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

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

Page standards status: Trial-use
Maturity Level: 4
Raw xml | Download

<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="CardiologyForm"/>
  <language value="en"/>
  <text>
    <status value="extensions"/>
    <div xml:lang="en" xmlns="http://www.w3.org/1999/xhtml" lang="en"><p class="res-header-id"><b>Generated Narrative: Questionnaire CardiologyForm</b></p><a name="CardiologyForm"> </a><a name="hcCardiologyForm"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Other attributes of the item">Flags</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d#4.0.0-ci-build</td></tr>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<tr><td colspan="6" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.patient_gender"> </a><p><b>Answer options for patient_gender </b></p><ul><li style="font-size: 11px">http://hl7.org/fhir/administrative-gender#male (&quot;Male&quot;)</li><li style="font-size: 11px">http://hl7.org/fhir/administrative-gender#female (&quot;Female&quot;)</li><li style="font-size: 11px">http://hl7.org/fhir/administrative-gender#other (&quot;Other&quot;)</li></ul><a name="opt-item.additionalinfo_sexassignedatbirth"> </a><p><b>Answer options for additionalinfo_sexassignedatbirth </b></p><ul><li style="font-size: 11px">http://loinc.org#LA3-6 (&quot;Female&quot;)</li><li style="font-size: 11px">http://loinc.org#LA2-8 (&quot;Male&quot;)</li><li style="font-size: 11px">http://example.com/CodeSystem/exampleCS#Intersex (&quot;Intersex&quot;)</li><li style="font-size: 11px">http://loinc.org#LA4489-6 (&quot;Unknown&quot;)</li></ul><a name="opt-item.additionalinfo_pronouns"> </a><p><b>Answer options for additionalinfo_pronouns </b></p><ul><li style="font-size: 11px">http://loinc.org#LA29519-8 (&quot;She/Her&quot;)</li><li style="font-size: 11px">http://loinc.org#LA29518-0 (&quot;He/Him&quot;)</li><li style="font-size: 11px">http://loinc.org#LA29519-8 (&quot;They/Them&quot;)</li><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name="opt-item.additionalinfo_preferredlanguage"> </a><p><b>Answer options for additionalinfo_preferredlanguage </b></p><ul><li style="font-size: 11px">urn:ietf:bcp:47#en (&quot;English&quot;)</li><li style="font-size: 11px">urn:ietf:bcp:47#fr (&quot;French&quot;)</li><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name="opt-item.additionalinfo_preferredlanguage_translatorrequired"> </a><p><b>Answer options for additionalinfo_preferredlanguage_translatorrequired </b></p><ul><li style="font-size: 11px">Translator Required</li></ul><a name="opt-item.additionalinfo_bestmethodofcontact"> </a><p><b>Answer options for additionalinfo_bestmethodofcontact </b></p><ul><li style="font-size: 11px">http://hl7.org/fhir/contact-point-use#mobile (&quot;Mobile&quot;)</li><li style="font-size: 11px">http://hl7.org/fhir/contact-point-use#home (&quot;Home&quot;)</li><li style="font-size: 11px">http://hl7.org/fhir/contact-point-use#work (&quot;Work&quot;)</li><li style="font-size: 11px">http://hl7.org/fhir/contact-point-system#email (&quot;Email&quot;)</li></ul><a name="opt-item.additionalinfo_bestmethodofcontact_voicemails"> </a><p><b>Answer options for additionalinfo_bestmethodofcontact_voicemails </b></p><ul><li style="font-size: 11px"> Voicemails acceptable</li></ul><a name="opt-item.additionalinfo_preferredname_select"> </a><p><b>Answer options for additionalinfo_preferredname_select </b></p><ul><li style="font-size: 11px">Preferred Name</li></ul><a name="opt-item.additionalinfo_alternatecontact_select"> </a><p><b>Answer options for additionalinfo_alternatecontact_select </b></p><ul><li style="font-size: 11px">Alternate contact</li></ul><a name="opt-item.additionalinfo_alternatecontact_bookingcontact"> </a><p><b>Answer options for additionalinfo_alternatecontact_bookingcontact </b></p><ul><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v2-0532#Y (&quot;Yes&quot;)</li><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v2-0532#N (&quot;No&quot;)</li></ul><a name="opt-item.additionalinfo_unsafecontacts_select"> </a><p><b>Answer options for additionalinfo_unsafecontacts_select </b></p><ul><li style="font-size: 11px">Unsafe contact persons (do not speak with)</li></ul><a name="opt-item.additionalinfo_unsafecontacts_speakwithpatientdirectly"> </a><p><b>Answer options for additionalinfo_unsafecontacts_speakwithpatientdirectly </b></p><ul><li style="font-size: 11px">Only speak with patient directly</li></ul><a name="opt-item.additionalinfo_accessibilityconcernsordisability_selectt"> </a><p><b>Answer options for additionalinfo_accessibilityconcernsordisability_selectt </b></p><ul><li style="font-size: 11px">Accessibility concerns or disability</li></ul><a name="opt-item.additionalinfo_accessibilityconcernsordisability"> </a><p><b>Answer options for additionalinfo_accessibilityconcernsordisability </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#129839007 (&quot;Falls risk&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#301621006 (&quot;Patient requires lift&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#105503008 (&quot;Wheelchair&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#15188001 (&quot;Hearing impaired&quot;)</li></ul><a name="opt-item.additionalinfo_specialconsiderations_select"> </a><p><b>Answer options for additionalinfo_specialconsiderations_select </b></p><ul><li style="font-size: 11px">Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)</li></ul><a name="opt-item.additionalinfo_sendcopiestoadditionalproviders"> </a><p><b>Answer options for additionalinfo_sendcopiestoadditionalproviders </b></p><ul><li style="font-size: 11px">Send copies of reports to additional providers</li></ul><a name="opt-item.additionalinfo_sendcopiestoadditionalproviders_ispcp"> </a><p><b>Answer options for additionalinfo_sendcopiestoadditionalproviders_ispcp </b></p><ul><li style="font-size: 11px">This is the Primary Care Provider</li></ul><a name="opt-item.referral_requestedpriority"> </a><p><b>Answer options for referral_requestedpriority </b></p><ul><li style="font-size: 11px">http://hl7.org/fhir/request-priority#routine (&quot;Routine&quot;)</li><li style="font-size: 11px">http://hl7.org/fhir/request-priority#urgent (&quot;Urgent&quot;)</li></ul><a name="opt-item.referral_secondopinion"> </a><p><b>Answer options for referral_secondopinion </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#77406008 (&quot;Second or third medical opinion&quot;)</li></ul><a name="opt-item.223886162384"> </a><p><b>Answer options for 223886162384 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20001 (&quot;Cardiac Testing&quot;)</li></ul><a name="opt-item.720409326878"> </a><p><b>Answer options for 720409326878 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20003 (&quot;24 Hour Ambulatory Blood Pressure Monitoring&quot;)</li></ul><a name="opt-item.960455115596"> </a><p><b>Answer options for 960455115596 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20004 (&quot;Coronary Angiogram&quot;)</li></ul><a name="opt-item.297634898828"> </a><p><b>Answer options for 297634898828 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20005 (&quot;Echocardiogram - Resting&quot;)</li></ul><a name="opt-item.165530569567"> </a><p><b>Answer options for 165530569567 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20012 (&quot;Echocardiogram (2D)&quot;)</li></ul><a name="opt-item.286552421895"> </a><p><b>Answer options for 286552421895 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20013 (&quot;Echocardiogram with Contrast&quot;)</li></ul><a name="opt-item.910527687300"> </a><p><b>Answer options for 910527687300 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20014 (&quot;Echocardiogram with Saline (Bubble)&quot;)</li></ul><a name="opt-item.657824763133"> </a><p><b>Answer options for 657824763133 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20015 (&quot;Pediatric Echocardiogram&quot;)</li></ul><a name="opt-item.992743200182"> </a><p><b>Answer options for 992743200182 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20016 (&quot;Transesophageal Echocardiogram (TEE)&quot;)</li></ul><a name="opt-item.894277763438"> </a><p><b>Answer options for 894277763438 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20006 (&quot;Electrocardiogram (ECG)&quot;)</li></ul><a name="opt-item.279226023495"> </a><p><b>Answer options for 279226023495 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20007 (&quot;Holter Monitoring&quot;)</li></ul><a name="opt-item.671328703851"> </a><p><b>Answer options for 671328703851 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20017 (&quot;24 Hours&quot;)</li></ul><a name="opt-item.423992261841"> </a><p><b>Answer options for 423992261841 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20018 (&quot;48 Hours&quot;)</li></ul><a name="opt-item.419924239187"> </a><p><b>Answer options for 419924239187 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20019 (&quot;72 Hours&quot;)</li></ul><a name="opt-item.731054417270"> </a><p><b>Answer options for 731054417270 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20020 (&quot;7 Days&quot;)</li></ul><a name="opt-item.235876421044"> </a><p><b>Answer options for 235876421044 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20021 (&quot;14 Days&quot;)</li></ul><a name="opt-item.374742834400"> </a><p><b>Answer options for 374742834400 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20008 (&quot;Loop / Event Monitor&quot;)</li></ul><a name="opt-item.159161544747"> </a><p><b>Answer options for 159161544747 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20009 (&quot;Stress Testing&quot;)</li></ul><a name="opt-item.814218498309"> </a><p><b>Answer options for 814218498309 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20022 (&quot;ECG - Exercise Stress Test&quot;)</li></ul><a name="opt-item.307107493993"> </a><p><b>Answer options for 307107493993 