Cardiology Form - JSON Representation - Structured Data Capture v4.0.0-ci-build

Structured Data Capture, published by HL7 International / FHIR Infrastructure. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ci-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/sdc/ and changes regularly. See the Directory of published versions
: Cardiology Form

Page standards status: Trial-use
Maturity Level: 4
Raw json | Download
{
  "resourceType" : "Questionnaire",
  "id" : "CardiologyForm",
  "language" : "en",
  "text" : {
    "status" : "extensions",
    "div" : "<div xml:lang=\"en\" xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire CardiologyForm</b></p><a name=\"CardiologyForm\"> </a><a name=\"hcCardiologyForm\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p></div><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Other attributes of the item\">Flags</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description &amp; Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> </td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d#4.0.0-ci-build</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.patient_header\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> patient_header</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Patient Information</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_surname\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_surname</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Surname:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_firstname\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_firstname</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">First Name:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_date_of_birth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> patient_date_of_birth</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">DOB:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_gender\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> patient_gender</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Gender:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.patient_gender\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.patient_hc_pc\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_hc_pc</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">HN PC:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Max Length: 2</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.patient_hc_number\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_hc_number</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">HN:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Max Length: 10</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.patient_hc_vc\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_hc_vc</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">HN VC:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.patient_address_line1\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_address_line1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address (Line 1):</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.patient_address_line2\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_address_line2</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address (Line 2):</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.patient_address_city\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_address_city</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">City:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.patient_address_province\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_address_province</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Province:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Max Length: 2</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.patient_address_postalcode\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_address_postalcode</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Postal Code:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_phone_mobile\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_phone_mobile</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Mobile #:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_phone_home\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_phone_home</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Home #:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.patient_phone_business\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_phone_business</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Business #:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.patient_email\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> patient_email</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Email:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.additionalinfo_header\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> additionalinfo_header</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">[Optional] Additional Patient Information</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_sexassignedatbirth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> additionalinfo_sexassignedatbirth</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Sex assigned at birth:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_sexassignedatbirth\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.additionalinfo_pronouns\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> additionalinfo_pronouns</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Pronouns:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_pronouns\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.additionalinfo_pronouns_other\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_pronouns_other</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other pronouns:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_pronouns\">additionalinfo_pronouns</a> = other (v3 Code System NullFlavor#OTH)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.additionalinfo_preferredlanguage\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> additionalinfo_preferredlanguage</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred language:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_preferredlanguage\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.additionalinfo_preferredlanguage_specify\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_preferredlanguage_specify</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Specify:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_preferredlanguage\">additionalinfo_preferredlanguage</a> = other (v3 Code System NullFlavor#OTH)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.additionalinfo_preferredlanguage_translatorrequired\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_preferredlanguage_translatorrequired</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Translator required</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_preferredlanguage\">additionalinfo_preferredlanguage</a> = other (v3 Code System NullFlavor#OTH)</span><br/>Options: <a href=\"#opt-item.additionalinfo_preferredlanguage_translatorrequired\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.additionalinfo_bestmethodofcontact\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> additionalinfo_bestmethodofcontact</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Best method of contact:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_bestmethodofcontact\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.additionalinfo_bestmethodofcontact_voicemails\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_bestmethodofcontact_voicemails</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Voicemails acceptable</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_bestmethodofcontact\">additionalinfo_bestmethodofcontact</a> = Mobile (ContactPointUse#mobile)</span><br/>Options: <a href=\"#opt-item.additionalinfo_bestmethodofcontact_voicemails\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredname_select\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_preferredname_select</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_preferredname_select\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_preferredname\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_preferredname</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Prefered name String</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_preferredname_select\">additionalinfo_preferredname_select</a> = Preferred Name</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_select\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_alternatecontact_select</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Alternate contact</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_alternatecontact_select\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_name\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_alternatecontact_name</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Name:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_phone\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_alternatecontact_phone</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Alternate contact phone #:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_relationship\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_alternatecontact_relationship</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Relationship:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_alternatecontact_bookingcontact\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> additionalinfo_alternatecontact_bookingcontact</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Is Alternate contact the appointment booking contact?:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_alternatecontact_select\">additionalinfo_alternatecontact_select</a> = Alternate contact</span><br/>Options: <a href=\"#opt-item.additionalinfo_alternatecontact_bookingcontact\">2 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_unsafecontacts_select\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_unsafecontacts_select</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Unsafe contact persons (do not speak with)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_unsafecontacts_select\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_unsafecontacts_speakwithpatientdirectly\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_unsafecontacts_speakwithpatientdirectly</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Only speak with patient directly</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_unsafecontacts_select\">additionalinfo_unsafecontacts_select</a> = Unsafe contact persons (do not speak with)</span><br/>Options: <a href=\"#opt-item.additionalinfo_unsafecontacts_speakwithpatientdirectly\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_unsafecontacts_donotspeakwith\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_unsafecontacts_donotspeakwith</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do not speak with:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_unsafecontacts_select\">additionalinfo_unsafecontacts_select</a> = Unsafe contact persons (do not speak with)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_accessibilityconcernsordisability_selectt\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_accessibilityconcernsordisability_selectt</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Accessibility concerns or disability</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_accessibilityconcernsordisability_selectt\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_accessibilityconcernsordisability\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> additionalinfo_accessibilityconcernsordisability</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Accessibility concerns Options</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_accessibilityconcernsordisability_selectt\">additionalinfo_accessibilityconcernsordisability_selectt</a> = Accessibility concerns or disability</span><br/>Options: <a href=\"#opt-item.additionalinfo_accessibilityconcernsordisability\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_specialconsiderations_select\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_specialconsiderations_select</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_specialconsiderations_select\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_specialconsiderations\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> additionalinfo_specialconsiderations</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Details of special considerations:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_specialconsiderations_select\">additionalinfo_specialconsiderations_select</a> = Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.additionalinfo_sendcopiestoadditionalproviders\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_sendcopiestoadditionalproviders</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Send copies of reports to additional providers</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.additionalinfo_sendcopiestoadditionalproviders\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck101.png)\" id=\"item.additionalinfo_sendcopiestoadditionalproviders_names\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_sendcopiestoadditionalproviders_names</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Name(s):</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_sendcopiestoadditionalproviders\">additionalinfo_sendcopiestoadditionalproviders</a> = Send copies of reports to additional providers</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1010.png)\" id=\"item.additionalinfo_sendcopiestoadditionalproviders_contactinfo\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_sendcopiestoadditionalproviders_contactinfo</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Contact information:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_sendcopiestoadditionalproviders\">additionalinfo_sendcopiestoadditionalproviders</a> = Send copies of reports to additional providers</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1000.png)\" id=\"item.additionalinfo_sendcopiestoadditionalproviders_ispcp\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> additionalinfo_sendcopiestoadditionalproviders_ispcp</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">This is the Primary Care Provider</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.additionalinfo_sendcopiestoadditionalproviders\">additionalinfo_sendcopiestoadditionalproviders</a> = Send copies of reports to additional providers</span><br/>Options: <a href=\"#opt-item.additionalinfo_sendcopiestoadditionalproviders_ispcp\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.102173268919\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 102173268919</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Referral Details</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.cardio_triagecons\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> cardio_triagecons</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Triage Considerations</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111.png)\" id=\"item.referral_requestedpriority\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> referral_requestedpriority</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Requested Priority:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.referral_requestedpriority\">2 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11100.png)\" id=\"item.referral_requestedpriority_urgentreason\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referral_requestedpriority_urgentreason</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Reason for urgent triage</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.referral_requestedpriority\">referral_requestedpriority</a> = Urgent (RequestPriority#urgent)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.referral_secondopinion\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> referral_secondopinion</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Second Opinion</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.referral_secondopinion\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.referral_secondopinion_reason\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> referral_secondopinion_reason</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Reason for second opinion:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.referral_secondopinion\">referral_secondopinion</a> = Second or third medical opinion (SNOMED CT#77406008)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.695991571585\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 695991571585</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Service(s) Requested Select all that apply:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.referralService\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referralService</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">HSCs Assigned:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/questionnaire-definitions.html#Questionnaire.item.readOnly\" title=\"Is Read Only\"><img src=\"icon-qi-readonly.png\" alt=\"icon\"/></a><img src=\"icon-qi-readonly.png\" alt=\"icon\"/><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-hidden.html\" title=\"Is a hidden item\"><img src=\"icon-qi-hidden.png\" alt=\"icon\"/></a><img src=\"icon-qi-hidden.