v: Cardiovascular Risk Assessment
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20033
      display:
        v: Cardiovascular Risk Assessment
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 459737733395
  text:
    v: Chest Pain or Angina
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20034
      display:
        v: Chest Pain or Angina
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  link id:
    v: 929919815516
  text:
    v: Congenital Heart Disease
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: http://example.com/CodeSystem/standardized-referral-form-codes
        l: standardized-referral-form-codes
      code:
        v: 20035
      display:
        v: Congenital Heart Disease
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
      l: questionnaire-choiceOrientation
    value: Code
      v: horizontal
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 832263816528
  text:
    v: Congestive Heart Failure
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: check-box

v: Check-box

v: choice

v: true

value: Coding
  system:
    v: http://example.com/CodeSystem/standardized-referral-form-codes
    l: standardized-referral-form-codes
  code:
    v: 20036
  display:
    v: Congestive Heart Failure

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 803760213460
text:
  v: Coronary Artery Disease
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20037
    display:
      v: Coronary Artery Disease

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 129767162379
text:
  v: Dyspnea
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20038
    display:
      v: Dyspnea

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 116150628533
text:
  v: Hypertension
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20039
    display:
      v: Hypertension

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 513825527027
text:
  v: Murmur
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20040
    display:
      v: Murmur

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 975075898688
text:
  v: Pericardial Disease
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20041
    display:
      v: Pericardial Disease

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 704148928571
text:
  v: Peripheral Edema
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20042
    display:
      v: Peripheral Edema

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 886489617115
text:
  v: Post-Myocardial Infarction
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20043
    display:
      v: Post-Myocardial Infarction

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 621745958993
text:
  v: Pre-operative Consultation
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20044
    display:
      v: Pre-operative Consultation

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: 873024527134
code: http://snomed.info/id/439272007
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 439272007
  display:
    v: Date of procedure
text:
  v: Procedure Date (if known)
type:
  v: date
enable when:
  question:
    v: 621745958993
  operator:
    v: =
  answer: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20044
    display:
      v: Pre-operative Consultation

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
link id:
  v: 197975129599
text:
  v: Syncope
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://example.com/CodeSystem/standardized-referral-form-codes
      l: standardized-referral-form-codes
    code:
      v: 20045
    display:
      v: Syncope

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 675849150752
text:
  v: Valvular Heart Disease or Prosthetic Heart Valve
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/368009
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 368009
    display:
      v: Valvular Heart Disease or Prosthetic Heart Valve

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation
    l: questionnaire-choiceOrientation
  value: Code
    v: horizontal
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    l: questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
        l: questionnaire-item-control
      code:
        v: check-box
      display:
        v: Check-box
link id:
  v: 721982740516
text:
  v: Other
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: display:none;
type:
  v: choice
repeats:
  v: true
answer option:
  value: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
      l: v3-NullFlavor
    code:
      v: OTH
    display:
      v: other

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: 720594942482
text:
  v: Specify
type:
  v: text
enable when:
  question:
    v: 721982740516
  operator:
    v: =
  answer: Coding
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
      l: v3-NullFlavor
    code:
      v: OTH
    display:
      v: other
required:
  v: true

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:white;border-style:solid;
link id:
  v: Descriptionofclinicalquestion
text:
  v: Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: font-weight:bold;
type:
  v: text
required:
  v: true