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20023 (&quot;ECG - Dobutamine/Persantine Stress Test&quot;)</li></ul><a name="opt-item.805303414102"> </a><p><b>Answer options for 805303414102 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20024 (&quot;Echocardiogram - Exercise Stress Test&quot;)</li></ul><a name="opt-item.193586908489"> </a><p><b>Answer options for 193586908489 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20025 (&quot;Echocardiogram - Dobutamine/Persantine Stress Test&quot;)</li></ul><a name="opt-item.918517139023"> </a><p><b>Answer options for 918517139023 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20010 (&quot;Nuclear Medicine&quot;)</li></ul><a name="opt-item.924189648184"> </a><p><b>Answer options for 924189648184 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20026 (&quot;MUGA - Resting&quot;)</li></ul><a name="opt-item.857163514910"> </a><p><b>Answer options for 857163514910 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20027 (&quot;Cardiac Pyrophosphate&quot;)</li></ul><a name="opt-item.892165959617"> </a><p><b>Answer options for 892165959617 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20028 (&quot;MIBI Scans / Myocardial Perfusion Imaging (MPI):&quot;)</li></ul><a name="opt-item.373435981917"> </a><p><b>Answer options for 373435981917 </b></p><ul><li style="font-size: 11px">MIBI Scan - Exercise Stress Test</li></ul><a name="opt-item.434394942688"> </a><p><b>Answer options for 434394942688 </b></p><ul><li style="font-size: 11px">MIBI Scan - Dobutamine/Persantine Stress Test</li></ul><a name="opt-item.913594478162"> </a><p><b>Answer options for 913594478162 </b></p><ul><li style="font-size: 11px">Thallium Viability Test</li></ul><a name="opt-item.992682216482"> </a><p><b>Answer options for 992682216482 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20011 (&quot;Tilt Table Testing&quot;)</li></ul><a name="opt-item.cardiology_referral_services_cardiactesting_other"> </a><p><b>Answer options for cardiology_referral_services_cardiactesting_other </b></p><ul><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name="opt-item.785727177547"> </a><p><b>Answer options for 785727177547 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20002 (&quot;Cardiology Consultation&quot;)</li></ul><a name="opt-item.219569805461"> </a><p><b>Answer options for 219569805461 </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#698247007 (&quot;Arrhythmias or Palpitations&quot;)</li></ul><a name="opt-item.571934328499"> </a><p><b>Answer options for 571934328499 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20033 (&quot;Cardiovascular Risk Assessment&quot;)</li></ul><a name="opt-item.459737733395"> </a><p><b>Answer options for 459737733395 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20034 (&quot;Chest Pain or Angina&quot;)</li></ul><a name="opt-item.929919815516"> </a><p><b>Answer options for 929919815516 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20035 (&quot;Congenital Heart Disease&quot;)</li></ul><a name="opt-item.832263816528"> </a><p><b>Answer options for 832263816528 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20036 (&quot;Congestive Heart Failure&quot;)</li></ul><a name="opt-item.803760213460"> </a><p><b>Answer options for 803760213460 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20037 (&quot;Coronary Artery Disease&quot;)</li></ul><a name="opt-item.129767162379"> </a><p><b>Answer options for 129767162379 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20038 (&quot;Dyspnea&quot;)</li></ul><a name="opt-item.116150628533"> </a><p><b>Answer options for 116150628533 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20039 (&quot;Hypertension&quot;)</li></ul><a name="opt-item.513825527027"> </a><p><b>Answer options for 513825527027 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20040 (&quot;Murmur&quot;)</li></ul><a name="opt-item.975075898688"> </a><p><b>Answer options for 975075898688 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20041 (&quot;Pericardial Disease&quot;)</li></ul><a name="opt-item.704148928571"> </a><p><b>Answer options for 704148928571 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20042 (&quot;Peripheral Edema&quot;)</li></ul><a name="opt-item.886489617115"> </a><p><b>Answer options for 886489617115 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20043 (&quot;Post-Myocardial Infarction&quot;)</li></ul><a name="opt-item.621745958993"> </a><p><b>Answer options for 621745958993 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20044 (&quot;Pre-operative Consultation&quot;)</li></ul><a name="opt-item.197975129599"> </a><p><b>Answer options for 197975129599 </b></p><ul><li style="font-size: 11px">http://example.com/CodeSystem/standardized-referral-form-codes#20045 (&quot;Syncope&quot;)</li></ul><a name="opt-item.675849150752"> </a><p><b>Answer options for 675849150752 </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#368009 (&quot;Valvular Heart Disease or Prosthetic Heart Valve&quot;)</li></ul><a name="opt-item.721982740516"> </a><p><b>Answer options for 721982740516 </b></p><ul><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul><a name="opt-item.cpp_separate"> </a><p><b>Answer options for cpp_separate </b></p><ul><li style="font-size: 11px">CPP attached separately (if not entered below)</li></ul><a name="opt-item.preferredconsultlocation_selector"> </a><p><b>Answer options for preferredconsultlocation_selector </b></p><ul><li style="font-size: 11px">Preferred consultant or location</li></ul><a name="opt-item.preferredconsultlocation_willingtotravel"> </a><p><b>Answer options for preferredconsultlocation_willingtotravel </b></p><ul><li style="font-size: 11px">Patient willing to travel for shorter wait time</li></ul><a name="opt-item.supportingdocumentation_details"> </a><p><b>Answer options for supportingdocumentation_details </b></p><ul><li style="font-size: 11px">Personal Health Information that is medically relevant has not been disclosed at the request of the patient.</li></ul><a name="opt-item.referrer_role"> </a><p><b>Answer options for referrer_role </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#309398001 (&quot;Allied Health Professional&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#62247001 (&quot;Family Physician&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#449161006 (&quot;Physician Assistant&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#398130009 (&quot;Medical Student&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#106292003 (&quot;Nurse&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#224571005 (&quot;Nurse Practitioner&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#405277009 (&quot;Resident&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#69280009 (&quot;Specialist&quot;)</li><li style="font-size: 11px">http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH (&quot;other&quot;)</li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm">
    <valueCoding>
      <system value="http://hl7.org/fhir/version-algorithm"/>
      <code value="semver"/>
    </valueCoding>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode">
    <valueCode value="random"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fhir"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="4">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/uv/sdc/ImplementationGuide/hl7.fhir.uv.sdc"/>
      </extension>
    </valueCode>
  </extension>
  <url value="urn:uuid:d7176d16-5fd4-48a7-b7e6-b488e8df763d"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.17.35.43"/>
  </identifier>
  <version value="4.0.0-ci-build"/>
  <title value="Cardiology Form"/>
  <status value="active"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2026-01-20T15:05:51.993+00:00"/>
  <publisher value="HL7 International / FHIR Infrastructure"/>
  <contact>
    <name value="HL7 International / FHIR Infrastructure"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <effectivePeriod>
    <start value="2025-02-03"/>
  </effectivePeriod>
  <code>
    <system value="http://snomed.info/sct"/>
    <code value="789718008"/>
    <display value="Cardiology service"/>
  </code>
  <item>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
      <valueCodeableConcept>
        <coding>
          <system value="http://hl7.org/fhir/questionnaire-item-control"/>
          <code value="list"/>
          <display value="List"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="patient_header"/>
    <text value="Patient Information">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;"/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <linkId value="patient_surname"/>
      <text value="Surname:"/>
      <type value="string"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="patient_firstname"/>
      <text value="First Name:"/>
      <type value="string"/>
      <required value="true"/>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/entryFormat">
        <valueString value="yyyy/MM/dd"/>
      </extension>
      <linkId value="patient_date_of_birth"/>
      <text value="DOB:"/>
      <type value="date"/>
      <required value="true"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="radio-button"/>
            <display value="Radio Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="patient_gender"/>
      <text value="Gender:"/>
      <type value="choice"/>
      <required value="true"/>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="male"/>
          <display value="Male"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="female"/>
          <display value="Female"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender"/>
          <code value="other"/>
          <display value="Other"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="patient_hc_pc"/>
      <text value="HN PC:"/>
      <type value="string"/>
      <maxLength value="2"/>
      <item>
        <linkId value="patient_hc_number"/>