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.223886162384\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 223886162384</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Cardiac Testing</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.223886162384\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111.png)\" id=\"item.660331267409\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 660331267409</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Exam(s) Requested</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.223886162384\">223886162384</a> = Cardiac Testing (standardized-referral-form-codes#20001)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.720409326878\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 720409326878</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">24 Hour Ambulatory Blood Pressure Monitoring</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.720409326878\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.960455115596\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 960455115596</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Coronary Angiogram</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.960455115596\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.297634898828\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 297634898828</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Echocardiogram - Resting</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.297634898828\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)\" id=\"item.443484577720\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 443484577720</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">sub Echocardiogram - Resting</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.297634898828\">297634898828</a> = Echocardiogram - Resting (standardized-referral-form-codes#20005)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.165530569567\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 165530569567</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Echocardiogram (2D)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.165530569567\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.286552421895\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 286552421895</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Echocardiogram with Contrast</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.286552421895\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.910527687300\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 910527687300</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Echocardiogram with Saline (Bubble)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.910527687300\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.657824763133\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 657824763133</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Pediatric Echocardiogram</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.657824763133\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)\" id=\"item.992743200182\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 992743200182</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Transesophageal Echocardiogram (TEE)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.992743200182\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.894277763438\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 894277763438</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Electrocardiogram (ECG)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.894277763438\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.279226023495\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 279226023495</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Holter Monitoring</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.279226023495\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)\" id=\"item.440449731882\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 440449731882</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">sub holter monitoring</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.279226023495\">279226023495</a> = Holter Monitoring (standardized-referral-form-codes#20007)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.671328703851\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 671328703851</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">24 Hours</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.671328703851\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.423992261841\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 423992261841</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">48 Hours</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.423992261841\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.419924239187\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 419924239187</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">72 Hours</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.419924239187\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.731054417270\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 731054417270</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">7 Days</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.731054417270\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)\" id=\"item.235876421044\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 235876421044</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">14 Days</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.235876421044\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.374742834400\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 374742834400</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Loop / Event Monitor</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.374742834400\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.159161544747\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 159161544747</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Cardiovascular stress testing</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.159161544747\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)\" id=\"item.370275060390\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 370275060390</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Sub Stress Testing</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.159161544747\">159161544747</a> = Stress Testing (standardized-referral-form-codes#20009)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.814218498309\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 814218498309</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">ECG - Exercise Stress Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.814218498309\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.307107493993\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 307107493993</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">ECG - Dobutamine/Persantine Stress Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.307107493993\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.805303414102\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 805303414102</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Echocardiogram - Exercise Stress Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.805303414102\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111100.png)\" id=\"item.193586908489\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 193586908489</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Echocardiogram - Dobutamine/Persantine Stress Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.193586908489\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.918517139023\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 918517139023</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Nuclear Medicine</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.918517139023\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11111.png)\" id=\"item.222686221935\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 222686221935</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">sub Nuclear Medicine</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.918517139023\">918517139023</a> = Nuclear Medicine (standardized-referral-form-codes#20010)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.924189648184\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 924189648184</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">MUGA - Resting</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.924189648184\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.857163514910\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 857163514910</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Cardiac Pyrophosphate</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.857163514910\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111110.png)\" id=\"item.892165959617\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 892165959617</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Myocardial perfusion scan</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.892165959617\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111101.png)\" id=\"item.538288549138\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 538288549138</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">sub MIBI</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.892165959617\">892165959617</a> = MIBI Scans / Myocardial Perfusion Imaging (MPI): (standardized-referral-form-codes#20028)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111010.png)\" id=\"item.373435981917\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> 373435981917</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">MIBI Scan - Exercise Stress Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.373435981917\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111010.png)\" id=\"item.434394942688\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> 434394942688</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">MIBI Scan - Dobutamine/Persantine Stress Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.434394942688\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1111000.png)\" id=\"item.913594478162\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> 913594478162</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Thallium Viability Test</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.913594478162\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.992682216482\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 992682216482</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Tilt Table Testing</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.992682216482\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11110.png)\" id=\"item.cardiology_referral_services_cardiactesting_other\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> cardiology_referral_services_cardiactesting_other</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.cardiology_referral_services_cardiactesting_other\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11100.png)\" id=\"item.cardiology_referral_services_cardiactesting_other_specify\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> cardiology_referral_services_cardiactesting_other_specify</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Specify</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.cardiology_referral_services_cardiactesting_other\">cardiology_referral_services_cardiactesting_other</a> = other (v3 Code System NullFlavor#OTH)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.785727177547\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 785727177547</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Cardiology Consultation</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.785727177547\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.186952778859\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> 186952778859</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Concern(s) / Indication(s) Triggering Referral Select all that apply:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.219569805461\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 219569805461</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Arrhythmias or Palpitations</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.219569805461\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.571934328499\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 571934328499</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Cardiovascular Risk Assessment</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.571934328499\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.459737733395\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 459737733395</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Chest Pain or Angina</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.459737733395\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.929919815516\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 929919815516</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Congenital Heart Disease</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.929919815516\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.832263816528\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 832263816528</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Congestive Heart Failure</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.832263816528\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.803760213460\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 803760213460</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Coronary Artery Disease</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.803760213460\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.129767162379\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 129767162379</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Dyspnea</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.129767162379\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.116150628533\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 116150628533</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Hypertension</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.116150628533\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.513825527027\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 513825527027</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Murmur</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.513825527027\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.975075898688\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 