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: cpp_header
text:
  v: Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: font-weight:bold;
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: cpp_separate
  text:
    v: CPP attached separately (if not entered below)
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: string
  repeats:
    v: true
  answer option:
    value: String
      v: CPP attached separately (if not entered below)
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: cpp_currentprob
  code: http://snomed.info/id/55607006
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 55607006
    display:
      v: Problem
  text:
    v: Current Problem List:
  type:
    v: text
  enable when:
    question:
      v: cpp_separate
    operator:
      v: exists
    answer: Boolean
      v: false
  enable behavior:
    v: all
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: cpp_pastmedicalhistory
  code: http://snomed.info/id/417662000
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 417662000
    display:
      v: History of clinical finding in subject
  text:
    v: Past Medical History:
  type:
    v: text
  enable when:
    question:
      v: cpp_separate
    operator:
      v: exists
    answer: Boolean
      v: false
  enable behavior:
    v: all
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: cpp_currentmedications
  code: http://snomed.info/id/129019007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 129019007
    display:
      v: Taking medication
  text:
    v: Current Medications :
  type:
    v: text
  enable when:
    question:
      v: cpp_separate
    operator:
      v: exists
    answer: Boolean
      v: false
  enable behavior:
    v: all
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: cpp_familyhistory
  code: http://snomed.info/id/57177007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 57177007
    display:
      v: Family history with explicit context
  text:
    v: Family History:
  type:
    v: text
  enable when:
    question:
      v: cpp_separate
    operator:
      v: exists
    answer: Boolean
      v: false
  enable behavior:
    v: all
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: cpp_allergies
  code: http://snomed.info/id/609328004
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 609328004
    display:
      v: Allergic disposition
  text:
    v: Allergies:
  type:
    v: text
  enable when:
    question:
      v: cpp_separate
    operator:
      v: exists
    answer: Boolean
      v: false
  enable behavior:
    v: all

v: check-box

v: Check-box

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: preferredconsultlocation_header
text:
  v: Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: preferredconsultlocation_selector
  text:
    v: Preferred consultant or location
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: string
  repeats:
    v: true
  answer option:
    value: String
      v: Preferred consultant or location
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: preferredconsultlocation_specify
  text:
    v: Please specify either a preferred consultant or location
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
        v: Please specify either a preferred consultant or location
  type:
    v: group
  enable when:
    question:
      v: preferredconsultlocation_selector
    operator:
      v: =
    answer: String
      v: Preferred consultant or location
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: border-style:solid;
    link id:
      v: preferredconsultlocation_consultant
    text:
      v: Consultant:
    type:
      v: string
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: border-style:solid;
    link id:
      v: preferredconsultlocation_location
    text:
      v: Location:
    type:
      v: string
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: preferredconsultlocation_willingtotravel
  text:
    v: Patient willing to travel for shorter wait time
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: string
  repeats:
    v: true
  answer option:
    value: String
      v: Patient willing to travel for shorter wait time
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: background-color:white;border-style:solid;
  link id:
    v: preferredconsultlocation_otherconsiderations
  text:
    v: Other considerations:
  type:
    v: string

v: check-box

v: Check-box

v: check-box

v: Check-box

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: supportingdocumentation_header
text:
  v: Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: supportingdocumentation_details
  text:
    v: Personal Health Information that is medically relevant has not been disclosed at the request of the patient.
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
        l: rendering-xhtml
      value: String
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/rendering-style
        l: rendering-style
      value: String
        v: display:none;
  type:
    v: string
  repeats:
    v: true
  answer option:
    value: String
      v: Personal Health Information that is medically relevant has not been disclosed at the request of the patient.

v: check-box

v: Check-box

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: application/pdf
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: image/gif
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: image/bmp
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: video/mp4
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: text/csv
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: image/jpeg
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: application/msword
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: image/png
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: application/vnd.openxmlformats-officedocument.wordprocessingml.document
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: application/vnd.ms-excel
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: text/plain
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: audio/mp4
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: audio/mpeg
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/mimeType
    l: mimeType
  value: Code
    v: image/tiff
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/maxSize
    l: maxSize
  value: Decimal
    v: 5000000
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
extension:
  extension:
    url:
      v: positiveText
      l: positiveText
    value: String
      v: Attachment Provided
  url:
    v: http://example.com/StructureDefinition/question-note-info
    l: question-note-info
link id:
  v: supportingdocumentation_attachment
text:
  v: Add Attachments
type:
  v: attachment

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: feedbacksurvey_cardiology
text:
  v: Click here to provide feedback on this form
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-xhtml
      l: rendering-xhtml
    value: String
      v: Click here to provide feedback on this form
type:
  v: display