        <text value="HN:"/>
        <type value="string"/>
        <maxLength value="10"/>
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
          <valueInteger value="2"/>
        </extension>
        <linkId value="patient_hc_vc"/>
        <text value="HN VC:"/>
        <type value="string"/>
      </item>
    </item>
    <item>
      <linkId value="patient_address_line1"/>
      <text value="Address (Line 1):"/>
      <type value="string"/>
      <required value="true"/>
      <item>
        <linkId value="patient_address_line2"/>
        <text value="Address (Line 2):"/>
        <type value="string"/>
      </item>
      <item>
        <linkId value="patient_address_city"/>
        <text value="City:"/>
        <type value="string"/>
        <required value="true"/>
      </item>
      <item>
        <linkId value="patient_address_province"/>
        <text value="Province:"/>
        <type value="string"/>
        <required value="true"/>
        <maxLength value="2"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
          <extension url="key">
            <valueId value="pat-pcode"/>
          </extension>
          <extension url="severity">
            <valueCode value="error"/>
          </extension>
          <extension url="expression">
            <valueExpression>
              <language value="text/fhirpath"/>
              <expression
                          value="%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]$'))"/>
            </valueExpression>
          </extension>
          <extension url="human">
            <valueString value="Must be a valid Canadian postal-code"/>
          </extension>
        </extension>
        <linkId value="patient_address_postalcode"/>
        <text value="Postal Code:"/>
        <type value="string"/>
        <required value="true"/>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="mobilephone"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid phone number"/>
        </extension>
      </extension>
      <linkId value="patient_phone_mobile"/>
      <text value="Mobile #:"/>
      <type value="string"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="homephone"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid phone number"/>
        </extension>
      </extension>
      <linkId value="patient_phone_home"/>
      <text value="Home #:"/>
      <type value="string"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="busphone"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid phone number"/>
        </extension>
      </extension>
      <linkId value="patient_phone_business"/>
      <text value="Business #:"/>
      <type value="string"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="patemail"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='patient_email').answer.all(value.matches('(?:[a-z0-9!#$%&amp;'*+/=?^_`{|}~-]+(?:\.[a-z0-9!#$%&amp;'*+/=?^_`{|}~-]+)*|&quot;(?:[\x01-\x08\x0b\x0c\x0e-\x1f\x21\x23-\x5b\x5d-\x7f]|\\[\x01-\x09\x0b\x0c\x0e-\x7f])*&quot;)@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\x01-\x08\x0b\x0c\x0e-\x1f\x21-\x5a\x53-\x7f]|\\[\x01-\x09\x0b\x0c\x0e-\x7f])+)\])'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid email address"/>
        </extension>
      </extension>
      <linkId value="patient_email"/>
      <text value="Email:"/>
      <type value="string"/>
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="additionalinfo_header"/>
    <text value="[Optional] Additional Patient Information">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
        <valueString
                     value="[Optional]&amp;#xa0;Additional&amp;#xa0;Patient&amp;#xa0;Information&lt;br/&gt;"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;"/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://example.com/CodeSystem/item-controls"/>
            <code value="push-button"/>
            <display value="Push Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_sexassignedatbirth"/>
      <text value="Sex assigned at birth:"/>
      <type value="choice"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="LA3-6"/>
          <display value="Female"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="LA2-8"/>
          <display value="Male"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://example.com/CodeSystem/exampleCS"/>
          <code value="Intersex"/>
          <display value="Intersex"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="LA4489-6"/>
          <display value="Unknown"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://example.com/CodeSystem/item-controls"/>
            <code value="push-button"/>
            <display value="Push Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_pronouns"/>
      <text value="Pronouns:"/>
      <type value="choice"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="LA29519-8"/>
          <display value="She/Her"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="LA29518-0"/>
          <display value="He/Him"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="LA29519-8"/>
          <display value="They/Them"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
          <code value="OTH"/>
          <display value="other"/>
        </valueCoding>
      </answerOption>
      <item>
        <linkId value="additionalinfo_pronouns_other"/>
        <text value="Other pronouns:"/>
        <type value="string"/>
        <enableWhen>
          <question value="additionalinfo_pronouns"/>
          <operator value="="/>
          <answerCoding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
            <code value="OTH"/>
            <display value="other"/>
          </answerCoding>
        </enableWhen>
        <enableBehavior value="all"/>
        <required value="true"/>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://example.com/CodeSystem/item-controls"/>
            <code value="push-button"/>
            <display value="Push Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_preferredlanguage"/>
      <text value="Preferred language:"/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="urn:ietf:bcp:47"/>
          <code value="en"/>
          <display value="English"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="urn:ietf:bcp:47"/>
          <code value="fr"/>
          <display value="French"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
          <code value="OTH"/>
          <display value="other"/>
        </valueCoding>
      </answerOption>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="additionalinfo_preferredlanguage_specify"/>
        <text value="Specify:"/>
        <type value="string"/>
        <enableWhen>
          <question value="additionalinfo_preferredlanguage"/>
          <operator value="="/>
          <answerCoding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
            <code value="OTH"/>
            <display value="other"/>
          </answerCoding>
        </enableWhen>
        <enableBehavior value="all"/>
        <required value="true"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="additionalinfo_preferredlanguage_translatorrequired"/>
        <text value="Translator required">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="string"/>
        <enableWhen>
          <question value="additionalinfo_preferredlanguage"/>
          <operator value="="/>
          <answerCoding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
            <code value="OTH"/>
            <display value="other"/>
          </answerCoding>
        </enableWhen>
        <repeats value="true"/>
        <answerOption>
          <valueString value="Translator Required"/>
        </answerOption>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://example.com/CodeSystem/item-controls"/>
            <code value="push-button"/>
            <display value="Push Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_bestmethodofcontact"/>
      <text value="Best method of contact:"/>
      <type value="choice"/>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-use"/>
          <code value="mobile"/>
          <display value="Mobile"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-use"/>
          <code value="home"/>
          <display value="Home"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-use"/>
          <code value="work"/>
          <display value="Work"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-system"/>
          <code value="email"/>
          <display value="Email"/>
        </valueCoding>
      </answerOption>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="additionalinfo_bestmethodofcontact_voicemails"/>
        <text value="Voicemails acceptable">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="string"/>
        <enableWhen>
          <question value="additionalinfo_bestmethodofcontact"/>
          <operator value="="/>
          <answerCoding>
            <system value="http://hl7.org/fhir/contact-point-use"/>
            <code value="mobile"/>
            <display value="Mobile"/>
          </answerCoding>
        </enableWhen>
        <enableBehavior value="any"/>
        <repeats value="true"/>
        <answerOption>
          <valueString value=" Voicemails acceptable"/>
        </answerOption>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_preferredname_select"/>
      <text value="Preferred name">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Preferred Name"/>
      </answerOption>
    </item>
    <item>
      <linkId value="additionalinfo_preferredname"/>
      <text value="Prefered name String">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_preferredname_select"/>
        <operator value="="/>
        <answerString value="Preferred Name"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_alternatecontact_select"/>
      <text value="Alternate contact">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Alternate contact"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_alternatecontact_name"/>