975075898688</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Pericardial Disease</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.975075898688\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.704148928571\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 704148928571</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Peripheral Edema</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.704148928571\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.886489617115\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 886489617115</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Post-Myocardial Infarction</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.886489617115\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.621745958993\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 621745958993</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Pre-operative Consultation</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.621745958993\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.873024527134\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> 873024527134</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Procedure Date (if known)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.621745958993\">621745958993</a> = Pre-operative Consultation (standardized-referral-form-codes#20044)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.197975129599\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 197975129599</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Syncope</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.197975129599\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.675849150752\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 675849150752</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Valvular Heart Disease or Prosthetic Heart Valve</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.675849150752\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.721982740516\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 721982740516</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/extension-questionnaire-choiceorientation.html\" title=\"Orientation: horizontal \"><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></a><img src=\"icon-qi-horizontal.png\" alt=\"icon\"/></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.721982740516\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.720594942482\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> 720594942482</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Specify</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.721982740516\">721982740516</a> = other (v3 Code System NullFlavor#OTH)</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.Descriptionofclinicalquestion\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> Descriptionofclinicalquestion</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.cpp_header\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> cpp_header</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.cpp_separate\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> cpp_separate</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">CPP attached separately (if not entered below)</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.cpp_separate\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.cpp_currentprob\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> cpp_currentprob</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Current Problem List:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> exists false</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.cpp_pastmedicalhistory\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> cpp_pastmedicalhistory</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Past Medical History:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> exists false</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.cpp_currentmedications\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> cpp_currentmedications</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Current Medications :</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> exists false</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.cpp_familyhistory\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> cpp_familyhistory</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Family History:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> exists false</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.cpp_allergies\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> cpp_allergies</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Allergies:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.cpp_separate\">cpp_separate</a> exists false</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.preferredconsultlocation_header\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> preferredconsultlocation_header</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.preferredconsultlocation_selector\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> preferredconsultlocation_selector</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred consultant or location</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.preferredconsultlocation_selector\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck111.png)\" id=\"item.preferredconsultlocation_specify\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> preferredconsultlocation_specify</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please specify either a preferred consultant or location</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.preferredconsultlocation_selector\">preferredconsultlocation_selector</a> = Preferred consultant or location</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1110.png)\" id=\"item.preferredconsultlocation_consultant\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> preferredconsultlocation_consultant</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Consultant:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1100.png)\" id=\"item.preferredconsultlocation_location\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> preferredconsultlocation_location</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Location:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.preferredconsultlocation_willingtotravel\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> preferredconsultlocation_willingtotravel</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Patient willing to travel for shorter wait time</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.preferredconsultlocation_willingtotravel\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.preferredconsultlocation_otherconsiderations\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> preferredconsultlocation_otherconsiderations</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other considerations:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.supportingdocumentation_header\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> supportingdocumentation_header</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.supportingdocumentation_details\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> supportingdocumentation_details</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Personal Health Information that is medically relevant has not been disclosed at the request of the patient.</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.supportingdocumentation_details\">1 option</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.supportingdocumentation_attachment\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-attachment.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"attachment\" class=\"hierarchy\"/> supportingdocumentation_attachment</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Add Attachments</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-attachment\">attachment</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.feedbacksurvey_cardiology\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> feedbacksurvey_cardiology</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Click here to provide feedback on this form</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" id=\"item.referrer_header\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> referrer_header</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Referrer's Information</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.referrer_sitename\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_sitename</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Site Name:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)\" id=\"item.referrer_address_line1\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_address_line1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address (Line 1):</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item.referrer_address_line2\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_address_line2</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address (Line 2):</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item.referrer_address_city\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_address_city</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">City:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item.referrer_address_province\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_address_province</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Province:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Max Length: 2</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)\" id=\"item.referrer_address_postalcode\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_address_postalcode</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Postal Code:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.referrer_phone\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_phone</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Phone #:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.referrer_fax\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> referrer_fax</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Fax #:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.referrer_billing\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-integer.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"integer\" class=\"hierarchy\"/> referrer_billing</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Billing Number:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer\">integer</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.referrer_professionalid\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-integer.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"integer\" class=\"hierarchy\"/> referrer_professionalid</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Professional ID:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer\">integer</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.referrer_signature\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> referrer_signature</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Signed:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" id=\"item.referrer_role\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> referrer_role</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Role:</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.referrer_role\">9 options</a></td></tr>\r\n<tr><td colspan=\"6\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name=\"opt-item.patient_gender\"> </a><p><b>Answer options for patient_gender </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#male (&quot;Male&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#female (&quot;Female&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#other (&quot;Other&quot;)</li></ul><a name=\"opt-item.additionalinfo_sexassignedatbirth\"> </a><p><b>Answer options for additionalinfo_sexassignedatbirth </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA3-6 (&quot;Female&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA2-8 (&quot;Male&quot;)</li><li style=\"font-size: 11px\">http://example.com/CodeSystem/exampleCS#Intersex (&quot;Intersex&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA4489-6 (&quot;Unknown&quot;)</li></ul><a name=\"opt-item.additionalinfo_pronouns\"> </a><p><b>Answer options for additionalinfo_pronouns </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA29519-8 (&quot;She/Her&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA29518-0 (&quot;He/Him&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA29519-8 (&quot;They/Them&quot;)</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name=\"opt-item.additionalinfo_preferredlanguage\"> </a><p><b>Answer options for additionalinfo_preferredlanguage </b></p><ul><li style=\"font-size: 11px\">urn:ietf:bcp:47#en (&quot;English&quot;)</li><li style=\"font-size: 11px\">urn:ietf:bcp:47#fr (&quot;French&quot;)</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name=\"opt-item.additionalinfo_preferredlanguage_translatorrequired\"> </a><p><b>Answer options for additionalinfo_preferredlanguage_translatorrequired </b></p><ul><li style=\"font-size: 11px\">Translator Required</li></ul><a name=\"opt-item.additionalinfo_bestmethodofcontact\"> </a><p><b>Answer options for additionalinfo_bestmethodofcontact </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#mobile (&quot;Mobile&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#home (&quot;Home&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#work (&quot;Work&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-system#email (&quot;Email&quot;)</li></ul><a name=\"opt-item.additionalinfo_bestmethodofcontact_voicemails\"> </a><p><b>Answer options for additionalinfo_bestmethodofcontact_voicemails </b></p><ul><li style=\"font-size: 11px\"> Voicemails acceptable</li></ul><a name=\"opt-item.additionalinfo_preferredname_select\"> </a><p><b>Answer options for additionalinfo_preferredname_select </b></p><ul><li style=\"font-size: 11px\">Preferred Name</li></ul><a name=\"opt-item.additionalinfo_alternatecontact_select\"> </a><p><b>Answer options for additionalinfo_alternatecontact_select </b></p><ul><li style=\"font-size: 11px\">Alternate contact</li></ul><a name=\"opt-item.additionalinfo_alternatecontact_bookingcontact\"> </a><p><b>Answer options for additionalinfo_alternatecontact_bookingcontact </b></p><ul><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v2-0532#Y (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v2-0532#N (&quot;No&quot;)</li></ul><a name=\"opt-item.additionalinfo_unsafecontacts_select\"> </a><p><b>Answer options for additionalinfo_unsafecontacts_select </b></p><ul><li style=\"font-size: 11px\">Unsafe contact persons (do not speak with)</li></ul><a name=\"opt-item.additionalinfo_unsafecontacts_speakwithpatientdirectly\"> </a><p><b>Answer options for additionalinfo_unsafecontacts_speakwithpatientdirectly </b></p><ul><li style=\"font-size: 11px\">Only speak with patient directly</li></ul><a name=\"opt-item.additionalinfo_accessibilityconcernsordisability_selectt\"> </a><p><b>Answer options for additionalinfo_accessibilityconcernsordisability_selectt </b></p><ul><li style=\"font-size: 11px\">Accessibility concerns or disability</li></ul><a name=\"opt-item.additionalinfo_accessibilityconcernsordisability\"> </a><p><b>Answer options for additionalinfo_accessibilityconcernsordisability </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#129839007 (&quot;Falls risk&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#301621006 (&quot;Patient requires lift&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#105503008 (&quot;Wheelchair&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#15188001 (&quot;Hearing impaired&quot;)</li></ul><a name=\"opt-item.additionalinfo_specialconsiderations_select\"> </a><p><b>Answer options for additionalinfo_specialconsiderations_select </b></p><ul><li style=\"font-size: 11px\">Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</li></ul><a