Structured Data Capture
4.0.0-ci-build - STU 4 CI-build
Structured Data Capture
4.0.0-ci-build - STU 4 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
| Page standards status: Trial-use | Maturity Level: 4 |
@prefix fhir: <http://hl7.org/fhir/> . @prefix loinc: <https://loinc.org/rdf/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix sct: <http://snomed.info/id/> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- a fhir:Questionnaire ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "CardiologyForm"] ; # fhir:language [ fhir:v "en"] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div [ fhir:v "<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 & 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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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>#xD;\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 (\"Male\")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#female (\"Female\")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/administrative-gender#other (\"Other\")</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 (\"Female\")</li><li style=\"font-size: 11px\">http://loinc.org#LA2-8 (\"Male\")</li><li style=\"font-size: 11px\">http://example.com/CodeSystem/exampleCS#Intersex (\"Intersex\")</li><li style=\"font-size: 11px\">http://loinc.org#LA4489-6 (\"Unknown\")</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 (\"She/Her\")</li><li style=\"font-size: 11px\">http://loinc.org#LA29518-0 (\"He/Him\")</li><li style=\"font-size: 11px\">http://loinc.org#LA29519-8 (\"They/Them\")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (\"other\")</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 (\"English\")</li><li style=\"font-size: 11px\">urn:ietf:bcp:47#fr (\"French\")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (\"other\")</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 (\"Mobile\")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#home (\"Home\")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-use#work (\"Work\")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/contact-point-system#email (\"Email\")</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 (\"Yes\")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v2-0532#N (\"No\")</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 (\"Falls risk\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#301621006 (\"Patient requires lift\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#105503008 (\"Wheelchair\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#15188001 (\"Hearing impaired\")</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 (\"Routine\")</li><li style=\"font-size: 11px\">http://hl7.org/fhir/request-priority#urgent (\"Urgent\")</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 (\"Second or third medical opinion\")</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 (\"Cardiac Testing\")</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 (\"24 Hour Ambulatory Blood Pressure Monitoring\")</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 (\"Coronary Angiogram\")</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 (\"Echocardiogram - Resting\")</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 (\"Echocardiogram (2D)\")</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 (\"Echocardiogram with Contrast\")</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 (\"Echocardiogram with Saline (Bubble)\")</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 (\"Pediatric Echocardiogram\")</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 (\"Transesophageal Echocardiogram (TEE)\")</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 (\"Electrocardiogram (ECG)\")</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 (\"Holter Monitoring\")</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 (\"24 Hours\")</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 (\"48 Hours\")</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 (\"72 Hours\")</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 (\"7 Days\")</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 (\"14 Days\")</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 (\"Loop / Event Monitor\")</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 (\"Stress Testing\")</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 (\"ECG - Exercise Stress Test\")</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 (\"ECG - Dobutamine/Persantine Stress Test\")</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 (\"Echocardiogram - Exercise Stress Test\")</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 (\"Echocardiogram - Dobutamine/Persantine Stress Test\")</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 (\"Nuclear Medicine\")</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 (\"MUGA - Resting\")</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 (\"Cardiac Pyrophosphate\")</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 (\"MIBI Scans / Myocardial Perfusion Imaging (MPI):\")</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 (\"Tilt Table Testing\")</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 (\"other\")</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 (\"Cardiology Consultation\")</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 (\"Arrhythmias or Palpitations\")</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 (\"Cardiovascular Risk Assessment\")</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 (\"Chest Pain or Angina\")</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 (\"Congenital Heart Disease\")</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 (\"Congestive Heart Failure\")</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 (\"Coronary Artery Disease\")</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 (\"Dyspnea\")</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 (\"Hypertension\")</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 (\"Murmur\")</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 (\"Pericardial Disease\")</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 (\"Peripheral Edema\")</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 (\"Post-Myocardial Infarction\")</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 (\"Pre-operative Consultation\")</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 (\"Syncope\")</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 (\"Valvular Heart Disease or Prosthetic Heart Valve\")</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 (\"other\")</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 (\"Allied Health Professional\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#62247001 (\"Family Physician\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#449161006 (\"Physician Assistant\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#398130009 (\"Medical Student\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#106292003 (\"Nurse\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#224571005 (\"Nurse Practitioner\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#405277009 (\"Resident\")</li><li style=\"font-size: 11px\">http://snomed.info/sct#69280009 (\"Specialist\")</li><li style=\"font-size: 11px\">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (\"other\")</li></ul></div>"^^rdf:XMLLiteral ] ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm> ] ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/version-algorithm"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/version-algorithm> ] ; fhir:code [ fhir:v "semver" ] ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode> ] ; fhir:value [ a fhir:Code ; fhir:v "random" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg> ] ; fhir:value [ a fhir:Code ; fhir:v "fhir" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm> ] ; fhir:value [ a fhir:Integer ; fhir:v 4 ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom> ] ; fhir:value [ a fhir:Canonical ; fhir:v "http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc> ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status> ] ; fhir:value [ a fhir:Code ; fhir:v "trial-use" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom> ] ; fhir:value [ a fhir:Canonical ; fhir:v "http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc> ] ] ) ] ] ) ; # fhir:url [ fhir:v "urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d"^^xsd:anyURI ; fhir:l <urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d> ] ; # fhir:identifier ( [ fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ; fhir:l <urn:ietf:rfc:3986> ] ; fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.40.17.35.43" ] ] ) ; # fhir:version [ fhir:v "4.0.0-ci-build"] ; # fhir:title [ fhir:v "Cardiology Form"] ; # fhir:status [ fhir:v "active"] ; # fhir:experimental [ fhir:v false] ; # fhir:subjectType ( [ fhir:v "Patient"] ) ; # fhir:date [ fhir:v "2026-01-20T15:05:51.993+00:00"^^xsd:dateTime] ; # fhir:publisher [ fhir:v "HL7 International / FHIR Infrastructure"] ; # fhir:contact ( [ fhir:name [ fhir:v "HL7 International / FHIR Infrastructure" ] ; ( fhir:telecom [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ] ] ) ] [ ( fhir:telecom [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ] ] ) ] ) ; # fhir:jurisdiction ( [ ( fhir:coding [ fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ; fhir:l <http://unstats.un.org/unsd/methods/m49/m49.htm> ] ; fhir:code [ fhir:v "001" ] ; fhir:display [ fhir:v "World" ] ] ) ] ) ; # fhir:effectivePeriod [ fhir:start [ fhir:v "2025-02-03"^^xsd:date ] ] ; # fhir:code ( [ a sct:789718008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "789718008" ] ; fhir:display [ fhir:v "Cardiology service" ] ] ) ; # fhir:item ( [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "list" ] ; fhir:display [ fhir:v "List" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "patient_header" ] ; fhir:text [ fhir:v "Patient Information" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ fhir:linkId [ fhir:v "patient_surname" ] ; fhir:text [ fhir:v "Surname:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "patient_firstname" ] ; fhir:text [ fhir:v "First Name:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/entryFormat"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/entryFormat> ] ; fhir:value [ a fhir:String ; fhir:v "yyyy/MM/dd" ] ] ) ; fhir:linkId [ fhir:v "patient_date_of_birth" ] ; fhir:text [ fhir:v "DOB:" ] ; fhir:type [ fhir:v "date" ] ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "patient_gender" ] ; fhir:text [ fhir:v "Gender:" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/administrative-gender> ] ; fhir:code [ fhir:v "male" ] ; fhir:display [ fhir:v "Male" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/administrative-gender> ] ; fhir:code [ fhir:v "female" ] ; fhir:display [ fhir:v "Female" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/administrative-gender> ] ; fhir:code [ fhir:v "other" ] ; fhir:display [ fhir:v "Other" ] ] ] ) ] [ fhir:linkId [ fhir:v "patient_hc_pc" ] ; fhir:text [ fhir:v "HN PC:" ] ; fhir:type [ fhir:v "string" ] ; fhir:maxLength [ fhir:v 2 ] ; ( fhir:item [ fhir:linkId [ fhir:v "patient_hc_number" ] ; fhir:text [ fhir:v "HN:" ] ; fhir:type [ fhir:v "string" ] ; fhir:maxLength [ fhir:v 10 ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/minLength"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/minLength> ] ; fhir:value [ a fhir:Integer ; fhir:v 2 ] ] ) ; fhir:linkId [ fhir:v "patient_hc_vc" ] ; fhir:text [ fhir:v "HN VC:" ] ; fhir:type [ fhir:v "string" ] ] ) ] [ fhir:linkId [ fhir:v "patient_address_line1" ] ; fhir:text [ fhir:v "Address (Line 1):" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ; ( fhir:item [ fhir:linkId [ fhir:v "patient_address_line2" ] ; fhir:text [ fhir:v "Address (Line 2):" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "patient_address_city" ] ; fhir:text [ fhir:v "City:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "patient_address_province" ] ; fhir:text [ fhir:v "Province:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ; fhir:maxLength [ fhir:v 2 ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "pat-pcode" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='patient_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid Canadian postal-code" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "patient_address_postalcode" ] ; fhir:text [ fhir:v "Postal Code:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "mobilephone" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid phone number" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "patient_phone_mobile" ] ; fhir:text [ fhir:v "Mobile #:" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "homephone" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid phone number" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "patient_phone_home" ] ; fhir:text [ fhir:v "Home #:" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "busphone" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid phone number" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "patient_phone_business" ] ; fhir:text [ fhir:v "Business #:" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "patemail" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='patient_email').answer.all(value.matches('(?:[a-z0-9!#$%&'*+/=?^_`{|}~-]+(?:\\.[a-z0-9!#$%&'*+/=?^_`{|}~-]+)*|\"(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21\\x23-\\x5b\\x5d-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])*\")@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21-\\x5a\\x53-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])+)\\])'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid email address" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "patient_email" ] ; fhir:text [ fhir:v "Email:" ] ; fhir:type [ fhir:v "string" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_header" ] ; fhir:text [ fhir:v "[Optional] Additional Patient Information" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "[Optional] Additional Patient Information<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://example.com/CodeSystem/item-controls"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/item-controls> ] ; fhir:code [ fhir:v "push-button" ] ; fhir:display [ fhir:v "Push Button" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_sexassignedatbirth" ] ; fhir:text [ fhir:v "Sex assigned at birth:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, loinc:LA3-6 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ; fhir:l <http://loinc.org> ] ; fhir:code [ fhir:v "LA3-6" ] ; fhir:display [ fhir:v "Female" ] ] ] [ fhir:value [ a fhir:Coding, loinc:LA2-8 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ; fhir:l <http://loinc.org> ] ; fhir:code [ fhir:v "LA2-8" ] ; fhir:display [ fhir:v "Male" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/exampleCS"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/exampleCS> ] ; fhir:code [ fhir:v "Intersex" ] ; fhir:display [ fhir:v "Intersex" ] ] ] [ fhir:value [ a