{ "resourceType" : "Questionnaire", "id" : "questionnaire-prostate-radiologist-referral", "language" : "en", "text" : { "status" : "generated", "div" : "

English

Generated Narrative: Questionnaire questionnaire-prostate-radiologist-referral

Language: en

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeFlagsDescription & Constraints\"doco\"
\".\"\".\" ProstateRadiologistReferralQuestionnairehttps://hl7.lt/fhir/prostate/Questionnaire/prostate-radiologist-referral#0.1.0
\".\"\".\"\".\" grp-referral-contextReferral context0..1group
\".\"\".\"\".\"\".\" diagnosisDiagnosis (ICD-10)1..1codingOptions: 2 options
\".\"\".\"\".\"\".\" diagnosis-grade-groupGrade group (if C61)0..1codingOptions: 5 options
\".\"\".\"\".\"\".\" specialist-qualificationSpecialist qualification1..1string\"icon\"/\"icon\"/Initial Value: string = Radiologist
\".\"\".\"\".\"\".\" institutionReferring institution1..1string
\".\"\".\"\".\"\".\" screening-programmeScreening programme participant1..1codingOptions: 2 options
\".\"\".\"\".\" grp-clinicalClinical information0..1group
\".\"\".\"\".\"\".\" complaints-anamnesisComplaints / anamnesis0..1text
\".\"\".\"\".\"\".\" condition-assessment-infoCondition assessment information1..1text
\".\"\".\"\".\" grp-family-historyFamily oncological history (first-degree)0..1group
\".\"\".\"\".\"\".\" family-hx-prostateProstate cancer0..1codingOptions: 3 options
\".\"\".\"\".\"\".\" family-hx-breastBreast cancer0..1codingOptions: 3 options
\".\"\".\"\".\"\".\" family-hx-ovarianOvarian cancer0..1codingOptions: 3 options
\".\"\".\"\".\"\".\" family-hx-colonColorectal cancer0..1codingOptions: 3 options
\".\"\".\"\".\" grp-dreDigital rectal examination0..1group
\".\"\".\"\".\"\".\" dre-findingsDRE findings (select all that apply)0..*codingOptions: 6 options
\".\"\".\"\".\" grp-vitalsAnthropometrics0..1group
\".\"\".\"\".\"\".\" height-cmHeight (cm)1..1quantity
\".\"\".\"\".\"\".\" weight-kgWeight (kg)1..1quantity
\".\"\".\"\".\"\".\" bmi-kg-m2BMI (kg/m2)0..1quantity\"icon\"/\"icon\"/
\".\"\".\"\".\" grp-psaPSA0..1group
\".\"\".\"\".\"\".\" first-psa-ngmlFirst PSA (ng/ml)1..1quantity
\".\"\".\"\".\"\".\" first-psa-dateFirst PSA date1..1date
\".\"\".\"\".\" grp-prior-imagingPrior prostate mpMRI0..1group
\".\"\".\"\".\"\".\" prior-mpmriPrior mpMRI documented0..1boolean
\".\"\".\"\".\"\".\" prior-mpmri-datePrior mpMRI date0..1date
\".\"\".\"\".\"\".\" prior-mpmri-piradsPrior mpMRI PI-RADS category0..1codingOptions: 4 options
\".\"\".\"\".\" grp-prior-therapyPrior prostate-directed therapy0..1group
\".\"\".\"\".\"\".\" prior-prostatectomyPrior prostate surgery0..1boolean
\".\"\".\"\".\"\".\" prior-prostatectomy-dateProstate surgery date0..1date
\".\"\".\"\".\"\".\" prior-prostate-radiationPrior prostate radiotherapy0..1boolean
\".\"\".\"\".\"\".\" prior-prostate-radiation-dateProstate radiotherapy date0..1date
\".\"\".\"\".\" grp-relatedRelated information0..1group
\".\"\".\"\".\"\".\" anticoagulant-useAnticoagulant use0..1boolean
\".\"\".\"\".\" grp-additionalAdditional information0..1group
\".\"\".\"\".\"\".\" specialist-additional-infoAdditional description for specialist0..1text