name=\"opt-item.additionalinfo_sendcopiestoadditionalproviders\"> </a><p><b>Answer options for additionalinfo_sendcopiestoadditionalproviders </b></p><ul><li style=\"font-size: 11px\">Send copies of reports to additional providers</li></ul><a name=\"opt-item.additionalinfo_sendcopiestoadditionalproviders_ispcp\"> </a><p><b>Answer options for additionalinfo_sendcopiestoadditionalproviders_ispcp </b></p><ul><li style=\"font-size: 11px\">This is the Primary Care Provider</li></ul><a name=\"opt-item.referral_requestedpriority\"> </a><p><b>Answer options for referral_requestedpriority </b></p><ul><li style=\"font-size: 11px\">http://hl7.org/fhir/request-priority#routine (&quot;Routine&quot;)</li><li style=\"font-size: 11px\">http://hl7.org/fhir/request-priority#urgent (&quot;Urgent&quot;)</li></ul><a name=\"opt-item.referral_secondopinion\"> </a><p><b>Answer options for referral_secondopinion </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#77406008 (&quot;Second or third medical opinion&quot;)</li></ul><a name=\"opt-item.223886162384\"> </a><p><b>Answer options for 223886162384 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20001 (&quot;Cardiac Testing&quot;)</li></ul><a name=\"opt-item.720409326878\"> </a><p><b>Answer options for 720409326878 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20003 (&quot;24 Hour Ambulatory Blood Pressure Monitoring&quot;)</li></ul><a name=\"opt-item.960455115596\"> </a><p><b>Answer options for 960455115596 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20004 (&quot;Coronary Angiogram&quot;)</li></ul><a name=\"opt-item.297634898828\"> </a><p><b>Answer options for 297634898828 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20005 (&quot;Echocardiogram - Resting&quot;)</li></ul><a name=\"opt-item.165530569567\"> </a><p><b>Answer options for 165530569567 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20012 (&quot;Echocardiogram (2D)&quot;)</li></ul><a name=\"opt-item.286552421895\"> </a><p><b>Answer options for 286552421895 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20013 (&quot;Echocardiogram with Contrast&quot;)</li></ul><a name=\"opt-item.910527687300\"> </a><p><b>Answer options for 910527687300 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20014 (&quot;Echocardiogram with Saline (Bubble)&quot;)</li></ul><a name=\"opt-item.657824763133\"> </a><p><b>Answer options for 657824763133 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20015 (&quot;Pediatric Echocardiogram&quot;)</li></ul><a name=\"opt-item.992743200182\"> </a><p><b>Answer options for 992743200182 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20016 (&quot;Transesophageal Echocardiogram (TEE)&quot;)</li></ul><a name=\"opt-item.894277763438\"> </a><p><b>Answer options for 894277763438 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20006 (&quot;Electrocardiogram (ECG)&quot;)</li></ul><a name=\"opt-item.279226023495\"> </a><p><b>Answer options for 279226023495 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20007 (&quot;Holter Monitoring&quot;)</li></ul><a name=\"opt-item.671328703851\"> </a><p><b>Answer options for 671328703851 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20017 (&quot;24 Hours&quot;)</li></ul><a name=\"opt-item.423992261841\"> </a><p><b>Answer options for 423992261841 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20018 (&quot;48 Hours&quot;)</li></ul><a name=\"opt-item.419924239187\"> </a><p><b>Answer options for 419924239187 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20019 (&quot;72 Hours&quot;)</li></ul><a name=\"opt-item.731054417270\"> </a><p><b>Answer options for 731054417270 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20020 (&quot;7 Days&quot;)</li></ul><a name=\"opt-item.235876421044\"> </a><p><b>Answer options for 235876421044 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20021 (&quot;14 Days&quot;)</li></ul><a name=\"opt-item.374742834400\"> </a><p><b>Answer options for 374742834400 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20008 (&quot;Loop / Event Monitor&quot;)</li></ul><a name=\"opt-item.159161544747\"> </a><p><b>Answer options for 159161544747 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20009 (&quot;Stress Testing&quot;)</li></ul><a name=\"opt-item.814218498309\"> </a><p><b>Answer options for 814218498309 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20022 (&quot;ECG - Exercise Stress Test&quot;)</li></ul><a name=\"opt-item.307107493993\"> </a><p><b>Answer options for 307107493993 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20023 (&quot;ECG - Dobutamine/Persantine Stress Test&quot;)</li></ul><a name=\"opt-item.805303414102\"> </a><p><b>Answer options for 805303414102 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20024 (&quot;Echocardiogram - Exercise Stress Test&quot;)</li></ul><a name=\"opt-item.193586908489\"> </a><p><b>Answer options for 193586908489 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20025 (&quot;Echocardiogram - Dobutamine/Persantine Stress Test&quot;)</li></ul><a name=\"opt-item.918517139023\"> </a><p><b>Answer options for 918517139023 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20010 (&quot;Nuclear Medicine&quot;)</li></ul><a name=\"opt-item.924189648184\"> </a><p><b>Answer options for 924189648184 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20026 (&quot;MUGA - Resting&quot;)</li></ul><a name=\"opt-item.857163514910\"> </a><p><b>Answer options for 857163514910 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20027 (&quot;Cardiac Pyrophosphate&quot;)</li></ul><a name=\"opt-item.892165959617\"> </a><p><b>Answer options for 892165959617 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20028 (&quot;MIBI Scans / Myocardial Perfusion Imaging (MPI):&quot;)</li></ul><a name=\"opt-item.373435981917\"> </a><p><b>Answer options for 373435981917 </b></p><ul><li style=\"font-size: 11px\">MIBI Scan - Exercise Stress Test</li></ul><a name=\"opt-item.434394942688\"> </a><p><b>Answer options for 434394942688 </b></p><ul><li style=\"font-size: 11px\">MIBI Scan - Dobutamine/Persantine Stress Test</li></ul><a name=\"opt-item.913594478162\"> </a><p><b>Answer options for 913594478162 </b></p><ul><li style=\"font-size: 11px\">Thallium Viability Test</li></ul><a name=\"opt-item.992682216482\"> </a><p><b>Answer options for 992682216482 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20011 (&quot;Tilt Table Testing&quot;)</li></ul><a name=\"opt-item.cardiology_referral_services_cardiactesting_other\"> </a><p><b>Answer options for cardiology_referral_services_cardiactesting_other </b></p><ul><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name=\"opt-item.785727177547\"> </a><p><b>Answer options for 785727177547 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20002 (&quot;Cardiology Consultation&quot;)</li></ul><a name=\"opt-item.219569805461\"> </a><p><b>Answer options for 219569805461 </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#698247007 (&quot;Arrhythmias or Palpitations&quot;)</li></ul><a name=\"opt-item.571934328499\"> </a><p><b>Answer options for 571934328499 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20033 (&quot;Cardiovascular Risk Assessment&quot;)</li></ul><a name=\"opt-item.459737733395\"> </a><p><b>Answer options for 459737733395 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20034 (&quot;Chest Pain or Angina&quot;)</li></ul><a name=\"opt-item.929919815516\"> </a><p><b>Answer options for 929919815516 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20035 (&quot;Congenital Heart Disease&quot;)</li></ul><a name=\"opt-item.832263816528\"> </a><p><b>Answer options for 832263816528 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20036 (&quot;Congestive Heart Failure&quot;)</li></ul><a name=\"opt-item.803760213460\"> </a><p><b>Answer options for 803760213460 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20037 (&quot;Coronary Artery Disease&quot;)</li></ul><a name=\"opt-item.129767162379\"> </a><p><b>Answer options for 129767162379 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20038 (&quot;Dyspnea&quot;)</li></ul><a name=\"opt-item.116150628533\"> </a><p><b>Answer options for 116150628533 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20039 (&quot;Hypertension&quot;)</li></ul><a name=\"opt-item.513825527027\"> </a><p><b>Answer options for 513825527027 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20040 (&quot;Murmur&quot;)</li></ul><a name=\"opt-item.975075898688\"> </a><p><b>Answer options for 975075898688 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20041 (&quot;Pericardial Disease&quot;)</li></ul><a name=\"opt-item.704148928571\"> </a><p><b>Answer options for 704148928571 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20042 (&quot;Peripheral Edema&quot;)</li></ul><a name=\"opt-item.886489617115\"> </a><p><b>Answer options for 886489617115 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20043 (&quot;Post-Myocardial Infarction&quot;)</li></ul><a name=\"opt-item.621745958993\"> </a><p><b>Answer options for 621745958993 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20044 (&quot;Pre-operative Consultation&quot;)</li></ul><a name=\"opt-item.197975129599\"> </a><p><b>Answer options for 197975129599 </b></p><ul><li style=\"font-size: 11px\">http://example.com/CodeSystem/standardized-referral-form-codes#20045 (&quot;Syncope&quot;)</li></ul><a name=\"opt-item.675849150752\"> </a><p><b>Answer options for 675849150752 </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#368009 (&quot;Valvular Heart Disease or Prosthetic Heart Valve&quot;)</li></ul><a name=\"opt-item.721982740516\"> </a><p><b>Answer options for 721982740516 </b></p><ul><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name=\"opt-item.cpp_separate\"> </a><p><b>Answer options for cpp_separate </b></p><ul><li style=\"font-size: 11px\">CPP attached separately (if not entered below)</li></ul><a name=\"opt-item.preferredconsultlocation_selector\"> </a><p><b>Answer options for preferredconsultlocation_selector </b></p><ul><li style=\"font-size: 11px\">Preferred consultant or location</li></ul><a name=\"opt-item.preferredconsultlocation_willingtotravel\"> </a><p><b>Answer options for preferredconsultlocation_willingtotravel </b></p><ul><li style=\"font-size: 11px\">Patient willing to travel for shorter wait time</li></ul><a name=\"opt-item.supportingdocumentation_details\"> </a><p><b>Answer options for supportingdocumentation_details </b></p><ul><li style=\"font-size: 11px\">Personal Health Information that is medically relevant has not been disclosed at the request of the patient.</li></ul><a name=\"opt-item.referrer_role\"> </a><p><b>Answer options for referrer_role </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#309398001 (&quot;Allied Health Professional&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#62247001 (&quot;Family Physician&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#449161006 (&quot;Physician Assistant&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#398130009 (&quot;Medical Student&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#106292003 (&quot;Nurse&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#224571005 (&quot;Nurse Practitioner&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#405277009 (&quot;Resident&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#69280009 (&quot;Specialist&quot;)</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm",
      "valueCoding" : {
        "system" : "http://hl7.org/fhir/version-algorithm",
        "code" : "semver"
      }
    },
    {
      "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
      "valueCode" : "random"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fhir"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 4,
      "_valueInteger" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc"
          }
        ]
      }
    }
  ],
  "url" : "urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.17.35.43"
    }
  ],
  "version" : "4.0.0-ci-build",
  "title" : "Cardiology Form",
  "status" : "active",
  "experimental" : false,
  "subjectType" : [
    "Patient"
  ],
  "date" : "2026-01-20T15:05:51.993+00:00",
  "publisher" : "HL7 International / FHIR Infrastructure",
  "contact" : [
    {
      "name" : "HL7 International / FHIR Infrastructure",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fiwg"
        }
      ]
    },
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fiwg"
        }
      ]
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "effectivePeriod" : {
    "start" : "2025-02-03"
  },
  "code" : [
    {
      "system" : "http://snomed.info/sct",
      "code" : "789718008",
      "display" : "Cardiology service"
    }
  ],
  "item" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                "code" : "list",
                "display" : "List"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
          "valueString" : "background-color:grey;border-style:solid;"
        }
      ],
      "linkId" : "patient_header",
      "text" : "Patient Information",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString" : "font-weight:bold;"
          }
        ]
      },
      "type" : "group",
      "item" : [
        {
          "linkId" : "patient_surname",
          "text" : "Surname:",
          "type" : "string",
          "required" : true
        },
        {
          "linkId" : "patient_firstname",
          "text" : "First Name:",
          "type" : "string",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/entryFormat",
              "valueString" : "yyyy/MM/dd"
            }
          ],
          "linkId" : "patient_date_of_birth",
          "text" : "DOB:",
          "type" : "date",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "radio-button",
                    "display" : "Radio Button"
                  }
                ]
              }
            }
          ],
          "linkId" : "patient_gender",
          "text" : "Gender:",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "male",
                "display" : "Male"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "female",
                "display" : "Female"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "other",
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "patient_hc_pc",
          "text" : "HN PC:",
          "type" : "string",
          "maxLength" : 2,
          "item" : [
            {
              "linkId" : "patient_hc_number",
              "text" : "HN:",
              "type" : "string",
              "maxLength" : 10
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/minLength",
                  "valueInteger" : 2
                }
              ],
              "linkId" : "patient_hc_vc",
              "text" : "HN VC:",
              "type" : "string"
            }
          ]
        },
        {
          "linkId" : "patient_address_line1",
          "text" : "Address (Line 1):",
          "type" : "string",
          "required" : true,
          "item" : [
            {
              "linkId" : "patient_address_line2",
              "text" : "Address (Line 2):",
              "type" : "string"
            },
            {
              "linkId" : "patient_address_city",
              "text" : "City:",
              "type" : "string",
              "required" : true
            },
            {
              "linkId" : "patient_address_province",
              "text" : "Province:",
              "type" : "string",
              "required" : true,
              "maxLength" : 2
            },
            {
              "extension" : [
                {
                  "extension" : [
                    {
                      "url" : "key",
                      "valueId" : "pat-pcode"
                    },
                    {
                      "url" : "severity",
                      "valueCode" : "error"
                    },
                    {
                      "url" : "expression",
                      "valueExpression" : {
                        "language" : "text/fhirpath",
                        "expression" : "%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]$'))"