fhir:Coding, loinc:LA4489-6 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ; fhir:l <http://loinc.org> ] ; fhir:code [ fhir:v "LA4489-6" ] ; fhir:display [ fhir:v "Unknown" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://example.com/CodeSystem/item-controls"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/item-controls> ] ; fhir:code [ fhir:v "push-button" ] ; fhir:display [ fhir:v "Push Button" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_pronouns" ] ; fhir:text [ fhir:v "Pronouns:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, loinc:LA29519-8 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ; fhir:l <http://loinc.org> ] ; fhir:code [ fhir:v "LA29519-8" ] ; fhir:display [ fhir:v "She/Her" ] ] ] [ fhir:value [ a fhir:Coding, loinc:LA29518-0 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ; fhir:l <http://loinc.org> ] ; fhir:code [ fhir:v "LA29518-0" ] ; fhir:display [ fhir:v "He/Him" ] ] ] [ fhir:value [ a fhir:Coding, loinc:LA29519-8 ; fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ; fhir:l <http://loinc.org> ] ; fhir:code [ fhir:v "LA29519-8" ] ; fhir:display [ fhir:v "They/Them" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; ( fhir:item [ fhir:linkId [ fhir:v "additionalinfo_pronouns_other" ] ; fhir:text [ fhir:v "Other pronouns:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_pronouns" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://example.com/CodeSystem/item-controls"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/item-controls> ] ; fhir:code [ fhir:v "push-button" ] ; fhir:display [ fhir:v "Push Button" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_preferredlanguage" ] ; fhir:text [ fhir:v "Preferred language:" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v false ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ; fhir:l <urn:ietf:bcp:47> ] ; fhir:code [ fhir:v "en" ] ; fhir:display [ fhir:v "English" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ; fhir:l <urn:ietf:bcp:47> ] ; fhir:code [ fhir:v "fr" ] ; fhir:display [ fhir:v "French" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_preferredlanguage_specify" ] ; fhir:text [ fhir:v "Specify:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_preferredlanguage" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_preferredlanguage_translatorrequired" ] ; fhir:text [ fhir:v "Translator required" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_preferredlanguage" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Translator Required" ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://example.com/CodeSystem/item-controls"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/item-controls> ] ; fhir:code [ fhir:v "push-button" ] ; fhir:display [ fhir:v "Push Button" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_bestmethodofcontact" ] ; fhir:text [ fhir:v "Best method of contact:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/contact-point-use"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/contact-point-use> ] ; fhir:code [ fhir:v "mobile" ] ; fhir:display [ fhir:v "Mobile" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/contact-point-use"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/contact-point-use> ] ; fhir:code [ fhir:v "home" ] ; fhir:display [ fhir:v "Home" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/contact-point-use"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/contact-point-use> ] ; fhir:code [ fhir:v "work" ] ; fhir:display [ fhir:v "Work" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/contact-point-system"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/contact-point-system> ] ; fhir:code [ fhir:v "email" ] ; fhir:display [ fhir:v "Email" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_bestmethodofcontact_voicemails" ] ; fhir:text [ fhir:v "Voicemails acceptable" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_bestmethodofcontact" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/contact-point-use"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/contact-point-use> ] ; fhir:code [ fhir:v "mobile" ] ; fhir:display [ fhir:v "Mobile" ] ] ] ) ; fhir:enableBehavior [ fhir:v "any" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v " Voicemails acceptable" ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_preferredname_select" ] ; fhir:text [ fhir:v "Preferred name" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Preferred Name" ] ] ) ] [ fhir:linkId [ fhir:v "additionalinfo_preferredname" ] ; fhir:text [ fhir:v "Prefered name String" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_preferredname_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Preferred Name" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_alternatecontact_select" ] ; fhir:text [ fhir:v "Alternate contact" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Alternate contact" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_alternatecontact_name" ] ; fhir:text [ fhir:v "Name:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_alternatecontact_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Alternate contact" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "altphone" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid phone number" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_alternatecontact_phone" ] ; fhir:text [ fhir:v "Alternate contact phone #:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_alternatecontact_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Alternate contact" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_alternatecontact_relationship" ] ; fhir:text [ fhir:v "Relationship:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_alternatecontact_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Alternate contact" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_alternatecontact_bookingcontact" ] ; fhir:text [ fhir:v "Is Alternate contact the appointment booking contact?:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_alternatecontact_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Alternate contact" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0532"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v2-0532> ] ; fhir:code [ fhir:v "Y" ] ; fhir:display [ fhir:v "Yes" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v2-0532"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v2-0532> ] ; fhir:code [ fhir:v "N" ] ; fhir:display [ fhir:v "No" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_unsafecontacts_select" ] ; fhir:text [ fhir:v "Unsafe contact persons (do not speak with)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Unsafe contact persons (do not speak with)" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_unsafecontacts_speakwithpatientdirectly" ] ; fhir:text [ fhir:v "Only speak with patient directly" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_unsafecontacts_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Unsafe contact persons (do not speak with)" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Only speak with patient directly" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_unsafecontacts_donotspeakwith" ] ; fhir:text [ fhir:v "Do not speak with:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_unsafecontacts_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Unsafe contact persons (do not speak with)" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_accessibilityconcernsordisability_selectt" ] ; fhir:text [ fhir:v "Accessibility concerns or disability" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Accessibility