      <text value="Name:"/>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select"/>
        <operator value="="/>
        <answerString value="Alternate contact"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="altphone"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid phone number"/>
        </extension>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_alternatecontact_phone"/>
      <text value="Alternate contact phone #:"/>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select"/>
        <operator value="="/>
        <answerString value="Alternate contact"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_alternatecontact_relationship"/>
      <text value="Relationship:"/>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select"/>
        <operator value="="/>
        <answerString value="Alternate contact"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="radio-button"/>
            <display value="Radio Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_alternatecontact_bookingcontact"/>
      <text value="Is Alternate contact the appointment booking contact?:"/>
      <type value="choice"/>
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select"/>
        <operator value="="/>
        <answerString value="Alternate contact"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <answerOption>
        <valueCoding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
          <code value="Y"/>
          <display value="Yes"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
          <code value="N"/>
          <display value="No"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_unsafecontacts_select"/>
      <text value="Unsafe contact persons (do not speak with)">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Unsafe contact persons (do not speak with)"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_unsafecontacts_speakwithpatientdirectly"/>
      <text value="Only speak with patient directly">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_unsafecontacts_select"/>
        <operator value="="/>
        <answerString value="Unsafe contact persons (do not speak with)"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Only speak with patient directly"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_unsafecontacts_donotspeakwith"/>
      <text value="Do not speak with:"/>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_unsafecontacts_select"/>
        <operator value="="/>
        <answerString value="Unsafe contact persons (do not speak with)"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId
              value="additionalinfo_accessibilityconcernsordisability_selectt"/>
      <text value="Accessibility concerns or disability">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Accessibility concerns or disability"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://example.com/CodeSystem/item-controls"/>
            <code value="push-button"/>
            <display value="Push Button"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_accessibilityconcernsordisability"/>
      <text value="Accessibility concerns Options">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
      </text>
      <type value="choice"/>
      <enableWhen>
        <question
                  value="additionalinfo_accessibilityconcernsordisability_selectt"/>
        <operator value="="/>
        <answerString value="Accessibility concerns or disability"/>
      </enableWhen>
      <repeats value="true"/>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="129839007"/>
          <display value="Falls risk"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="301621006"/>
          <display value="Patient requires lift"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="105503008"/>
          <display value="Wheelchair"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="15188001"/>
          <display value="Hearing impaired"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_specialconsiderations_select"/>
      <text
            value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString
                     value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="additionalinfo_specialconsiderations"/>
      <text value="Details of special considerations:"/>
      <type value="text"/>
      <enableWhen>
        <question value="additionalinfo_specialconsiderations_select"/>
        <operator value="="/>
        <answerString
                      value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)"/>
      </enableWhen>
      <required value="true"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="additionalinfo_sendcopiestoadditionalproviders"/>
      <text value="Send copies of reports to additional providers">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Send copies of reports to additional providers"/>
      </answerOption>
    </item>
    <item>
      <linkId value="additionalinfo_sendcopiestoadditionalproviders_names"/>
      <text value="Name(s):"/>
      <type value="string"/>
      <enableWhen>
        <question value="additionalinfo_sendcopiestoadditionalproviders"/>
        <operator value="="/>
        <answerString value="Send copies of reports to additional providers"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
      <item>
        <linkId
                value="additionalinfo_sendcopiestoadditionalproviders_contactinfo"/>
        <text value="Contact information:"/>
        <type value="string"/>
        <enableWhen>
          <question value="additionalinfo_sendcopiestoadditionalproviders"/>
          <operator value="="/>
          <answerString
                        value="Send copies of reports to additional providers"/>
        </enableWhen>
        <enableBehavior value="all"/>
        <required value="true"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="additionalinfo_sendcopiestoadditionalproviders_ispcp"/>
        <text value="This is the Primary Care Provider">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="string"/>
        <enableWhen>
          <question value="additionalinfo_sendcopiestoadditionalproviders"/>
          <operator value="="/>
          <answerString
                        value="Send copies of reports to additional providers"/>
        </enableWhen>
        <enableBehavior value="all"/>
        <repeats value="true"/>
        <answerOption>
          <valueString value="This is the Primary Care Provider"/>
        </answerOption>
      </item>
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <extension url="http://example.com/StructureDefinition/group-note-info">
      <extension url="sortIndex">
        <valuePositiveInt value="1"/>
      </extension>
      <extension url="text">
        <valueString value="Referral Details">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;Referral Details&lt;br/&gt;"/>
          </extension>
        </valueString>
      </extension>
      <extension url="style">
        <valueString value="font-weight:bold;text-decoration:underline;"/>
      </extension>
      <extension url="groupItems">
        <valueBoolean value="false"/>
      </extension>
    </extension>
    <linkId value="102173268919"/>
    <text value="Referral Details">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
        <valueString value="Referral&amp;#xa0;Details&lt;br/&gt;"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;color:#202035;"/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <extension
                 url="http://example.com/StructureDefinition/group-note-info">
        <extension url="enableWhenExpression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression value="true"/>
          </valueExpression>
        </extension>
        <extension url="sortIndex">
          <valuePositiveInt value="1"/>
        </extension>
        <extension url="text">
          <valueString value="Triage Considerations"/>
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;"/>
        </extension>
      </extension>
      <linkId value="cardio_triagecons"/>
      <text value="Triage Considerations">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString
                       value="Triage&amp;#xa0;Considerations&lt;br/&gt;&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="font-weight:bold;"/>
        </extension>
      </text>
      <type value="group"/>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://example.com/CodeSystem/item-controls"/>
              <code value="push-button"/>
              <display value="Push Button"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://example.com/StructureDefinition/question-note-info">
          <extension url="sortIndex">
            <valuePositiveInt value="1"/>
          </extension>
          <extension url="text">
            <valueString value="Requested Priority:"/>
          </extension>
          <extension url="sameLine">
            <valueBoolean value="true"/>
          </extension>
          <extension url="answerStyle">
            <valueString value="font-weight:bold;color:#EE6B00;"/>
          </extension>
        </extension>
        <linkId value="referral_requestedpriority"/>
        <text value="Requested Priority:"/>
        <type value="choice"/>
        <required value="true"/>
        <answerOption>
          <extension
                     url="http://example.com/StructureDefinition/option-note-info">
            <extension url="text">
              <valueString value="Routine"/>
            </extension>
            <extension url="style">
              <valueString value="font-weight:bold;color:#EE6B00;"/>
            </extension>
          </extension>
          <valueCoding>
            <system value="http://hl7.org/fhir/request-priority"/>
            <code value="routine"/>
            <display value="Routine"/>
          </valueCoding>