\"doco\" Documentation for this format

Options Sets

Answer options for diagnosis

Answer options for diagnosis-grade-group

Answer options for screening-programme

Answer options for family-hx-prostate

Answer options for family-hx-breast

Answer options for family-hx-ovarian

Answer options for family-hx-colon

Answer options for dre-findings

Answer options for prior-mpmri-pirads

" }, "url" : "https://hl7.lt/fhir/prostate/Questionnaire/prostate-radiologist-referral", "version" : "0.1.0", "name" : "ProstateRadiologistReferral", "title" : "Referral to a radiologist (E027)", "status" : "draft", "subjectType" : ["Patient"], "date" : "2025-06-01", "publisher" : "Lithuanian Medical Library", "contact" : [{ "name" : "Lithuanian Medical Library", "telecom" : [{ "system" : "url", "value" : "https://medicinosnk.lt" }, { "system" : "email", "value" : "info@medicinosnk.lt" }] }], "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "LT" }] }], "item" : [{ "linkId" : "grp-referral-context", "text" : "Referral context", "type" : "group", "item" : [{ "linkId" : "diagnosis", "text" : "Diagnosis (ICD-10)", "type" : "coding", "required" : true, "answerOption" : [{ "valueCoding" : { "system" : "http://hl7.org/fhir/sid/icd-10", "code" : "N40", "display" : "Enlargement of prostate" } }, { "valueCoding" : { "system" : "http://hl7.org/fhir/sid/icd-10", "code" : "C61", "display" : "Malignant neoplasm of prostate" } }] }, { "linkId" : "diagnosis-grade-group", "text" : "Grade group (if C61)", "type" : "coding", "required" : false, "answerOption" : [{ "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "1279715000", "display" : "ISUP Grade Group 1 (Gleason 3+3)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "1279714001", "display" : "ISUP Grade Group 2 (Gleason 3+4)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "1279716004", "display" : "ISUP Grade Group 3 (Gleason 4+3)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "1279717008", "display" : "ISUP Grade Group 4 (Gleason 8)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "1279720000", "display" : "ISUP Grade Group 5 (Gleason 9-10)" } }] }, { "linkId" : "specialist-qualification", "text" : "Specialist qualification", "type" : "string", "required" : true, "readOnly" : true, "initial" : [{ "valueString" : "Radiologist" }] }, { "linkId" : "institution", "text" : "Referring institution", "type" : "string", "required" : true }, { "linkId" : "screening-programme", "text" : "Screening programme participant", "type" : "coding", "required" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-no", "display" : "No" } }] }] }, { "linkId" : "grp-clinical", "text" : "Clinical information", "type" : "group", "item" : [{ "linkId" : "complaints-anamnesis", "text" : "Complaints / anamnesis", "type" : "text", "required" : false }, { "linkId" : "condition-assessment-info", "text" : "Condition assessment information", "type" : "text", "required" : true }] }, { "linkId" : "grp-family-history", "text" : "Family oncological history (first-degree)", "type" : "group", "item" : [{ "linkId" : "family-hx-prostate", "text" : "Prostate cancer", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-no", "display" : "No" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-unknown", "display" : "Unknown" } }] }, { "linkId" : "family-hx-breast", "text" : "Breast cancer", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-no", "display" : "No" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-unknown", "display" : "Unknown" } }] }, { "linkId" : "family-hx-ovarian", "text" : "Ovarian cancer", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-no", "display" : "No" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-unknown", "display" : "Unknown" } }] }, { "linkId" : "family-hx-colon", "text" : "Colorectal cancer", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-no", "display" : "No" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "ynk-unknown", "display" : "Unknown" } }] }] }, { "linkId" : "grp-dre", "text" : "Digital rectal examination", "type" : "group", "item" : [{ "linkId" : "dre-findings", "text" : "DRE findings (select all that apply)", "type" : "coding", "required" : false, "repeats" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/snomed-prostate-extension", "code" : "standard-prostate", "display" : "Standard prostate (finding)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "276387009", "display" : "Hard prostate (finding)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "276385001", "display" : "Soft prostate (finding)" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/snomed-prostate-extension", "code" : "flexible-prostate", "display" : "Flexible prostate (finding)" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/snomed-prostate-extension", "code" : "inflexible-prostate", "display" : "Inflexible prostate (finding)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "443607001", "display" : "Palpable mass (finding)" } }] }] }, { "linkId" : "grp-vitals", "text" : "Anthropometrics", "type" : "group", "item" : [{ "linkId" : "height-cm", "text" : "Height (cm)", "type" : "quantity", "required" : true }, { "linkId" : "weight-kg", "text" : "Weight (kg)", "type" : "quantity", "required" : true }, { "linkId" : "bmi-kg-m2", "text" : "BMI (kg/m2)", "type" : "quantity", "readOnly" : true }] }, { "linkId" : "grp-psa", "text" : "PSA", "type" : "group", "item" : [{ "linkId" : "first-psa-ngml", "text" : "First PSA (ng/ml)", "type" : "quantity", "required" : true }, { "linkId" : "first-psa-date", "text" : "First PSA date", "type" : "date", "required" : true }] }, { "linkId" : "grp-prior-imaging", "text" : "Prior prostate mpMRI", "type" : "group", "item" : [{ "linkId" : "prior-mpmri", "text" : "Prior mpMRI documented", "type" : "boolean" }, { "linkId" : "prior-mpmri-date", "text" : "Prior mpMRI date", "type" : "date" }, { "linkId" : "prior-mpmri-pirads", "text" : "Prior mpMRI PI-RADS category", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "pirads-cat-1-2", "display" : "PI-RADS 1-2" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "pirads-cat-3", "display" : "PI-RADS 3" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "pirads-cat-4", "display" : "PI-RADS 4" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/prostate-questionnaire-options", "code" : "pirads-cat-5", "display" : "PI-RADS 5" } }] }] }, { "linkId" : "grp-prior-therapy", "text" : "Prior prostate-directed therapy", "type" : "group", "item" : [{ "linkId" : "prior-prostatectomy", "text" : "Prior prostate surgery", "type" : "boolean" }, { "linkId" : "prior-prostatectomy-date", "text" : "Prostate surgery date", "type" : "date" }, { "linkId" : "prior-prostate-radiation", "text" : "Prior prostate radiotherapy", "type" : "boolean" }, { "linkId" : "prior-prostate-radiation-date", "text" : "Prostate radiotherapy date", "type" : "date" }] }, { "linkId" : "grp-related", "text" : "Related information", "type" : "group", "item" : [{ "linkId" : "anticoagulant-use", "text" : "Anticoagulant use", "type" : "boolean" }] }, { "linkId" : "grp-additional", "text" : "Additional information", "type" : "group", "item" : [{ "linkId" : "specialist-additional-info", "text" : "Additional description for specialist", "type" : "text" }] }] }