concerns or disability" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://example.com/CodeSystem/item-controls"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/item-controls> ] ; fhir:code [ fhir:v "push-button" ] ; fhir:display [ fhir:v "Push Button" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_accessibilityconcernsordisability" ] ; fhir:text [ fhir:v "Accessibility concerns Options" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_accessibilityconcernsordisability_selectt" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Accessibility concerns or disability" ] ] ) ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, sct:129839007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "129839007" ] ; fhir:display [ fhir:v "Falls risk" ] ] ] [ fhir:value [ a fhir:Coding, sct:301621006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "301621006" ] ; fhir:display [ fhir:v "Patient requires lift" ] ] ] [ fhir:value [ a fhir:Coding, sct:105503008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "105503008" ] ; fhir:display [ fhir:v "Wheelchair" ] ] ] [ fhir:value [ a fhir:Coding, sct:15188001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "15188001" ] ; fhir:display [ fhir:v "Hearing impaired" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_specialconsiderations_select" ] ; fhir:text [ fhir:v "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_specialconsiderations" ] ; fhir:text [ fhir:v "Details of special considerations:" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_specialconsiderations_select" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)" ] ] ) ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_sendcopiestoadditionalproviders" ] ; fhir:text [ fhir:v "Send copies of reports to additional providers" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Send copies of reports to additional providers" ] ] ) ] [ fhir:linkId [ fhir:v "additionalinfo_sendcopiestoadditionalproviders_names" ] ; fhir:text [ fhir:v "Name(s):" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_sendcopiestoadditionalproviders" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Send copies of reports to additional providers" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:required [ fhir:v true ] ; ( fhir:item [ fhir:linkId [ fhir:v "additionalinfo_sendcopiestoadditionalproviders_contactinfo" ] ; fhir:text [ fhir:v "Contact information:" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_sendcopiestoadditionalproviders" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Send copies of reports to additional providers" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "additionalinfo_sendcopiestoadditionalproviders_ispcp" ] ; fhir:text [ fhir:v "This is the Primary Care Provider" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "additionalinfo_sendcopiestoadditionalproviders" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Send copies of reports to additional providers" ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "This is the Primary Care Provider" ] ] ) ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "sortIndex"^^xsd:anyURI ; fhir:l fhir:sortIndex ] ; fhir:value [ a fhir:PositiveInt ; fhir:v "1"^^xsd:positiveInteger ] ] [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "Referral Details" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>Referral Details<br/>" ] ] ) ] ] [ fhir:url [ fhir:v "style"^^xsd:anyURI ; fhir:l fhir:style ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;text-decoration:underline;" ] ] [ fhir:url [ fhir:v "groupItems"^^xsd:anyURI ; fhir:l fhir:groupItems ] ; fhir:value [ a fhir:Boolean ; fhir:v false ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/group-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/group-note-info> ] ] ) ; fhir:linkId [ fhir:v "102173268919" ] ; fhir:text [ fhir:v "Referral Details" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "Referral Details<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;color:#202035;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "enableWhenExpression"^^xsd:anyURI ; fhir:l fhir:enableWhenExpression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "true" ] ] ] [ fhir:url [ fhir:v "sortIndex"^^xsd:anyURI ; fhir:l fhir:sortIndex ] ; fhir:value [ a fhir:PositiveInt ; fhir:v "1"^^xsd:positiveInteger ] ] [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "Triage Considerations" ] ] [ fhir:url [ fhir:v "style"^^xsd:anyURI ; fhir:l fhir:style ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/group-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/group-note-info> ] ] ) ; fhir:linkId [ fhir:v "cardio_triagecons" ] ; fhir:text [ fhir:v "Triage Considerations" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "Triage Considerations<br/><br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://example.com/CodeSystem/item-controls"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/item-controls> ] ; fhir:code [ fhir:v "push-button" ] ; fhir:display [ fhir:v "Push Button" ] ] ) ] ] [ ( fhir:extension [ fhir:url [ fhir:v "sortIndex"^^xsd:anyURI ; fhir:l fhir:sortIndex ] ; fhir:value [ a fhir:PositiveInt ; fhir:v "1"^^xsd:positiveInteger ] ] [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "Requested Priority:" ] ] [ fhir:url [ fhir:v "sameLine"^^xsd:anyURI ; fhir:l fhir:sameLine ] ; fhir:value [ a fhir:Boolean ; fhir:v true ] ] [ fhir:url [ fhir:v "answerStyle"^^xsd:anyURI ; fhir:l fhir:answerStyle ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;color:#EE6B00;" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/question-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/question-note-info> ] ] ) ; fhir:linkId [ fhir:v "referral_requestedpriority" ] ; fhir:text [ fhir:v "Requested Priority:" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; ( fhir:answerOption [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "Routine" ] ] [ fhir:url [ fhir:v "style"^^xsd:anyURI ; fhir:l fhir:style ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;color:#EE6B00;" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/option-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/option-note-info> ] ] ) ; fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/request-priority"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/request-priority> ] ; fhir:code [ fhir:v "routine" ] ; fhir:display [ fhir:v "Routine" ] ] ; fhir:initialSelected [ fhir:v true ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/request-priority"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/request-priority> ] ; fhir:code [ fhir:v "urgent" ] ; fhir:display [ fhir:v "Urgent" ] ] ] ) ; ( fhir:item [ fhir:linkId [ fhir:v "referral_requestedpriority_urgentreason" ] ; fhir:text [ fhir:v "Reason for urgent triage" ] ; fhir:type [ fhir:v "string" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "referral_requestedpriority" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/request-priority"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/request-priority> ] ; fhir:code [ fhir:v "urgent" ] ; fhir:display [ fhir:v "Urgent" ] ] ] ) ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ ( fhir:extension [ fhir:url [ fhir:v "sortIndex"^^xsd:anyURI ; fhir:l fhir:sortIndex ] ; fhir:value [ a fhir:PositiveInt ; fhir:v "2"^^xsd:positiveInteger ] ] [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "Second Opinion" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/question-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/question-note-info> ] ] ) ; fhir:linkId [ fhir:v "referral_secondopinion" ] ; fhir:text [ fhir:v "Second Opinion" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, sct:77406008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "77406008" ] ; fhir:display [ fhir:v "Second or third medical opinion" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "referral_secondopinion_reason" ] ; fhir:text [ fhir:v "Reason for second opinion:" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "referral_secondopinion" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding, sct:77406008 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "77406008" ] ; fhir:display [ fhir:v "Second or third medical opinion" ] ] ] ) ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "sortIndex"^^xsd:anyURI ; fhir:l fhir:sortIndex ] ; fhir:value [ a fhir:PositiveInt ; fhir:v "2"^^xsd:positiveInteger ] ] [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "Service(s) Requested" ] ] [ fhir:url [ fhir:v "style"^^xsd:anyURI ; fhir:l fhir:style ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/group-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/group-note-info> ] ] ) ; fhir:linkId [ fhir:v "695991571585" ] ; fhir:text [ fhir:v "Service(s) Requested Select all that apply:" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<b>Service(s) Requested</b><br/><i>Select all that apply:</i><br/><br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "color:Gray20;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; fhir:required [ fhir:v true ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression> ] ; fhir:value [ a fhir:Expression ; fhir:description [ fhir:v "Calculates HSC services based on selected checkboxes for cardiac testing and cardiology consult" ] ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "iif(%resource.item.where(linkId='223886162384').answer.value.exists(), 'CARDIOLOGY_SERVICES', '') + iif(%resource.item.where(linkId='223886162384').answer.value.exists() and %resource.item.where(linkId='785727177547').answer.value.exists(), '|', '') + iif(%resource.item.where(linkId='785727177547').answer.value.exists(), 'CARDIOLOGY', '')" ] ] ] [ ( fhir:extension [ fhir:url [ fhir:v "text"^^xsd:anyURI ; fhir:l fhir:text ] ; fhir:value [ a fhir:String ; fhir:v "HSCs Assigned:" ] ] [ fhir:url [ fhir:v "style"^^xsd:anyURI ; fhir:l fhir:style ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/question-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/question-note-info> ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-hidden> ] ; fhir:value [ a fhir:Boolean ; fhir:v true ] ] ) ; fhir:linkId [ fhir:v "referralService" ] ; fhir:text [ fhir:v "HSCs Assigned:" ] ; fhir:type [ fhir:v "string" ] ; fhir:readOnly [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "223886162384" ] ; fhir:text [ fhir:v "Cardiac Testing" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20001" ] ; fhir:display [ fhir:v "Cardiac Testing" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "660331267409" ] ; fhir:text [ fhir:v "Exam(s) Requested" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "Exam(s) Requested<br/><br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "color:Gray20;font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "223886162384" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20001" ] ; fhir:display [ fhir:v "Cardiac Testing" ] ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "720409326878" ] ; fhir:text [ fhir:v "24 Hour Ambulatory Blood Pressure Monitoring" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20003" ] ; fhir:display [ fhir:v "24 Hour Ambulatory Blood Pressure Monitoring" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "960455115596" ] ; fhir:text [ fhir:v "Coronary Angiogram" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20004" ] ; fhir:display [ fhir:v "Coronary Angiogram" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "297634898828" ] ; fhir:text [ fhir:v "Echocardiogram - Resting" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20005" ] ; fhir:display [ fhir:v "Echocardiogram - Resting" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "443484577720" ] ; fhir:text [ fhir:v "sub Echocardiogram - Resting" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "297634898828" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20005" ] ; fhir:display [ fhir:v "Echocardiogram - Resting" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "165530569567" ] ; fhir:text [ fhir:v "Echocardiogram (2D)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20012" ] ; fhir:display [ fhir:v "Echocardiogram (2D)" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "286552421895" ] ; fhir:text [ fhir:v "Echocardiogram with Contrast" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20013" ] ; fhir:display [ fhir:v "Echocardiogram with Contrast" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "910527687300" ] ; fhir:text [ fhir:v "Echocardiogram with Saline (Bubble)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20014" ] ; fhir:display [ fhir:v "Echocardiogram with Saline (Bubble)" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "657824763133" ] ; fhir:text [ fhir:v "Pediatric Echocardiogram" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20015" ] ; fhir:display [ fhir:v "Pediatric Echocardiogram" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "992743200182" ] ; fhir:text [ fhir:v "Transesophageal Echocardiogram (TEE)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20016" ] ; fhir:display [ fhir:v "Transesophageal Echocardiogram (TEE)" ] ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "894277763438" ] ; fhir:text [ fhir:v "Electrocardiogram (ECG)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20006" ] ; fhir:display [ fhir:v "Electrocardiogram (ECG)" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "279226023495" ] ; fhir:text [ fhir:v "Holter Monitoring" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20007" ] ; fhir:display [ fhir:v "Holter Monitoring" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "440449731882" ] ; fhir:text [ fhir:v "sub holter monitoring" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "279226023495" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20007" ] ; fhir:display [ fhir:v "Holter Monitoring" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "671328703851" ] ; fhir:text [ fhir:v "24 Hours" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20017" ] ; fhir:display [ fhir:v "24 Hours" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "423992261841" ] ; fhir:text [ fhir:v "48 Hours" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20018" ] ; fhir:display [ fhir:v "48 Hours" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "419924239187" ] ; fhir:text [ fhir:v "72 Hours" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20019" ] ; fhir:display [ fhir:v "72 Hours" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "731054417270" ] ; fhir:text [ fhir:v "7 Days" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20020" ] ; fhir:display [ fhir:v "7 Days" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "235876421044" ] ; fhir:text [ fhir:v "14 Days" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20021" ] ; fhir:display [ fhir:v "14 Days" ] ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "374742834400" ] ; fhir:text [ fhir:v "Loop / Event Monitor" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20008" ] ; fhir:display [ fhir:v "Loop / Event Monitor" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "159161544747" ] ; fhir:text [ fhir:v "Cardiovascular stress testing" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20009" ] ; fhir:display [ fhir:v "Stress Testing" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "370275060390" ] ; fhir:text [ fhir:v "Sub Stress Testing" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "159161544747" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20009" ] ; fhir:display [ fhir:v "Stress Testing" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "814218498309" ] ; fhir:text [ fhir:v "ECG - Exercise Stress Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20022" ] ; fhir:display [ fhir:v "ECG - Exercise Stress Test" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "307107493993" ] ; fhir:text [ fhir:v "ECG - Dobutamine/Persantine Stress Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20023" ] ; fhir:display [ fhir:v "ECG - Dobutamine/Persantine Stress Test" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "805303414102" ] ; fhir:text [ fhir:v "Echocardiogram - Exercise Stress Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20024" ] ; fhir:display [ fhir:v "Echocardiogram - Exercise Stress Test" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "193586908489" ] ; fhir:text [ fhir:v "Echocardiogram - Dobutamine/Persantine Stress Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20025" ] ; fhir:display [ fhir:v "Echocardiogram - Dobutamine/Persantine Stress Test" ] ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "918517139023" ] ; fhir:text [ fhir:v "Nuclear Medicine" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20010" ] ; fhir:display [ fhir:v "Nuclear Medicine" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "222686221935" ] ; fhir:text [ fhir:v "sub Nuclear Medicine" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "918517139023" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20010" ] ; fhir:display [ fhir:v "Nuclear Medicine" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "924189648184" ] ; fhir:text [ fhir:v "MUGA - Resting" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20026" ] ; fhir:display [ fhir:v "MUGA - Resting" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "857163514910" ] ; fhir:text [ fhir:v "Cardiac Pyrophosphate" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20027" ] ; fhir:display [ fhir:v "Cardiac Pyrophosphate" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "892165959617" ] ; fhir:text [ fhir:v "Myocardial perfusion scan" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20028" ] ; fhir:display [ fhir:v "MIBI Scans / Myocardial Perfusion Imaging (MPI):" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "radio-button" ] ; fhir:display [ fhir:v "Radio Button" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "538288549138" ] ; fhir:text [ fhir:v "sub MIBI" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "892165959617" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20028" ] ; fhir:display [ fhir:v "MIBI Scans / Myocardial Perfusion Imaging (MPI):" ] ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "373435981917" ] ; fhir:text [ fhir:v "MIBI Scan - Exercise Stress Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "MIBI Scan - Exercise Stress Test" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "434394942688" ] ; fhir:text [ fhir:v "MIBI Scan - Dobutamine/Persantine Stress Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "MIBI Scan - Dobutamine/Persantine Stress Test" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "913594478162" ] ; fhir:text [ fhir:v "Thallium Viability Test" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Thallium Viability Test" ] ] ) ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "992682216482" ] ; fhir:text [ fhir:v "Tilt Table Testing" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20011" ] ; fhir:display [ fhir:v "Tilt Table Testing" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "cardiology_referral_services_cardiactesting_other" ] ; fhir:text [ fhir:v "Other" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ] [ fhir:linkId [ fhir:v "cardiology_referral_services_cardiactesting_other_specify" ] ; fhir:text [ fhir:v "Specify" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "cardiology_referral_services_cardiactesting_other" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "785727177547" ] ; fhir:text [ fhir:v "Cardiology Consultation" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20002" ] ; fhir:display [ fhir:v "Cardiology Consultation" ] ] ] ) ] ) ] [ fhir:linkId [ fhir:v "186952778859" ] ; fhir:text [ fhir:v "Concern(s) / Indication(s) Triggering Referral Select all that apply:" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<b>Concern(s) / Indication(s) Triggering Referral</b><br/><i>Select all that apply:</i><br/>" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; fhir:required [ fhir:v true ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "219569805461" ] ; fhir:text [ fhir:v "Arrhythmias or Palpitations" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, sct:698247007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "698247007" ] ; fhir:display [ fhir:v "Arrhythmias or Palpitations" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "571934328499" ] ; fhir:text [ fhir:v "Cardiovascular Risk Assessment" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20033" ] ; fhir:display [ fhir:v "Cardiovascular Risk Assessment" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "459737733395" ] ; fhir:text [ fhir:v "Chest Pain or Angina" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20034" ] ; fhir:display [ fhir:v "Chest Pain or Angina" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "929919815516" ] ; fhir:text [ fhir:v "Congenital Heart Disease" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20035" ] ; fhir:display [ fhir:v "Congenital Heart Disease" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "832263816528" ] ; fhir:text [ fhir:v "Congestive Heart Failure" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20036" ] ; fhir:display [ fhir:v "Congestive Heart Failure" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "803760213460" ] ; fhir:text [ fhir:v "Coronary Artery Disease" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20037" ] ; fhir:display [ fhir:v "Coronary Artery Disease" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "129767162379" ] ; fhir:text [ fhir:v "Dyspnea" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20038" ] ; fhir:display [ fhir:v "Dyspnea" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "116150628533" ] ; fhir:text [ fhir:v "Hypertension" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20039" ] ; fhir:display [ fhir:v "Hypertension" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "513825527027" ] ; fhir:text [ fhir:v "Murmur" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20040" ] ; fhir:display [ fhir:v "Murmur" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "975075898688" ] ; fhir:text [ fhir:v "Pericardial Disease" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20041" ] ; fhir:display [ fhir:v "Pericardial Disease" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "704148928571" ] ; fhir:text [ fhir:v "Peripheral Edema" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20042" ] ; fhir:display [ fhir:v "Peripheral Edema" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "886489617115" ] ; fhir:text [ fhir:v "Post-Myocardial Infarction" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20043" ] ; fhir:display [ fhir:v "Post-Myocardial