          <initialSelected value="true"/>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://hl7.org/fhir/request-priority"/>
            <code value="urgent"/>
            <display value="Urgent"/>
          </valueCoding>
        </answerOption>
        <item>
          <linkId value="referral_requestedpriority_urgentreason"/>
          <text value="Reason for urgent triage"/>
          <type value="string"/>
          <enableWhen>
            <question value="referral_requestedpriority"/>
            <operator value="="/>
            <answerCoding>
              <system value="http://hl7.org/fhir/request-priority"/>
              <code value="urgent"/>
              <display value="Urgent"/>
            </answerCoding>
          </enableWhen>
          <required value="true"/>
        </item>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://example.com/StructureDefinition/question-note-info">
          <extension url="sortIndex">
            <valuePositiveInt value="2"/>
          </extension>
          <extension url="text">
            <valueString value="Second Opinion"/>
          </extension>
        </extension>
        <linkId value="referral_secondopinion"/>
        <text value="Second Opinion">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system value="http://snomed.info/sct"/>
            <code value="77406008"/>
            <display value="Second or third medical opinion"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="referral_secondopinion_reason"/>
        <text value="Reason for second opinion:"/>
        <type value="text"/>
        <enableWhen>
          <question value="referral_secondopinion"/>
          <operator value="="/>
          <answerCoding>
            <system value="http://snomed.info/sct"/>
            <code value="77406008"/>
            <display value="Second or third medical opinion"/>
          </answerCoding>
        </enableWhen>
      </item>
    </item>
    <item>
      <extension
                 url="http://example.com/StructureDefinition/group-note-info">
        <extension url="sortIndex">
          <valuePositiveInt value="2"/>
        </extension>
        <extension url="text">
          <valueString value="Service(s) Requested"/>
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;"/>
        </extension>
      </extension>
      <linkId value="695991571585"/>
      <text value="Service(s) Requested Select all that apply:">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString
                       value="&lt;b&gt;Service(s)&amp;#xa0;Requested&lt;/b&gt;&lt;br/&gt;&lt;i&gt;Select&amp;#xa0;all&amp;#xa0;that&amp;#xa0;apply:&lt;/i&gt;&lt;br/&gt;&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="color:Gray20;"/>
        </extension>
      </text>
      <type value="group"/>
      <required value="true"/>
      <item>
        <extension
                   url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression">
          <valueExpression>
            <description
                         value="Calculates HSC services based on selected checkboxes for cardiac testing and cardiology consult"/>
            <language value="text/fhirpath"/>
            <expression
                        value="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', '')"/>
          </valueExpression>
        </extension>
        <extension
                   url="http://example.com/StructureDefinition/question-note-info">
          <extension url="text">
            <valueString value="HSCs Assigned:"/>
          </extension>
          <extension url="style">
            <valueString value="font-weight:bold;"/>
          </extension>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
          <valueBoolean value="true"/>
        </extension>
        <linkId value="referralService"/>
        <text value="HSCs Assigned:"/>
        <type value="string"/>
        <readOnly value="true"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="223886162384"/>
        <text value="Cardiac Testing">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20001"/>
            <display value="Cardiac Testing"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="660331267409"/>
        <text value="Exam(s) Requested">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString
                         value="Exam(s)&amp;#xa0;Requested&lt;br/&gt;&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="color:Gray20;font-weight:bold;"/>
          </extension>
        </text>
        <type value="group"/>
        <enableWhen>
          <question value="223886162384"/>
          <operator value="="/>
          <answerCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20001"/>
            <display value="Cardiac Testing"/>
          </answerCoding>
        </enableWhen>
        <enableBehavior value="all"/>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="720409326878"/>
          <text value="24 Hour Ambulatory Blood Pressure Monitoring">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20003"/>
              <display value="24 Hour Ambulatory Blood Pressure Monitoring"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="960455115596"/>
          <text value="Coronary Angiogram">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20004"/>
              <display value="Coronary Angiogram"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="297634898828"/>
          <text value="Echocardiogram - Resting">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20005"/>
              <display value="Echocardiogram - Resting"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="background-color:grey;border-style:solid;"/>
          </extension>
          <linkId value="443484577720"/>
          <text value="sub Echocardiogram - Resting">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="group"/>
          <enableWhen>
            <question value="297634898828"/>
            <operator value="="/>
            <answerCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20005"/>
              <display value="Echocardiogram - Resting"/>
            </answerCoding>
          </enableWhen>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="165530569567"/>
            <text value="Echocardiogram (2D)">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20012"/>
                <display value="Echocardiogram (2D)"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="286552421895"/>
            <text value="Echocardiogram with Contrast">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20013"/>
                <display value="Echocardiogram with Contrast"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="910527687300"/>
            <text value="Echocardiogram with Saline (Bubble)">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20014"/>
                <display value="Echocardiogram with Saline (Bubble)"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="657824763133"/>
            <text value="Pediatric Echocardiogram">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20015"/>
                <display value="Pediatric Echocardiogram"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="992743200182"/>
            <text value="Transesophageal Echocardiogram (TEE)">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20016"/>
                <display value="Transesophageal Echocardiogram (TEE)"/>
              </valueCoding>
            </answerOption>
          </item>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="894277763438"/>
          <text value="Electrocardiogram (ECG)">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20006"/>
              <display value="Electrocardiogram (ECG)"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="279226023495"/>
          <text value="Holter Monitoring">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20007"/>
              <display value="Holter Monitoring"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="background-color:grey;border-style:solid;"/>
          </extension>
          <linkId value="440449731882"/>
          <text value="sub holter monitoring">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="group"/>
          <enableWhen>
            <question value="279226023495"/>
            <operator value="="/>
            <answerCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20007"/>
              <display value="Holter Monitoring"/>
            </answerCoding>
          </enableWhen>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="671328703851"/>
            <text value="24 Hours">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20017"/>
                <display value="24 Hours"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="423992261841"/>
            <text value="48 Hours">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20018"/>
                <display value="48 Hours"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="419924239187"/>
            <text value="72 Hours">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20019"/>
                <display value="72 Hours"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="731054417270"/>
            <text value="7 Days">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20020"/>
                <display value="7 Days"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="235876421044"/>
            <text value="14 Days">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20021"/>
                <display value="14 Days"/>
              </valueCoding>
            </answerOption>
          </item>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="374742834400"/>
          <text value="Loop / Event Monitor">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20008"/>
              <display value="Loop / Event Monitor"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <linkId value="159161544747"/>
          <text value="Cardiovascular stress testing">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20009"/>
