Generated Narrative: Questionnaire FollowupSurPass Structure LinkID Text Cardinality Type Flags Description & Constraints FollowupSurPass Follow up form. The first Followup-Surpass form must be completed at the same time as the SurPass is delivered or in any case at the first visit after the end of the treatment (OT). Questionnaire http://hl7.eu/fhir/ig/pcsp/Questionnaire/FollowupSurPass#1.0.0 #xD; first-visit First visit? 1..1 choice Value Set: YesNoVS #xD; consent Informed consent to participate in the Followup-SurPass 1..1 choice Enable When: first-visit = Value Set: YesNoVS #xD; consent-date Consent date 0..1 date Enable When: first-visit = #xD; visit-date Visit date 1..1 date #xD; new-cancer-after-off-therapy Predisposing genetic syndromes or clinical conditions associated with the tumor diagnosed after the first off-therapy 0..1 choice Enable When: first-visit = Value Set: YesNoVS #xD; sepcify-new-cancer-txt-1 If yes, specify 1..1 text Enable When: new-cancer-after-off-therapy = #xD; other-clinical Other clinical pictures, not associated with the tumor at the time of diagnosis 0..1 choice Enable When: first-visit = Value Set: YesNoVS #xD; sepcify-other-clinical-txt-1 If yes, specify 1..1 text Enable When: other-clinical = #xD; new-condition-after-off-therapy After the first off therapy the patient experienced one or more pathological conditions 1..1 choice Enable When: first-visit = Value Set: YesNoVS #xD; group-condition-1 Pathological conditions 1..* group Enable When: new-condition-after-off-therapy = #xD; condition-1 Condition 1..1 choice Value Set: Conditions: follow up #xD; condition-note-1 null 0..1 text Initial Value: string = This space will contain guidance for the selected condition. Content is not yet available. #xD; condition-other-1 If other, specify 1..1 text Enable When: condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = condition-1 = #xD; appearance-date-1 Onset date 1..1 date #xD; condition-grading-1 Grading m-CTCAE at onset/last visit 1..1 choice Value Set: Grade: follow up #xD; condition-evolution-1 Evolution 1..1 choice Options: 2 options #xD; resolution-date-1 If yes, date 1..1 date Enable When: condition-evolution-1 = #xD; new-condition-grading-1 If changed, new grading 1..1 choice Enable When: condition-evolution-1 = Value Set: Grade: follow up #xD; details-1 Details 0..1 text #xD; next-check-1 Next check-up planned on 0..1 text #xD; condition-changed Have any pathological conditions that were still present (unresolved) at the previous visit resolved or changed in degree? 1..1 choice Enable When: first-visit = Value Set: YesNoNAVS #xD; group-condition-2 Pathological conditions 1..* group Enable When: condition-changed = condition-changed = #xD; condition-2 Condition 1..1 choice Value Set: Conditions: follow up #xD; condition-note-2 null 0..1 text Initial Value: string = This space will contain guidance for the selected condition. Content is not yet available. #xD; condition-other-2 If other, specify 1..1 text Enable When: condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = condition-2 = #xD; appearance-date-2 Onset date 1..1 date #xD; condition-grading-2 Grading m-CTCAE at onset/last visit 1..1 choice Value Set: Grade: follow up #xD; condition-evolution-2 Evolution 1..1 choice Enable When: condition-changed = Options: 3 options #xD; resolution-date-2 If yes, date 1..1 date Enable When: condition-evolution-2 = #xD; new-condition-grading-2 If changed, new grading 1..1 choice Enable When: condition-evolution-2 = Value Set: Grade: follow up #xD; details-2 Details 0..1 text #xD; next-check-2 Next check-up planned on 0..1 text #xD; new-cancer-after-last-visit After the first off therapy the patient experienced one or more pathological conditions? 0..1 choice Enable When: first-visit = Value Set: YesNoVS #xD; group-condition-3 Pathological conditions 1..* group Enable When: new-cancer-after-last-visit = #xD; condition-3 Condition 1..1 choice Value Set: Conditions: follow up #xD; condition-note-3 null 0..1 text Initial Value: string = This space will contain guidance for the selected condition. Content is not yet available. #xD; condition-other-3 If other, specify 1..1 text Enable When: condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = condition-3 = #xD; appearance-date-3 Onset date 1..1 date #xD; condition-grading-3 Grading m-CTCAE at onset/last visit 1..1 choice Value Set: Grade: follow up #xD; condition-evolution-3 Evolution 1..1 choice Options: 2 options #xD; resolution-date-3 If yes, date 1..1 date Enable When: condition-evolution-3 = #xD; new-condition-grading-3 If changed, new grading 1..1 choice Enable When: condition-evolution-3 = Value Set: Grade: follow up #xD; details-3 Details 0..1 text #xD; next-check-3 Next check-up planned on 0..1 text #xD; notes Notes 0..1 string #xD; notes-attachments Reports relating to significant laboratory instrumental tests 0..* attachment #xD; Documentation for this format Options Sets Answer options for condition-evolution-1 Yes, resolved No, not resolved Answer options for condition-evolution-2 No, unchanged Yes, changed Yes, solved Answer options for condition-evolution-3 Yes, resolved No, not resolved Contained Resources ValueSet #YesNoVS Include these codes as defined in http://loinc.org version Not Stated (use latest from terminology server) Code Display LA32-8 NO LA33-6 YES ValueSet #YesNoNAVS Include these codes as defined in http://loinc.org version Not Stated (use latest from terminology server) Code Display LA32-8 NO LA33-6 YES LA30226-7 Not applicable (N/A)
Follow up form. The first Followup-Surpass form must be completed at the same time as the SurPass is delivered or in any case at the first visit after the end of the treatment (OT).
Informed consent to participate in the Followup-SurPass
Predisposing genetic syndromes or clinical conditions associated with the tumor diagnosed after the first off-therapy
Other clinical pictures, not associated with the tumor at the time of diagnosis
After the first off therapy the patient experienced one or more pathological conditions
This space will contain guidance for the selected condition. Content is not yet available.
Have any pathological conditions that were still present (unresolved) at the previous visit resolved or changed in degree?
After the first off therapy the patient experienced one or more pathological conditions?
Reports relating to significant laboratory instrumental tests