Infarction" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "621745958993" ] ; fhir:text [ fhir:v "Pre-operative Consultation" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20044" ] ; fhir:display [ fhir:v "Pre-operative Consultation" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "873024527134" ] ; ( fhir:code [ a sct:439272007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "439272007" ] ; fhir:display [ fhir:v "Date of procedure" ] ] ) ; fhir:text [ fhir:v "Procedure Date (if known)" ] ; fhir:type [ fhir:v "date" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "621745958993" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20044" ] ; fhir:display [ fhir:v "Pre-operative Consultation" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] ) ; fhir:linkId [ fhir:v "197975129599" ] ; fhir:text [ fhir:v "Syncope" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://example.com/CodeSystem/standardized-referral-form-codes"^^xsd:anyURI ; fhir:l <http://example.com/CodeSystem/standardized-referral-form-codes> ] ; fhir:code [ fhir:v "20045" ] ; fhir:display [ fhir:v "Syncope" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "675849150752" ] ; fhir:text [ fhir:v "Valvular Heart Disease or Prosthetic Heart Valve" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, sct:368009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "368009" ] ; fhir:display [ fhir:v "Valvular Heart Disease or Prosthetic Heart Valve" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation> ] ; fhir:value [ a fhir:Code ; fhir:v "horizontal" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "721982740516" ] ; fhir:text [ fhir:v "Other" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "720594942482" ] ; fhir:text [ fhir:v "Specify" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "721982740516" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "Descriptionofclinicalquestion" ] ; fhir:text [ fhir:v "Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "text" ] ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "cpp_header" ] ; fhir:text [ fhir:v "Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "Cumulative Patient Profile<br/><br/><i>Please delete any sensitive information you do not intend to share from the CPP</i>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "cpp_separate" ] ; fhir:text [ fhir:v "CPP attached separately (if not entered below)" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "CPP attached separately (if not entered below)" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "cpp_currentprob" ] ; ( fhir:code [ a sct:55607006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "55607006" ] ; fhir:display [ fhir:v "Problem" ] ] ) ; fhir:text [ fhir:v "Current Problem List:" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "cpp_separate" ] ; fhir:operator [ fhir:v "exists" ] ; fhir:answer [ a fhir:Boolean ; fhir:v false ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "cpp_pastmedicalhistory" ] ; ( fhir:code [ a sct:417662000 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "417662000" ] ; fhir:display [ fhir:v "History of clinical finding in subject" ] ] ) ; fhir:text [ fhir:v "Past Medical History:" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "cpp_separate" ] ; fhir:operator [ fhir:v "exists" ] ; fhir:answer [ a fhir:Boolean ; fhir:v false ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "cpp_currentmedications" ] ; ( fhir:code [ a sct:129019007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "129019007" ] ; fhir:display [ fhir:v "Taking medication" ] ] ) ; fhir:text [ fhir:v "Current Medications :" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "cpp_separate" ] ; fhir:operator [ fhir:v "exists" ] ; fhir:answer [ a fhir:Boolean ; fhir:v false ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "cpp_familyhistory" ] ; ( fhir:code [ a sct:57177007 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "57177007" ] ; fhir:display [ fhir:v "Family history with explicit context" ] ] ) ; fhir:text [ fhir:v "Family History:" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "cpp_separate" ] ; fhir:operator [ fhir:v "exists" ] ; fhir:answer [ a fhir:Boolean ; fhir:v false ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "cpp_allergies" ] ; ( fhir:code [ a sct:609328004 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "609328004" ] ; fhir:display [ fhir:v "Allergic disposition" ] ] ) ; fhir:text [ fhir:v "Allergies:" ] ; fhir:type [ fhir:v "text" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "cpp_separate" ] ; fhir:operator [ fhir:v "exists" ] ; fhir:answer [ a fhir:Boolean ; fhir:v false ] ] ) ; fhir:enableBehavior [ fhir:v "all" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_header" ] ; fhir:text [ fhir:v "Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered." ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<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." ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_selector" ] ; fhir:text [ fhir:v "Preferred consultant or location" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Preferred consultant or location" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_specify" ] ; fhir:text [ fhir:v "Please specify either a preferred consultant or location" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "Please specify either a <b>preferred</b> consultant or location" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:enableWhen [ fhir:question [ fhir:v "preferredconsultlocation_selector" ] ; fhir:operator [ fhir:v "=" ] ; fhir:answer [ a fhir:String ; fhir:v "Preferred consultant or location" ] ] ) ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_consultant" ] ; fhir:text [ fhir:v "Consultant:" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_location" ] ; fhir:text [ fhir:v "Location:" ] ; fhir:type [ fhir:v "string" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_willingtotravel" ] ; fhir:text [ fhir:v "Patient willing to travel for shorter wait time" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Patient willing to travel for shorter wait time" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:white;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "preferredconsultlocation_otherconsiderations" ] ; fhir:text [ fhir:v "Other considerations:" ] ; fhir:type [ fhir:v "string" ] ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "supportingdocumentation_header" ] ; fhir:text [ fhir:v "Supporting Documentation Please attach all relevant laboratory and diagnostic investigations." ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<b>Supporting Documentation</b><br/>Please attach all <b><span style=\"text-decoration: underline\">relevant</span></b> laboratory and diagnostic investigations.<br/>" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "check-box" ] ; fhir:display [ fhir:v "Check-box" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "supportingdocumentation_details" ] ; fhir:text [ fhir:v "Personal Health Information that is medically relevant has not been disclosed at the request of the patient." ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<br/>" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "display:none;" ] ] ) ] ; fhir:type [ fhir:v "string" ] ; fhir:repeats [ fhir:v true ] ; ( fhir:answerOption [ fhir:value [ a fhir:String ; fhir:v "Personal Health Information that is medically relevant has not been disclosed at the request of the patient." ] ] ) ] ) ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "application/pdf" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "image/gif" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "image/bmp" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "video/mp4" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "text/csv" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "image/jpeg" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "application/msword" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "image/png" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "application/vnd.openxmlformats-officedocument.wordprocessingml.document" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "application/vnd.ms-excel" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "text/plain" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "audio/mp4" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "audio/mpeg" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/mimeType"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/mimeType> ] ; fhir:value [ a fhir:Code ; fhir:v "image/tiff" ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/maxSize"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/maxSize> ] ; fhir:value [ a fhir:Decimal ; fhir:v "5000000"^^xsd:decimal ] ] [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "positiveText"^^xsd:anyURI ; fhir:l fhir:positiveText ] ; fhir:value [ a fhir:String ; fhir:v "Attachment Provided" ] ] ) ; fhir:url [ fhir:v "http://example.com/StructureDefinition/question-note-info"^^xsd:anyURI ; fhir:l <http://example.com/StructureDefinition/question-note-info> ] ] ) ; fhir:linkId [ fhir:v "supportingdocumentation_attachment" ] ; fhir:text [ fhir:v "Add Attachments" ] ; fhir:type [ fhir:v "attachment" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "feedbacksurvey_cardiology" ] ; fhir:text [ fhir:v "Click here to provide feedback on this form" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-xhtml"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-xhtml> ] ; fhir:value [ a fhir:String ; fhir:v "<a href=\"https://www.surveymonkey.com/r/cardioSRF\" rel=\"noopener noreferrer\" target=\"_blank\">Click here to provide feedback on this form</a><br/>" ] ] ) ] ; fhir:type [ fhir:v "display" ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "background-color:grey;border-style:solid;" ] ] ) ; fhir:linkId [ fhir:v "referrer_header" ] ; fhir:text [ fhir:v "Referrer's Information" ; ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/rendering-style"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/rendering-style> ] ; fhir:value [ a fhir:String ; fhir:v "font-weight:bold;" ] ] ) ] ; fhir:type [ fhir:v "group" ] ; ( fhir:item [ fhir:linkId [ fhir:v "referrer_sitename" ] ; fhir:text [ fhir:v "Site Name:" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "referrer_address_line1" ] ; fhir:text [ fhir:v "Address (Line 1):" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ; ( fhir:item [ fhir:linkId [ fhir:v "referrer_address_line2" ] ; fhir:text [ fhir:v "Address (Line 2):" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "referrer_address_city" ] ; fhir:text [ fhir:v "City:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "referrer_address_province" ] ; fhir:text [ fhir:v "Province:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ; fhir:maxLength [ fhir:v 2 ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "ref-pcode" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='referrer_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid Canadian postal-code" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "referrer_address_postalcode" ] ; fhir:text [ fhir:v "Postal Code:" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] ) ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "refphone" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='referrer_phone').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid phone number" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "referrer_phone" ] ; fhir:text [ fhir:v "Phone #:" ] ; fhir:type [ fhir:v "string" ] ] [ ( fhir:extension [ ( fhir:extension [ fhir:url [ fhir:v "key"^^xsd:anyURI ; fhir:l fhir:key ] ; fhir:value [ a fhir:Id ; fhir:v "reffax" ] ] [ fhir:url [ fhir:v "severity"^^xsd:anyURI ; fhir:l fhir:severity ] ; fhir:value [ a fhir:Code ; fhir:v "error" ] ] [ fhir:url [ fhir:v "expression"^^xsd:anyURI ; fhir:l fhir:expression ] ; fhir:value [ a fhir:Expression ; fhir:language [ fhir:v "text/fhirpath" ] ; fhir:expression [ fhir:v "%resource.repeat(item).where(linkId='referrer_fax').answer.all(value.matches('^(\\+\\d{1,2}\\s?)?\\(?\\d{3}\\)?[\\s.-]?\\d{3}[\\s.-]?\\d{4}$'))" ] ] ] [ fhir:url [ fhir:v "human"^^xsd:anyURI ; fhir:l fhir:human ] ; fhir:value [ a fhir:String ; fhir:v "Must be a valid phone number" ] ] ) ; fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/targetConstraint"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/targetConstraint> ] ] ) ; fhir:linkId [ fhir:v "referrer_fax" ] ; fhir:text [ fhir:v "Fax #:" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "referrer_billing" ] ; fhir:text [ fhir:v "Billing Number:" ] ; fhir:type [ fhir:v "integer" ] ] [ fhir:linkId [ fhir:v "referrer_professionalid" ] ; fhir:text [ fhir:v "Professional ID:" ] ; fhir:type [ fhir:v "integer" ] ] [ fhir:linkId [ fhir:v "referrer_signature" ] ; fhir:text [ fhir:v "Signed:" ] ; fhir:type [ fhir:v "text" ] ; fhir:required [ fhir:v true ] ] [ ( fhir:extension [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl> ] ; fhir:value [ a fhir:CodeableConcept ; ( fhir:coding [ fhir:system [ fhir:v "http://hl7.org/fhir/questionnaire-item-control"^^xsd:anyURI ; fhir:l <http://hl7.org/fhir/questionnaire-item-control> ] ; fhir:code [ fhir:v "drop-down" ] ; fhir:display [ fhir:v "Drop down" ] ] ) ] ] ) ; fhir:linkId [ fhir:v "referrer_role" ] ; fhir:text [ fhir:v "Role:" ] ; fhir:type [ fhir:v "choice" ] ; ( fhir:answerOption [ fhir:value [ a fhir:Coding, sct:309398001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "309398001" ] ; fhir:display [ fhir:v "Allied Health Professional" ] ] ] [ fhir:value [ a fhir:Coding, sct:62247001 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "62247001" ] ; fhir:display [ fhir:v "Family Physician" ] ] ] [ fhir:value [ a fhir:Coding, sct:449161006 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "449161006" ] ; fhir:display [ fhir:v "Physician Assistant" ] ] ] [ fhir:value [ a fhir:Coding, sct:398130009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "398130009" ] ; fhir:display [ fhir:v "Medical Student" ] ] ] [ fhir:value [ a fhir:Coding, sct:106292003 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "106292003" ] ; fhir:display [ fhir:v "Nurse" ] ] ] [ fhir:value [ a fhir:Coding, sct:224571005 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "224571005" ] ; fhir:display [ fhir:v "Nurse Practitioner" ] ] ] [ fhir:value [ a fhir:Coding, sct:405277009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "405277009" ] ; fhir:display [ fhir:v "Resident" ] ] ] [ fhir:value [ a fhir:Coding, sct:69280009 ; fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ; fhir:l <http://snomed.info/sct> ] ; fhir:code [ fhir:v "69280009" ] ; fhir:display [ fhir:v "Specialist" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-NullFlavor"^^xsd:anyURI ; fhir:l <http://terminology.hl7.org/CodeSystem/v3-NullFlavor> ] ; fhir:code [ fhir:v "OTH" ] ; fhir:display [ fhir:v "other" ] ] ] ) ] ) ] ) . #
IG © 2022+ HL7 International / FHIR Infrastructure.
Package hl7.fhir.uv.sdc#4.0.0-ci-build based on FHIR 4.0.1.
Generated
2026-06-11
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