              <display value="Stress Testing"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="background-color:grey;border-style:solid;"/>
          </extension>
          <linkId value="370275060390"/>
          <text value="Sub Stress Testing">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="group"/>
          <enableWhen>
            <question value="159161544747"/>
            <operator value="="/>
            <answerCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20009"/>
              <display value="Stress Testing"/>
            </answerCoding>
          </enableWhen>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="814218498309"/>
            <text value="ECG - Exercise Stress Test">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20022"/>
                <display value="ECG - Exercise Stress Test"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="307107493993"/>
            <text value="ECG - Dobutamine/Persantine Stress Test">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20023"/>
                <display value="ECG - Dobutamine/Persantine Stress Test"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="805303414102"/>
            <text value="Echocardiogram - Exercise Stress Test">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20024"/>
                <display value="Echocardiogram - Exercise Stress Test"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <linkId value="193586908489"/>
            <text value="Echocardiogram - Dobutamine/Persantine Stress Test">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20025"/>
                <display
                         value="Echocardiogram - Dobutamine/Persantine Stress Test"/>
              </valueCoding>
            </answerOption>
          </item>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <linkId value="918517139023"/>
          <text value="Nuclear Medicine">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20010"/>
              <display value="Nuclear Medicine"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="background-color:grey;border-style:solid;"/>
          </extension>
          <linkId value="222686221935"/>
          <text value="sub Nuclear Medicine">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="group"/>
          <enableWhen>
            <question value="918517139023"/>
            <operator value="="/>
            <answerCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20010"/>
              <display value="Nuclear Medicine"/>
            </answerCoding>
          </enableWhen>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="924189648184"/>
            <text value="MUGA - Resting">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20026"/>
                <display value="MUGA - Resting"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="857163514910"/>
            <text value="Cardiac Pyrophosphate">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20027"/>
                <display value="Cardiac Pyrophosphate"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
              <valueCode value="horizontal"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="check-box"/>
                  <display value="Check-box"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <linkId value="892165959617"/>
            <text value="Myocardial perfusion scan">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="choice"/>
            <repeats value="true"/>
            <answerOption>
              <valueCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20028"/>
                <display
                         value="MIBI Scans / Myocardial Perfusion Imaging (MPI):"/>
              </valueCoding>
            </answerOption>
          </item>
          <item>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
              <valueCodeableConcept>
                <coding>
                  <system
                          value="http://hl7.org/fhir/questionnaire-item-control"/>
                  <code value="radio-button"/>
                  <display value="Radio Button"/>
                </coding>
              </valueCodeableConcept>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString
                           value="background-color:white;border-style:solid;"/>
            </extension>
            <linkId value="538288549138"/>
            <text value="sub MIBI">
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                <valueString value="&lt;br/&gt;"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                <valueString value="display:none;"/>
              </extension>
            </text>
            <type value="group"/>
            <enableWhen>
              <question value="892165959617"/>
              <operator value="="/>
              <answerCoding>
                <system
                        value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
                <code value="20028"/>
                <display
                         value="MIBI Scans / Myocardial Perfusion Imaging (MPI):"/>
              </answerCoding>
            </enableWhen>
            <item>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="check-box"/>
                    <display value="Check-box"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <linkId value="373435981917"/>
              <text value="MIBI Scan - Exercise Stress Test">
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="&lt;br/&gt;"/>
                </extension>
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                  <valueString value="display:none;"/>
                </extension>
              </text>
              <type value="string"/>
              <repeats value="true"/>
              <answerOption>
                <valueString value="MIBI Scan - Exercise Stress Test"/>
              </answerOption>
            </item>
            <item>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="check-box"/>
                    <display value="Check-box"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <linkId value="434394942688"/>
              <text value="MIBI Scan - Dobutamine/Persantine Stress Test">
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="&lt;br/&gt;"/>
                </extension>
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                  <valueString value="display:none;"/>
                </extension>
              </text>
              <type value="string"/>
              <repeats value="true"/>
              <answerOption>
                <valueString
                             value="MIBI Scan - Dobutamine/Persantine Stress Test"/>
              </answerOption>
            </item>
            <item>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
                <valueCodeableConcept>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/questionnaire-item-control"/>
                    <code value="check-box"/>
                    <display value="Check-box"/>
                  </coding>
                </valueCodeableConcept>
              </extension>
              <linkId value="913594478162"/>
              <text value="Thallium Viability Test">
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
                  <valueString value="&lt;br/&gt;"/>
                </extension>
                <extension
                           url="http://hl7.org/fhir/StructureDefinition/rendering-style">
                  <valueString value="display:none;"/>
                </extension>
              </text>
              <type value="string"/>
              <repeats value="true"/>
              <answerOption>
                <valueString value="Thallium Viability Test"/>
              </answerOption>
            </item>
          </item>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="992682216482"/>
          <text value="Tilt Table Testing">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
              <code value="20011"/>
              <display value="Tilt Table Testing"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
            <valueCode value="horizontal"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/questionnaire-item-control"/>
                <code value="check-box"/>
                <display value="Check-box"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <linkId value="cardiology_referral_services_cardiactesting_other"/>
          <text value="Other">
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
              <valueString value="&lt;br/&gt;"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/rendering-style">
              <valueString value="display:none;"/>
            </extension>
          </text>
          <type value="choice"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
              <code value="OTH"/>
              <display value="other"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <linkId
                  value="cardiology_referral_services_cardiactesting_other_specify"/>
          <text value="Specify"/>
          <type value="text"/>
          <enableWhen>
            <question
                      value="cardiology_referral_services_cardiactesting_other"/>
            <operator value="="/>
            <answerCoding>
              <system
                      value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
              <code value="OTH"/>
              <display value="other"/>
            </answerCoding>
          </enableWhen>
          <enableBehavior value="all"/>
          <required value="true"/>
        </item>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="785727177547"/>
        <text value="Cardiology Consultation">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20002"/>
            <display value="Cardiology Consultation"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
    <item>