                      }
                    },
                    {
                      "url" : "human",
                      "valueString" : "Must be a valid Canadian postal-code"
                    }
                  ],
                  "url" : "http://hl7.org/fhir/StructureDefinition/targetConstraint"
                }
              ],
              "linkId" : "patient_address_postalcode",
              "text" : "Postal Code:",
              "type" : "string",
              "required" : true
            }
          ]
        },
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "key",
                  "valueId" : "mobilephone"
                },
                {
                  "url" : "severity",
                  "valueCode" : "error"
                },
                {
                  "url" : "expression",
                  "valueExpression" : {
                    "language" : "text/fhirpath",
                    "expression" : "%resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url" : "human",
                  "valueString" : "Must be a valid phone number"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            }
          ],
          "linkId" : "patient_phone_mobile",
          "text" : "Mobile #:",
          "type" : "string"
        },
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "key",
                  "valueId" : "homephone"
                },
                {
                  "url" : "severity",
                  "valueCode" : "error"
                },
                {
                  "url" : "expression",
                  "valueExpression" : {
                    "language" : "text/fhirpath",
                    "expression" : "%resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url" : "human",
                  "valueString" : "Must be a valid phone number"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            }
          ],
          "linkId" : "patient_phone_home",
          "text" : "Home #:",
          "type" : "string"
        },
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "key",
                  "valueId" : "busphone"
                },
                {
                  "url" : "severity",
                  "valueCode" : "error"
                },
                {
                  "url" : "expression",
                  "valueExpression" : {
                    "language" : "text/fhirpath",
                    "expression" : "%resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url" : "human",
                  "valueString" : "Must be a valid phone number"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            }
          ],
          "linkId" : "patient_phone_business",
          "text" : "Business #:",
          "type" : "string"
        },
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "key",
                  "valueId" : "patemail"
                },
                {
                  "url" : "severity",
                  "valueCode" : "error"
                },
                {
                  "url" : "expression",
                  "valueExpression" : {
                    "language" : "text/fhirpath",
                    "expression" : "%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])+)\\])'))"
                  }
                },
                {
                  "url" : "human",
                  "valueString" : "Must be a valid email address"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            }
          ],
          "linkId" : "patient_email",
          "text" : "Email:",
          "type" : "string"
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
          "valueString" : "background-color:grey;border-style:solid;"
        }
      ],
      "linkId" : "additionalinfo_header",
      "text" : "[Optional] Additional Patient Information",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString" : "[Optional]&#xa0;Additional&#xa0;Patient&#xa0;Information<br/>"
          },
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString" : "font-weight:bold;"
          }
        ]
      },
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode" : "horizontal"
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://example.com/CodeSystem/item-controls",
                    "code" : "push-button",
                    "display" : "Push Button"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_sexassignedatbirth",
          "text" : "Sex assigned at birth:",
          "type" : "choice",
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA3-6",
                "display" : "Female"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA2-8",
                "display" : "Male"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://example.com/CodeSystem/exampleCS",
                "code" : "Intersex",
                "display" : "Intersex"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA4489-6",
                "display" : "Unknown"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://example.com/CodeSystem/item-controls",
                    "code" : "push-button",
                    "display" : "Push Button"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_pronouns",
          "text" : "Pronouns:",
          "type" : "choice",
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA29519-8",
                "display" : "She/Her"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA29518-0",
                "display" : "He/Him"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "LA29519-8",
                "display" : "They/Them"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                "code" : "OTH",
                "display" : "other"
              }
            }
          ],
          "item" : [
            {
              "linkId" : "additionalinfo_pronouns_other",
              "text" : "Other pronouns:",
              "type" : "string",
              "enableWhen" : [
                {
                  "question" : "additionalinfo_pronouns",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code" : "OTH",
                    "display" : "other"
                  }
                }
              ],
              "enableBehavior" : "all",
              "required" : true
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode" : "horizontal"
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://example.com/CodeSystem/item-controls",
                    "code" : "push-button",
                    "display" : "Push Button"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_preferredlanguage",
          "text" : "Preferred language:",
          "type" : "choice",
          "required" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "urn:ietf:bcp:47",
                "code" : "en",
                "display" : "English"
              }
            },
            {
              "valueCoding" : {
                "system" : "urn:ietf:bcp:47",
                "code" : "fr",
                "display" : "French"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                "code" : "OTH",
                "display" : "other"
              }
            }
          ],
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "additionalinfo_preferredlanguage_specify",
              "text" : "Specify:",
              "type" : "string",
              "enableWhen" : [
                {
                  "question" : "additionalinfo_preferredlanguage",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code" : "OTH",
                    "display" : "other"
                  }
                }
              ],
              "enableBehavior" : "all",
              "required" : true
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "additionalinfo_preferredlanguage_translatorrequired",
              "text" : "Translator required",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "string",
              "enableWhen" : [
                {
                  "question" : "additionalinfo_preferredlanguage",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code" : "OTH",
                    "display" : "other"
                  }
                }
              ],
              "repeats" : true,
              "answerOption" : [
                {
                  "valueString" : "Translator Required"
                }
              ]
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://example.com/CodeSystem/item-controls",
                    "code" : "push-button",
                    "display" : "Push Button"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_bestmethodofcontact",
          "text" : "Best method of contact:",
          "type" : "choice",
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/contact-point-use",
                "code" : "mobile",
                "display" : "Mobile"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/contact-point-use",
                "code" : "home",
                "display" : "Home"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/contact-point-use",
                "code" : "work",
                "display" : "Work"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/contact-point-system",
                "code" : "email",
                "display" : "Email"
              }
            }
          ],
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "additionalinfo_bestmethodofcontact_voicemails",
              "text" : "Voicemails acceptable",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "string",
              "enableWhen" : [
                {
                  "question" : "additionalinfo_bestmethodofcontact",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://hl7.org/fhir/contact-point-use",
                    "code" : "mobile",
                    "display" : "Mobile"
                  }
                }
              ],
              "enableBehavior" : "any",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueString" : " Voicemails acceptable"
                }
              ]
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_preferredname_select",
          "text" : "Preferred name",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Preferred Name"
            }
          ]
        },
        {
          "linkId" : "additionalinfo_preferredname",
          "text" : "Prefered name String",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_preferredname_select",
              "operator" : "=",
              "answerString" : "Preferred Name"
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_alternatecontact_select",
          "text" : "Alternate contact",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Alternate contact"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_alternatecontact_name",
          "text" : "Name:",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_alternatecontact_select",
              "operator" : "=",
              "answerString" : "Alternate contact"
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        },
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "key",
                  "valueId" : "altphone"
                },
                {
                  "url" : "severity",
                  "valueCode" : "error"
                },
                {
                  "url" : "expression",
                  "valueExpression" : {
                    "language" : "text/fhirpath",
                    "expression" : "%resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))"
                  }
                },
                {
                  "url" : "human",
                  "valueString" : "Must be a valid phone number"
                }
              ],
              "url" : "http://hl7.org/fhir/StructureDefinition/targetConstraint"
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_alternatecontact_phone",
          "text" : "Alternate contact phone #:",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_alternatecontact_select",
              "operator" : "=",
              "answerString" : "Alternate contact"
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_alternatecontact_relationship",
          "text" : "Relationship:",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_alternatecontact_select",
              "operator" : "=",
              "answerString" : "Alternate contact"
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "radio-button",
                    "display" : "Radio Button"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode" : "horizontal"
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_alternatecontact_bookingcontact",
          "text" : "Is Alternate contact the appointment booking contact?:",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "additionalinfo_alternatecontact_select",
              "operator" : "=",
              "answerString" : "Alternate contact"
            }
          ],
          "enableBehavior" : "all",
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0532",
                "code" : "Y",
                "display" : "Yes"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v2-0532",
                "code" : "N",
                "display" : "No"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_unsafecontacts_select",
          "text" : "Unsafe contact persons (do not speak with)",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Unsafe contact persons (do not speak with)"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_unsafecontacts_speakwithpatientdirectly",
          "text" : "Only speak with patient directly",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_unsafecontacts_select",
              "operator" : "=",
              "answerString" : "Unsafe contact persons (do not speak with)"
            }
          ],
          "enableBehavior" : "all",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Only speak with patient directly"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_unsafecontacts_donotspeakwith",
          "text" : "Do not speak with:",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_unsafecontacts_select",
              "operator" : "=",
              "answerString" : "Unsafe contact persons (do not speak with)"
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_accessibilityconcernsordisability_selectt",
          "text" : "Accessibility concerns or disability",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Accessibility concerns or disability"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
              "valueCode" : "horizontal"
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://example.com/CodeSystem/item-controls",
                    "code" : "push-button",
                    "display" : "Push Button"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_accessibilityconcernsordisability",
          "text" : "Accessibility concerns Options",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              }
            ]
          },
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "additionalinfo_accessibilityconcernsordisability_selectt",
              "operator" : "=",
              "answerString" : "Accessibility concerns or disability"
            }
          ],
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "129839007",
                "display" : "Falls risk"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "301621006",
                "display" : "Patient requires lift"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "105503008",
                "display" : "Wheelchair"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "15188001",
                "display" : "Hearing impaired"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_specialconsiderations_select",
          "text" : "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "additionalinfo_specialconsiderations",
          "text" : "Details of special considerations:",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "additionalinfo_specialconsiderations_select",
              "operator" : "=",
              "answerString" : "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"
            }
          ],