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/rendering-style
    l: rendering-style
  value: String
    v: background-color:grey;border-style:solid;
link id:
  v: referrer_header
text:
  v: Referrer's Information
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/rendering-style
      l: rendering-style
    value: String
      v: font-weight:bold;
type:
  v: group
item:
  link id:
    v: referrer_sitename
  text:
    v: Site Name:
  type:
    v: string
item:
  link id:
    v: referrer_address_line1
  text:
    v: Address (Line 1):
  type:
    v: string
  required:
    v: true
  item:
    link id:
      v: referrer_address_line2
    text:
      v: Address (Line 2):
    type:
      v: string
  item:
    link id:
      v: referrer_address_city
    text:
      v: City:
    type:
      v: string
    required:
      v: true
  item:
    link id:
      v: referrer_address_province
    text:
      v: Province:
    type:
      v: string
    required:
      v: true
    max length:
      v: 2
  item:
    extension:
      extension:
        value: Id
      extension:
        value: Code
      extension:
        value: Expression
      extension:
        value: String
      url:
        v: http://hl7.org/fhir/StructureDefinition/targetConstraint
        l: targetConstraint
    link id:
      v: referrer_address_postalcode
    text:
      v: Postal Code:
    type:
      v: string
    required:
      v: true
item:
  extension:
    extension:
      url:
        v: key
        l: key
      value: Id
        v: refphone
    extension:
      url:
        v: severity
        l: severity
      value: Code
        v: error
    extension:
      url:
        v: expression
        l: expression
      value: Expression
    extension:
      url:
        v: human
        l: human
      value: String
        v: Must be a valid phone number
    url:
      v: http://hl7.org/fhir/StructureDefinition/targetConstraint
      l: targetConstraint
  link id:
    v: referrer_phone
  text:
    v: Phone #:
  type:
    v: string
item:
  extension:
    extension:
      url:
        v: key
        l: key
      value: Id
        v: reffax
    extension:
      url:
        v: severity
        l: severity
      value: Code
        v: error
    extension:
      url:
        v: expression
        l: expression
      value: Expression
    extension:
      url:
        v: human
        l: human
      value: String
        v: Must be a valid phone number
    url:
      v: http://hl7.org/fhir/StructureDefinition/targetConstraint
      l: targetConstraint
  link id:
    v: referrer_fax
  text:
    v: Fax #:
  type:
    v: string
item:
  link id:
    v: referrer_billing
  text:
    v: Billing Number:
  type:
    v: integer
item:
  link id:
    v: referrer_professionalid
  text:
    v: Professional ID:
  type:
    v: integer
item:
  link id:
    v: referrer_signature
  text:
    v: Signed:
  type:
    v: text
  required:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      l: questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: referrer_role
  text:
    v: Role:
  type:
    v: choice
  answer option:
    value: Coding
      type: http://snomed.info/id/309398001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 309398001
      display:
        v: Allied Health Professional
  answer option:
    value: Coding
      type: http://snomed.info/id/62247001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 62247001

v: key
l: key

Id
v: ref-pcode

v: severity
l: severity

Code
v: error

v: expression
l: expression

Expression
language:
  v: text/fhirpath
expression:
  v: %resource.repeat(item).where(linkId='referrer_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))

v: human
l: human

String
v: Must be a valid Canadian postal-code

v: text/fhirpath

v: %resource.repeat(item).where(linkId='referrer_phone').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))

v: text/fhirpath

v: %resource.repeat(item).where(linkId='referrer_fax').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))

v: drop-down

v: Drop down

v: Family Physician

value: Coding
  type: http://snomed.info/id/449161006
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 449161006
  display:
    v: Physician Assistant

value: Coding
  type: http://snomed.info/id/398130009
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 398130009
  display:
    v: Medical Student

value: Coding
  type: http://snomed.info/id/106292003
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 106292003
  display:
    v: Nurse

value: Coding
  type: http://snomed.info/id/224571005
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 224571005
  display:
    v: Nurse Practitioner

value: Coding
  type: http://snomed.info/id/405277009
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 405277009
  display:
    v: Resident

value: Coding
  type: http://snomed.info/id/69280009
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 69280009
  display:
    v: Specialist

value: Coding
  system:
    v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
    l: v3-NullFlavor
  code:
    v: OTH
  display:
    v: other