      <linkId value="186952778859"/>
      <text
            value="Concern(s) / Indication(s) Triggering Referral Select all that apply:">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString
                       value="&lt;b&gt;Concern(s)&amp;#xa0;/&amp;#xa0;Indication(s)&amp;#xa0;Triggering&amp;#xa0;Referral&lt;/b&gt;&lt;br/&gt;&lt;i&gt;Select&amp;#xa0;all&amp;#xa0;that&amp;#xa0;apply:&lt;/i&gt;&lt;br/&gt;"/>
        </extension>
      </text>
      <type value="group"/>
      <required value="true"/>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="219569805461"/>
        <text value="Arrhythmias or Palpitations">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system value="http://snomed.info/sct"/>
            <code value="698247007"/>
            <display value="Arrhythmias or Palpitations"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="571934328499"/>
        <text value="Cardiovascular Risk Assessment">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20033"/>
            <display value="Cardiovascular Risk Assessment"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="459737733395"/>
        <text value="Chest Pain or Angina">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20034"/>
            <display value="Chest Pain or Angina"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <linkId value="929919815516"/>
        <text value="Congenital Heart Disease">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20035"/>
            <display value="Congenital Heart Disease"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="832263816528"/>
        <text value="Congestive Heart Failure">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20036"/>
            <display value="Congestive Heart Failure"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="803760213460"/>
        <text value="Coronary Artery Disease">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20037"/>
            <display value="Coronary Artery Disease"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <linkId value="129767162379"/>
        <text value="Dyspnea">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20038"/>
            <display value="Dyspnea"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <linkId value="116150628533"/>
        <text value="Hypertension">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20039"/>
            <display value="Hypertension"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <linkId value="513825527027"/>
        <text value="Murmur">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20040"/>
            <display value="Murmur"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <linkId value="975075898688"/>
        <text value="Pericardial Disease">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20041"/>
            <display value="Pericardial Disease"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="704148928571"/>
        <text value="Peripheral Edema">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20042"/>
            <display value="Peripheral Edema"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="886489617115"/>
        <text value="Post-Myocardial Infarction">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20043"/>
            <display value="Post-Myocardial Infarction"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="621745958993"/>
        <text value="Pre-operative Consultation">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20044"/>
            <display value="Pre-operative Consultation"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="873024527134"/>
        <code>
          <system value="http://snomed.info/sct"/>
          <code value="439272007"/>
          <display value="Date of procedure"/>
        </code>
        <text value="Procedure Date (if known)"/>
        <type value="date"/>
        <enableWhen>
          <question value="621745958993"/>
          <operator value="="/>
          <answerCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20044"/>
            <display value="Pre-operative Consultation"/>
          </answerCoding>
        </enableWhen>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <linkId value="197975129599"/>
        <text value="Syncope">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://example.com/CodeSystem/standardized-referral-form-codes"/>
            <code value="20045"/>
            <display value="Syncope"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="675849150752"/>
        <text value="Valvular Heart Disease or Prosthetic Heart Valve">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system value="http://snomed.info/sct"/>
            <code value="368009"/>
            <display
                     value="Valvular Heart Disease or Prosthetic Heart Valve"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
          <valueCode value="horizontal"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="check-box"/>
              <display value="Check-box"/>
            </coding>
          </valueCodeableConcept>
        </extension>
        <linkId value="721982740516"/>
        <text value="Other">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="display:none;"/>
          </extension>
        </text>
        <type value="choice"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
            <code value="OTH"/>
            <display value="other"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="background-color:white;border-style:solid;"/>
        </extension>
        <linkId value="720594942482"/>
        <text value="Specify"/>
        <type value="text"/>
        <enableWhen>
          <question value="721982740516"/>
          <operator value="="/>
          <answerCoding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
            <code value="OTH"/>
            <display value="other"/>
          </answerCoding>
        </enableWhen>
        <required value="true"/>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="Descriptionofclinicalquestion"/>
      <text
            value="Clinical Question / Goal(s) of Referral with Relevant History, Management and Investigations">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString
                       value="Clinical&amp;#xa0;Question&amp;#xa0;/&amp;#xa0;Goal(s)&amp;#xa0;of&amp;#xa0;Referral&amp;#xa0;with&amp;#xa0;Relevant&amp;#xa0;History,&amp;#xa0;Management&amp;#xa0;and&amp;#xa0;Investigations&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="font-weight:bold;"/>
        </extension>
      </text>
      <type value="text"/>
      <required value="true"/>
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="cpp_header"/>
    <text
          value="Cumulative Patient Profile Please delete any sensitive information you do not intend to share from the CPP">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
        <valueString
                     value="Cumulative Patient Profile&lt;br/&gt;&lt;br/&gt;&lt;i&gt;Please delete any sensitive information you do not intend to share from the CPP&lt;/i&gt;"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;"/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="cpp_separate"/>
      <text value="CPP attached separately (if not entered below)">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="CPP attached separately (if not entered below)"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="cpp_currentprob"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="55607006"/>
        <display value="Problem"/>
      </code>
      <text value="Current Problem List:"/>
      <type value="text"/>
      <enableWhen>
        <question value="cpp_separate"/>
        <operator value="exists"/>
        <answerBoolean value="false"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="cpp_pastmedicalhistory"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="417662000"/>
        <display value="History of clinical finding in subject"/>
      </code>
      <text value="Past Medical History:"/>
      <type value="text"/>
      <enableWhen>
        <question value="cpp_separate"/>
        <operator value="exists"/>
        <answerBoolean value="false"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="cpp_currentmedications"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="129019007"/>
        <display value="Taking medication"/>
      </code>
      <text value="Current Medications :"/>
      <type value="text"/>
      <enableWhen>
        <question value="cpp_separate"/>
        <operator value="exists"/>
        <answerBoolean value="false"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="cpp_familyhistory"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="57177007"/>
        <display value="Family history with explicit context"/>
      </code>
      <text value="Family History:"/>
      <type value="text"/>
      <enableWhen>
        <question value="cpp_separate"/>
        <operator value="exists"/>
        <answerBoolean value="false"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="cpp_allergies"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="609328004"/>
        <display value="Allergic disposition"/>
      </code>
      <text value="Allergies:"/>
      <type value="text"/>
      <enableWhen>
        <question value="cpp_separate"/>
        <operator value="exists"/>
        <answerBoolean value="false"/>
      </enableWhen>
      <enableBehavior value="all"/>
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="preferredconsultlocation_header"/>
    <text
          value="Preferred Consultant or Location All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered.">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
        <valueString
                     value="&lt;b&gt;Preferred Consultant or Location&lt;/b&gt;&lt;br/&gt;&lt;br/&gt;All patients will be triaged to the shortest wait time unless a preferred consultant or location is entered."/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="preferredconsultlocation_selector"/>