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "additionalinfo_sendcopiestoadditionalproviders",
          "text" : "Send copies of reports to additional providers",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Send copies of reports to additional providers"
            }
          ]
        },
        {
          "linkId" : "additionalinfo_sendcopiestoadditionalproviders_names",
          "text" : "Name(s):",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "additionalinfo_sendcopiestoadditionalproviders",
              "operator" : "=",
              "answerString" : "Send copies of reports to additional providers"
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "item" : [
            {
              "linkId" : "additionalinfo_sendcopiestoadditionalproviders_contactinfo",
              "text" : "Contact information:",
              "type" : "string",
              "enableWhen" : [
                {
                  "question" : "additionalinfo_sendcopiestoadditionalproviders",
                  "operator" : "=",
                  "answerString" : "Send copies of reports to additional providers"
                }
              ],
              "enableBehavior" : "all",
              "required" : true
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "additionalinfo_sendcopiestoadditionalproviders_ispcp",
              "text" : "This is the Primary Care Provider",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "string",
              "enableWhen" : [
                {
                  "question" : "additionalinfo_sendcopiestoadditionalproviders",
                  "operator" : "=",
                  "answerString" : "Send copies of reports to additional providers"
                }
              ],
              "enableBehavior" : "all",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueString" : "This is the Primary Care Provider"
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
          "valueString" : "background-color:grey;border-style:solid;"
        },
        {
          "extension" : [
            {
              "url" : "sortIndex",
              "valuePositiveInt" : 1
            },
            {
              "url" : "text",
              "valueString" : "Referral Details",
              "_valueString" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>Referral Details<br/>"
                  }
                ]
              }
            },
            {
              "url" : "style",
              "valueString" : "font-weight:bold;text-decoration:underline;"
            },
            {
              "url" : "groupItems",
              "valueBoolean" : false
            }
          ],
          "url" : "http://example.com/StructureDefinition/group-note-info"
        }
      ],
      "linkId" : "102173268919",
      "text" : "Referral Details",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString" : "Referral&#xa0;Details<br/>"
          },
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString" : "font-weight:bold;color:#202035;"
          }
        ]
      },
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "enableWhenExpression",
                  "valueExpression" : {
                    "language" : "text/fhirpath",
                    "expression" : "true"
                  }
                },
                {
                  "url" : "sortIndex",
                  "valuePositiveInt" : 1
                },
                {
                  "url" : "text",
                  "valueString" : "Triage Considerations"
                },
                {
                  "url" : "style",
                  "valueString" : "font-weight:bold;"
                }
              ],
              "url" : "http://example.com/StructureDefinition/group-note-info"
            }
          ],
          "linkId" : "cardio_triagecons",
          "text" : "Triage Considerations",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "Triage&#xa0;Considerations<br/><br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "font-weight:bold;"
              }
            ]
          },
          "type" : "group",
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://example.com/CodeSystem/item-controls",
                        "code" : "push-button",
                        "display" : "Push Button"
                      }
                    ]
                  }
                },
                {
                  "extension" : [
                    {
                      "url" : "sortIndex",
                      "valuePositiveInt" : 1
                    },
                    {
                      "url" : "text",
                      "valueString" : "Requested Priority:"
                    },
                    {
                      "url" : "sameLine",
                      "valueBoolean" : true
                    },
                    {
                      "url" : "answerStyle",
                      "valueString" : "font-weight:bold;color:#EE6B00;"
                    }
                  ],
                  "url" : "http://example.com/StructureDefinition/question-note-info"
                }
              ],
              "linkId" : "referral_requestedpriority",
              "text" : "Requested Priority:",
              "type" : "choice",
              "required" : true,
              "answerOption" : [
                {
                  "extension" : [
                    {
                      "extension" : [
                        {
                          "url" : "text",
                          "valueString" : "Routine"
                        },
                        {
                          "url" : "style",
                          "valueString" : "font-weight:bold;color:#EE6B00;"
                        }
                      ],
                      "url" : "http://example.com/StructureDefinition/option-note-info"
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://hl7.org/fhir/request-priority",
                    "code" : "routine",
                    "display" : "Routine"
                  },
                  "initialSelected" : true
                },
                {
                  "valueCoding" : {
                    "system" : "http://hl7.org/fhir/request-priority",
                    "code" : "urgent",
                    "display" : "Urgent"
                  }
                }
              ],
              "item" : [
                {
                  "linkId" : "referral_requestedpriority_urgentreason",
                  "text" : "Reason for urgent triage",
                  "type" : "string",
                  "enableWhen" : [
                    {
                      "question" : "referral_requestedpriority",
                      "operator" : "=",
                      "answerCoding" : {
                        "system" : "http://hl7.org/fhir/request-priority",
                        "code" : "urgent",
                        "display" : "Urgent"
                      }
                    }
                  ],
                  "required" : true
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "extension" : [
                    {
                      "url" : "sortIndex",
                      "valuePositiveInt" : 2
                    },
                    {
                      "url" : "text",
                      "valueString" : "Second Opinion"
                    }
                  ],
                  "url" : "http://example.com/StructureDefinition/question-note-info"
                }
              ],
              "linkId" : "referral_secondopinion",
              "text" : "Second Opinion",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "77406008",
                    "display" : "Second or third medical opinion"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "referral_secondopinion_reason",
              "text" : "Reason for second opinion:",
              "type" : "text",
              "enableWhen" : [
                {
                  "question" : "referral_secondopinion",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "77406008",
                    "display" : "Second or third medical opinion"
                  }
                }
              ]
            }
          ]
        },
        {
          "extension" : [
            {
              "extension" : [
                {
                  "url" : "sortIndex",
                  "valuePositiveInt" : 2
                },
                {
                  "url" : "text",
                  "valueString" : "Service(s) Requested"
                },
                {
                  "url" : "style",
                  "valueString" : "font-weight:bold;"
                }
              ],
              "url" : "http://example.com/StructureDefinition/group-note-info"
            }
          ],
          "linkId" : "695991571585",
          "text" : "Service(s) Requested Select all that apply:",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<b>Service(s)&#xa0;Requested</b><br/><i>Select&#xa0;all&#xa0;that&#xa0;apply:</i><br/><br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "color:Gray20;"
              }
            ]
          },
          "type" : "group",
          "required" : true,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
                  "valueExpression" : {
                    "description" : "Calculates HSC services based on selected checkboxes for cardiac testing and cardiology consult",
                    "language" : "text/fhirpath",
                    "expression" : "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" : [
                    {
                      "url" : "text",
                      "valueString" : "HSCs Assigned:"
                    },
                    {
                      "url" : "style",
                      "valueString" : "font-weight:bold;"
                    }
                  ],
                  "url" : "http://example.com/StructureDefinition/question-note-info"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                  "valueBoolean" : true
                }
              ],
              "linkId" : "referralService",
              "text" : "HSCs Assigned:",
              "type" : "string",
              "readOnly" : true
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "223886162384",
              "text" : "Cardiac Testing",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20001",
                    "display" : "Cardiac Testing"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "660331267409",
              "text" : "Exam(s) Requested",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "Exam(s)&#xa0;Requested<br/><br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "color:Gray20;font-weight:bold;"
                  }
                ]
              },
              "type" : "group",
              "enableWhen" : [
                {
                  "question" : "223886162384",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20001",
                    "display" : "Cardiac Testing"
                  }
                }
              ],
              "enableBehavior" : "all",
              "item" : [
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "720409326878",
                  "text" : "24 Hour Ambulatory Blood Pressure Monitoring",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20003",
                        "display" : "24 Hour Ambulatory Blood Pressure Monitoring"
                      }
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "960455115596",
                  "text" : "Coronary Angiogram",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20004",
                        "display" : "Coronary Angiogram"
                      }
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "297634898828",
                  "text" : "Echocardiogram - Resting",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20005",
                        "display" : "Echocardiogram - Resting"
                      }
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                      "valueString" : "background-color:grey;border-style:solid;"
                    }
                  ],
                  "linkId" : "443484577720",
                  "text" : "sub Echocardiogram - Resting",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "group",
                  "enableWhen" : [
                    {
                      "question" : "297634898828",
                      "operator" : "=",
                      "answerCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20005",
                        "display" : "Echocardiogram - Resting"
                      }
                    }
                  ],
                  "item" : [
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId" : "165530569567",
                      "text" : "Echocardiogram (2D)",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20012",
                            "display" : "Echocardiogram (2D)"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId" : "286552421895",
                      "text" : "Echocardiogram with Contrast",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20013",
                            "display" : "Echocardiogram with Contrast"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "910527687300",
                      "text" : "Echocardiogram with Saline (Bubble)",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20014",
                            "display" : "Echocardiogram with Saline (Bubble)"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "657824763133",
                      "text" : "Pediatric Echocardiogram",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20015",
                            "display" : "Pediatric Echocardiogram"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId" : "992743200182",
                      "text" : "Transesophageal Echocardiogram (TEE)",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20016",
                            "display" : "Transesophageal Echocardiogram (TEE)"
                          }
                        }
                      ]
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "894277763438",
                  "text" : "Electrocardiogram (ECG)",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20006",
                        "display" : "Electrocardiogram (ECG)"
                      }
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "279226023495",
                  "text" : "Holter Monitoring",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
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                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20007",
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                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                      "valueString" : "background-color:grey;border-style:solid;"
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                  ],
                  "linkId" : "440449731882",
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                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
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                  "type" : "group",
                  "enableWhen" : [
                    {
                      "question" : "279226023495",
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                      "answerCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20007",
                        "display" : "Holter Monitoring"
                      }
                    }
                  ],
                  "item" : [
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                                "code" : "check-box",
                                "display" : "Check-box"
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                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
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                      ],
                      "linkId" : "671328703851",
                      "text" : "24 Hours",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
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                            "display" : "24 Hours"
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                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
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                                "display" : "Check-box"
                              }
                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "423992261841",
                      "text" : "48 Hours",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
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                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20018",
                            "display" : "48 Hours"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
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                                "display" : "Check-box"
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                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "419924239187",
                      "text" : "72 Hours",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
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                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20019",
                            "display" : "72 Hours"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
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                                "display" : "Check-box"
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                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "731054417270",
                      "text" : "7 Days",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
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                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20020",
                            "display" : "7 Days"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
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                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "235876421044",
                      "text" : "14 Days",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20021",
                            "display" : "14 Days"
                          }
                        }
                      ]
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "374742834400",
                  "text" : "Loop / Event Monitor",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
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                        "display" : "Loop / Event Monitor"
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                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                      }
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    }
                  ],
                  "linkId" : "159161544747",
                  "text" : "Cardiovascular stress testing",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
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                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
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                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20009",
                        "display" : "Stress Testing"
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                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                      "valueString" : "background-color:grey;border-style:solid;"
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                  ],
                  "linkId" : "370275060390",
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                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                  "type" : "group",
                  "enableWhen" : [
                    {
                      "question" : "159161544747",
                      "operator" : "=",
                      "answerCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20009",
                        "display" : "Stress Testing"
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                    }
                  ],
                  "item" : [
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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                                "display" : "Check-box"
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                            ]
                          }
                        }
                      ],
                      "linkId" : "814218498309",
                      "text" : "ECG - Exercise Stress Test",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                      },
                      "type" : "choice",
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                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
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                            "display" : "ECG - Exercise Stress Test"
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                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                                "code" : "check-box",
                                "display" : "Check-box"
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                          }
                        }
                      ],
                      "linkId" : "307107493993",
                      "text" : "ECG - Dobutamine/Persantine Stress Test",
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                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                      "type" : "choice",
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                      "answerOption" : [
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                          "valueCoding" : {
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                            "code" : "20023",
                            "display" : "ECG - Dobutamine/Persantine Stress Test"
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                        }
                      ]
                    },
                    {
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                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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                      ],
                      "linkId" : "805303414102",
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                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
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                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                        ]
                      },
                      "type" : "choice",
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                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20024",
                            "display" : "Echocardiogram - Exercise Stress Test"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
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                                "display" : "Check-box"
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                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        }
                      ],
                      "linkId" : "193586908489",
                      "text" : "Echocardiogram - Dobutamine/Persantine Stress Test",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
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                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20025",
                            "display" : "Echocardiogram - Dobutamine/Persantine Stress Test"
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                        }
                      ]
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
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                            "display" : "Check-box"
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                        ]
                      }
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    }
                  ],
                  "linkId" : "918517139023",
                  "text" : "Nuclear Medicine",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
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                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20010",
                        "display" : "Nuclear Medicine"
                      }
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                      "valueString" : "background-color:grey;border-style:solid;"
                    }
                  ],
                  "linkId" : "222686221935",
                  "text" : "sub Nuclear Medicine",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "group",
                  "enableWhen" : [
                    {
                      "question" : "918517139023",
                      "operator" : "=",
                      "answerCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20010",
                        "display" : "Nuclear Medicine"
                      }
                    }
                  ],
                  "item" : [
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId" : "924189648184",
                      "text" : "MUGA - Resting",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20026",
                            "display" : "MUGA - Resting"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId" : "857163514910",
                      "text" : "Cardiac Pyrophosphate",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20027",
                            "display" : "Cardiac Pyrophosphate"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode" : "horizontal"
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "check-box",
                                "display" : "Check-box"
                              }
                            ]
                          }
                        }
                      ],
                      "linkId" : "892165959617",
                      "text" : "Myocardial perfusion scan",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "choice",
                      "repeats" : true,
                      "answerOption" : [
                        {
                          "valueCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20028",
                            "display" : "MIBI Scans / Myocardial Perfusion Imaging (MPI):"
                          }
                        }
                      ]
                    },
                    {
                      "extension" : [
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept" : {
                            "coding" : [
                              {
                                "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                "code" : "radio-button",
                                "display" : "Radio Button"
                              }
                            ]
                          }
                        },
                        {
                          "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                          "valueString" : "background-color:white;border-style:solid;"
                        }
                      ],
                      "linkId" : "538288549138",
                      "text" : "sub MIBI",
                      "_text" : {
                        "extension" : [
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                            "valueString" : "<br/>"
                          },
                          {
                            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                            "valueString" : "display:none;"
                          }
                        ]
                      },
                      "type" : "group",
                      "enableWhen" : [
                        {
                          "question" : "892165959617",
                          "operator" : "=",
                          "answerCoding" : {
                            "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                            "code" : "20028",
                            "display" : "MIBI Scans / Myocardial Perfusion Imaging (MPI):"
                          }
                        }
                      ],
                      "item" : [
                        {
                          "extension" : [
                            {
                              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                              "valueCodeableConcept" : {
                                "coding" : [
                                  {
                                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                    "code" : "check-box",
                                    "display" : "Check-box"
                                  }
                                ]
                              }
                            }
                          ],
                          "linkId" : "373435981917",
                          "text" : "MIBI Scan - Exercise Stress Test",
                          "_text" : {
                            "extension" : [
                              {
                                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                                "valueString" : "<br/>"
                              },
                              {
                                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                                "valueString" : "display:none;"
                              }
                            ]
                          },
                          "type" : "string",
                          "repeats" : true,
                          "answerOption" : [
                            {
                              "valueString" : "MIBI Scan - Exercise Stress Test"
                            }
                          ]
                        },
                        {
                          "extension" : [
                            {
                              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                              "valueCodeableConcept" : {
                                "coding" : [
                                  {
                                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                    "code" : "check-box",
                                    "display" : "Check-box"
                                  }
                                ]
                              }
                            }
                          ],
                          "linkId" : "434394942688",
                          "text" : "MIBI Scan - Dobutamine/Persantine Stress Test",
                          "_text" : {
                            "extension" : [
                              {
                                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                                "valueString" : "<br/>"
                              },
                              {
                                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                                "valueString" : "display:none;"
                              }
                            ]
                          },
                          "type" : "string",
                          "repeats" : true,
                          "answerOption" : [
                            {
                              "valueString" : "MIBI Scan - Dobutamine/Persantine Stress Test"
                            }
                          ]
                        },
                        {
                          "extension" : [
                            {
                              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                              "valueCodeableConcept" : {
                                "coding" : [
                                  {