      <text value="Preferred consultant or location">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Preferred consultant or location"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="preferredconsultlocation_specify"/>
      <text value="Please specify either a preferred consultant or location">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString
                       value="Please specify either a &lt;b&gt;preferred&lt;/b&gt; consultant or location"/>
        </extension>
      </text>
      <type value="group"/>
      <enableWhen>
        <question value="preferredconsultlocation_selector"/>
        <operator value="="/>
        <answerString value="Preferred consultant or location"/>
      </enableWhen>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="border-style:solid;"/>
        </extension>
        <linkId value="preferredconsultlocation_consultant"/>
        <text value="Consultant:"/>
        <type value="string"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="border-style:solid;"/>
        </extension>
        <linkId value="preferredconsultlocation_location"/>
        <text value="Location:"/>
        <type value="string"/>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="preferredconsultlocation_willingtotravel"/>
      <text value="Patient willing to travel for shorter wait time">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString value="Patient willing to travel for shorter wait time"/>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;"/>
      </extension>
      <linkId value="preferredconsultlocation_otherconsiderations"/>
      <text value="Other considerations:"/>
      <type value="string"/>
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="supportingdocumentation_header"/>
    <text
          value="Supporting Documentation Please attach all relevant laboratory and diagnostic investigations.">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
        <valueString
                     value="&lt;b&gt;Supporting&amp;#xa0;Documentation&lt;/b&gt;&lt;br/&gt;Please&amp;#xa0;attach&amp;#xa0;all&amp;#xa0;&lt;b&gt;&lt;span style=&quot;text-decoration: underline&quot;&gt;relevant&lt;/span&gt;&lt;/b&gt;&amp;#xa0;laboratory&amp;#xa0;and&amp;#xa0;diagnostic&amp;#xa0;investigations.&lt;br/&gt;"/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="check-box"/>
            <display value="Check-box"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="supportingdocumentation_details"/>
      <text
            value="Personal Health Information that is medically relevant has not been disclosed at the request of the patient.">
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;"/>
        </extension>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;"/>
        </extension>
      </text>
      <type value="string"/>
      <repeats value="true"/>
      <answerOption>
        <valueString
                     value="Personal Health Information that is medically relevant has not been disclosed at the request of the patient."/>
      </answerOption>
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="application/pdf"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="image/gif"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="image/bmp"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode
                 value="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="video/mp4"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="text/csv"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="image/jpeg"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="application/msword"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="image/png"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode
                 value="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="application/vnd.ms-excel"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="text/plain"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="audio/mp4"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="audio/mpeg"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/mimeType">
      <valueCode value="image/tiff"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/maxSize">
      <valueDecimal value="5000000"/>
    </extension>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <extension
               url="http://example.com/StructureDefinition/question-note-info">
      <extension url="positiveText">
        <valueString value="Attachment Provided"/>
      </extension>
    </extension>
    <linkId value="supportingdocumentation_attachment"/>
    <text value="Add Attachments"/>
    <type value="attachment"/>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="feedbacksurvey_cardiology"/>
    <text value="Click here to provide feedback on this form">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
        <valueString
                     value="&lt;a href=&quot;https://www.surveymonkey.com/r/cardioSRF&quot; rel=&quot;noopener noreferrer&quot; target=&quot;_blank&quot;&gt;Click&amp;#xa0;here&amp;#xa0;to&amp;#xa0;provide&amp;#xa0;feedback&amp;#xa0;on&amp;#xa0;this&amp;#xa0;form&lt;/a&gt;&lt;br/&gt;"/>
      </extension>
    </text>
    <type value="display"/>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
      <valueString value="background-color:grey;border-style:solid;"/>
    </extension>
    <linkId value="referrer_header"/>
    <text value="Referrer's Information">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;"/>
      </extension>
    </text>
    <type value="group"/>
    <item>
      <linkId value="referrer_sitename"/>
      <text value="Site Name:"/>
      <type value="string"/>
    </item>
    <item>
      <linkId value="referrer_address_line1"/>
      <text value="Address (Line 1):"/>
      <type value="string"/>
      <required value="true"/>
      <item>
        <linkId value="referrer_address_line2"/>
        <text value="Address (Line 2):"/>
        <type value="string"/>
      </item>
      <item>
        <linkId value="referrer_address_city"/>
        <text value="City:"/>
        <type value="string"/>
        <required value="true"/>
      </item>
      <item>
        <linkId value="referrer_address_province"/>
        <text value="Province:"/>
        <type value="string"/>
        <required value="true"/>
        <maxLength value="2"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
          <extension url="key">
            <valueId value="ref-pcode"/>
          </extension>
          <extension url="severity">
            <valueCode value="error"/>
          </extension>
          <extension url="expression">
            <valueExpression>
              <language value="text/fhirpath"/>
              <expression
                          value="%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]$'))"/>
            </valueExpression>
          </extension>
          <extension url="human">
            <valueString value="Must be a valid Canadian postal-code"/>
          </extension>
        </extension>
        <linkId value="referrer_address_postalcode"/>
        <text value="Postal Code:"/>
        <type value="string"/>
        <required value="true"/>
      </item>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="refphone"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='referrer_phone').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid phone number"/>
        </extension>
      </extension>
      <linkId value="referrer_phone"/>
      <text value="Phone #:"/>
      <type value="string"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="reffax"/>
        </extension>
        <extension url="severity">
          <valueCode value="error"/>
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath"/>
            <expression
                        value="%resource.repeat(item).where(linkId='referrer_fax').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))"/>
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid phone number"/>
        </extension>
      </extension>
      <linkId value="referrer_fax"/>
      <text value="Fax #:"/>
      <type value="string"/>
    </item>
    <item>
      <linkId value="referrer_billing"/>
      <text value="Billing Number:"/>
      <type value="integer"/>
    </item>
    <item>
      <linkId value="referrer_professionalid"/>
      <text value="Professional ID:"/>
      <type value="integer"/>
    </item>
    <item>
      <linkId value="referrer_signature"/>
      <text value="Signed:"/>
      <type value="text"/>
      <required value="true"/>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="drop-down"/>
            <display value="Drop down"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <linkId value="referrer_role"/>
      <text value="Role:"/>
      <type value="choice"/>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="309398001"/>
          <display value="Allied Health Professional"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="62247001"/>
          <display value="Family Physician"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="449161006"/>
          <display value="Physician Assistant"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="398130009"/>
          <display value="Medical Student"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="106292003"/>
          <display value="Nurse"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="224571005"/>
          <display value="Nurse Practitioner"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="405277009"/>
          <display value="Resident"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="69280009"/>
          <display value="Specialist"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
          <code value="OTH"/>
          <display value="other"/>
        </valueCoding>
      </answerOption>
    </item>
  </item>
</Questionnaire>