                                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                                    "code" : "check-box",
                                    "display" : "Check-box"
                                  }
                                ]
                              }
                            }
                          ],
                          "linkId" : "913594478162",
                          "text" : "Thallium Viability Test",
                          "_text" : {
                            "extension" : [
                              {
                                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                                "valueString" : "<br/>"
                              },
                              {
                                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                                "valueString" : "display:none;"
                              }
                            ]
                          },
                          "type" : "string",
                          "repeats" : true,
                          "answerOption" : [
                            {
                              "valueString" : "Thallium Viability Test"
                            }
                          ]
                        }
                      ]
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "992682216482",
                  "text" : "Tilt Table Testing",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                        "code" : "20011",
                        "display" : "Tilt Table Testing"
                      }
                    }
                  ]
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                      "valueCode" : "horizontal"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "check-box",
                            "display" : "Check-box"
                          }
                        ]
                      }
                    }
                  ],
                  "linkId" : "cardiology_referral_services_cardiactesting_other",
                  "text" : "Other",
                  "_text" : {
                    "extension" : [
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                        "valueString" : "<br/>"
                      },
                      {
                        "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                        "valueString" : "display:none;"
                      }
                    ]
                  },
                  "type" : "choice",
                  "repeats" : true,
                  "answerOption" : [
                    {
                      "valueCoding" : {
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                        "code" : "OTH",
                        "display" : "other"
                      }
                    }
                  ]
                },
                {
                  "linkId" : "cardiology_referral_services_cardiactesting_other_specify",
                  "text" : "Specify",
                  "type" : "text",
                  "enableWhen" : [
                    {
                      "question" : "cardiology_referral_services_cardiactesting_other",
                      "operator" : "=",
                      "answerCoding" : {
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                        "code" : "OTH",
                        "display" : "other"
                      }
                    }
                  ],
                  "enableBehavior" : "all",
                  "required" : true
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "785727177547",
              "text" : "Cardiology Consultation",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20002",
                    "display" : "Cardiology Consultation"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "186952778859",
          "text" : "Concern(s) / Indication(s) Triggering Referral Select all that apply:",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<b>Concern(s)&#xa0;/&#xa0;Indication(s)&#xa0;Triggering&#xa0;Referral</b><br/><i>Select&#xa0;all&#xa0;that&#xa0;apply:</i><br/>"
              }
            ]
          },
          "type" : "group",
          "required" : true,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "219569805461",
              "text" : "Arrhythmias or Palpitations",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "698247007",
                    "display" : "Arrhythmias or Palpitations"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "571934328499",
              "text" : "Cardiovascular Risk Assessment",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20033",
                    "display" : "Cardiovascular Risk Assessment"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "459737733395",
              "text" : "Chest Pain or Angina",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20034",
                    "display" : "Chest Pain or Angina"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                }
              ],
              "linkId" : "929919815516",
              "text" : "Congenital Heart Disease",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20035",
                    "display" : "Congenital Heart Disease"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "832263816528",
              "text" : "Congestive Heart Failure",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20036",
                    "display" : "Congestive Heart Failure"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "803760213460",
              "text" : "Coronary Artery Disease",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20037",
                    "display" : "Coronary Artery Disease"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                }
              ],
              "linkId" : "129767162379",
              "text" : "Dyspnea",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20038",
                    "display" : "Dyspnea"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                }
              ],
              "linkId" : "116150628533",
              "text" : "Hypertension",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20039",
                    "display" : "Hypertension"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                }
              ],
              "linkId" : "513825527027",
              "text" : "Murmur",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20040",
                    "display" : "Murmur"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                }
              ],
              "linkId" : "975075898688",
              "text" : "Pericardial Disease",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20041",
                    "display" : "Pericardial Disease"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "704148928571",
              "text" : "Peripheral Edema",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20042",
                    "display" : "Peripheral Edema"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "886489617115",
              "text" : "Post-Myocardial Infarction",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20043",
                    "display" : "Post-Myocardial Infarction"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "621745958993",
              "text" : "Pre-operative Consultation",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20044",
                    "display" : "Pre-operative Consultation"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "873024527134",
              "code" : [
                {
                  "system" : "http://snomed.info/sct",
                  "code" : "439272007",
                  "display" : "Date of procedure"
                }
              ],
              "text" : "Procedure Date (if known)",
              "type" : "date",
              "enableWhen" : [
                {
                  "question" : "621745958993",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20044",
                    "display" : "Pre-operative Consultation"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                }
              ],
              "linkId" : "197975129599",
              "text" : "Syncope",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://example.com/CodeSystem/standardized-referral-form-codes",
                    "code" : "20045",
                    "display" : "Syncope"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "675849150752",
              "text" : "Valvular Heart Disease or Prosthetic Heart Valve",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "368009",
                    "display" : "Valvular Heart Disease or Prosthetic Heart Valve"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                  "valueCode" : "horizontal"
                },
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "check-box",
                        "display" : "Check-box"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "721982740516",
              "text" : "Other",
              "_text" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                    "valueString" : "<br/>"
                  },
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                    "valueString" : "display:none;"
                  }
                ]
              },
              "type" : "choice",
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code" : "OTH",
                    "display" : "other"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "background-color:white;border-style:solid;"
                }
              ],
              "linkId" : "720594942482",
              "text" : "Specify",
              "type" : "text",
              "enableWhen" : [
                {
                  "question" : "721982740516",
                  "operator" : "=",
                  "answerCoding" : {
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code" : "OTH",
                    "display" : "other"
                  }
                }
              ],
              "required" : true
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "Descriptionofclinicalquestion",
          "text" : "Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "Clinical&#xa0;Question&#xa0;/&#xa0;Goal(s)&#xa0;of&#xa0;Referral&#xa0;with&#xa0;Relevant&#xa0;History,&#xa0;Management&#xa0;and&#xa0;Investigations<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "font-weight:bold;"
              }
            ]
          },
          "type" : "text",
          "required" : true
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
          "valueString" : "background-color:grey;border-style:solid;"
        }
      ],
      "linkId" : "cpp_header",
      "text" : "Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString" : "Cumulative Patient Profile<br/><br/><i>Please delete any sensitive information you do not intend to share from the CPP</i>"
          },
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
            "valueString" : "font-weight:bold;"
          }
        ]
      },
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "cpp_separate",
          "text" : "CPP attached separately (if not entered below)",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "CPP attached separately (if not entered below)"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "cpp_currentprob",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "55607006",
              "display" : "Problem"
            }
          ],
          "text" : "Current Problem List:",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "cpp_separate",
              "operator" : "exists",
              "answerBoolean" : false
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "cpp_pastmedicalhistory",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "417662000",
              "display" : "History of clinical finding in subject"
            }
          ],
          "text" : "Past Medical History:",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "cpp_separate",
              "operator" : "exists",
              "answerBoolean" : false
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "cpp_currentmedications",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "129019007",
              "display" : "Taking medication"
            }
          ],
          "text" : "Current Medications :",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "cpp_separate",
              "operator" : "exists",
              "answerBoolean" : false
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "cpp_familyhistory",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "57177007",
              "display" : "Family history with explicit context"
            }
          ],
          "text" : "Family History:",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "cpp_separate",
              "operator" : "exists",
              "answerBoolean" : false
            }
          ],
          "enableBehavior" : "all"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "cpp_allergies",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "609328004",
              "display" : "Allergic disposition"
            }
          ],
          "text" : "Allergies:",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "cpp_separate",
              "operator" : "exists",
              "answerBoolean" : false
            }
          ],
          "enableBehavior" : "all"
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
          "valueString" : "background-color:grey;border-style:solid;"
        }
      ],
      "linkId" : "preferredconsultlocation_header",
      "text" : "Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString" : "<b>Preferred Consultant or Location</b><br/><br/>All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered."
          }
        ]
      },
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "preferredconsultlocation_selector",
          "text" : "Preferred consultant or location",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Preferred consultant or location"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
              "valueString" : "background-color:white;border-style:solid;"
            }
          ],
          "linkId" : "preferredconsultlocation_specify",
          "text" : "Please specify either a preferred consultant or location",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "Please specify either a <b>preferred</b> consultant or location"
              }
            ]
          },
          "type" : "group",
          "enableWhen" : [
            {
              "question" : "preferredconsultlocation_selector",
              "operator" : "=",
              "answerString" : "Preferred consultant or location"
            }
          ],
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "border-style:solid;"
                }
              ],
              "linkId" : "preferredconsultlocation_consultant",
              "text" : "Consultant:",
              "type" : "string"
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                  "valueString" : "border-style:solid;"
                }
              ],
              "linkId" : "preferredconsultlocation_location",
              "text" : "Location:",
              "type" : "string"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "preferredconsultlocation_willingtotravel",
          "text" : "Patient willing to travel for shorter wait time",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<br/>"
              },
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
                "valueString" : "display:none;"
              }
            ]
          },
          "type" : "string",
          "repeats" : true,
          "answerOption" : [
            {
              "valueString" : "Patient willing to travel for shorter wait time"
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/rendering-style",
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