CanShare Forms Implementation Guide, published by CanShare. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/davidhay25/canshareFormsIG/ and changes regularly. See the Directory of published versions
Questionnaire: Breast Request () Questionnaire
| Official URL: http://canshare.co.nz/questionnaire/Breastrequestsandreports-BreastRequest | Version: 0.1.0 | |||
| Draft as of 2026-05-02 | Computable Name: Breastrequestsandreports-BreastRequest | |||
The main request form
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  Breastrequestsandreports-BreastRequest | The main request form | Questionnaire | http://canshare.co.nz/questionnaire/Breastrequestsandreports-BreastRequest#0.1.0 | ||
  66aAjg | BreastRequest | 0..1 | group | Value Set: | |
  tV0v8Q | Patient | 0..1 | group | Value Set: | |
  qaOktA | NHI | 0..1 | string | Definition: Patient.identifier.value Value Set: | |
  yCCn1Q | help text for NHI | 0..1 | display | Value Set: | |
 Ah66bA | Given name | 0..* | string | Value Set: | |
| HgydRQ | Family name | 0..1 | string | Value Set: | |
 Eko8vA | Date of Birth | 0..1 | date | Definition: Patient.birthDate Value Set: | |
 t39aiw | Ethnicity | 0..1 | open-choice | Definition: Patient.extension.value Enable When: sLExmA = Female (AdministrativeGender#female) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/ethnic-group-level-4-code | |
| sLExmA | Gender | 0..1 | choice |  | Definition: Patient.gender Value Set: AdministrativeGender |
| 9gYExQ | Administration | 0..1 | group | Value Set: | |
 acEEWg | Date | 0..1 | dateTime | Value Set: | |
| LpmleA | Clinical Information | 0..1 | group | Value Set: | |
| afqj9Q | Pathway | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-referral-pathway-simple | |
| 1Sb4CQ | The method or programme that led to this service request, e.g. screening, diagnostic. | 0..1 | display | Value Set: | |
| eOT4Hw | Clinical Impression (Screening) | 0..1 | choice | Enable When: afqj9Q = National screening programme (SNOMED CT#381081000210101) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-tumour-origin | |
| P23GAQ | 1321324 | 0..1 | display | Value Set: | |
| HZj_FA | Clinical Impression (Diagnostic) | 0..1 | choice | Enable When: afqj9Q = Diagnostic assessment (SNOMED CT#165197003) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-tumour-origin | |
| Y-eZsA | Clinical Presentation | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-clinical-presentation | |
| KQV-sQ | Clinical Behaviour | 0..1 | group | Value Set: | |
| u-TOCw | Clinical behaviour | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-clinical-impression-behaviour | |
| 2KwHtg | Clinical category | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-clinical-behaviour-category | |
| q9r65Q | Previous Medical condition | 0..* | group | Value Set: | |
| n6j-yA | Condition | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-previous-condition | |
| sPFwog | Comments | 0..1 | string | Value Set: | |
| eZ40Tg | Menopausal status | 0..1 | choice | | Definition: Observation.valueCodeableConcept.coding Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-menopause-status |
| WTJCLw | Neoadjuvant summary | 0..* | group | Value Set: | |
| Ku_rMA | Adjuvant therapy type | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-neoadjuvant-therapy-type | |
| gQ-Y5A | Adjuvant therapy status | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-neoadjuvant-therapy-status |
| y_T8Hg | Neoadjuvent summary (2) | 0..1 | group | Value Set: | |
| xkxV6A | Neoadjuvant chemotherapy | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-neoadjuvant-therapy-status |
| 3yCfIA | Neoadjuvant hormone therapy | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-neoadjuvant-therapy-status |
| O4rysA | Neoadjuvant radiotherapy | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-neoadjuvant-therapy-status |
| VI-F4w | Other neoadjuvant therapy | 0..1 | string | Value Set: | |
| UFsaIA | Radiology | 0..* | group | Value Set: | |
| lnvhoA | Radiology type | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-radiology-type | |
| 8DOCXg | Radiologic category | 0..1 | choice | Enable When: lnvhoA = Other (SNOMED CT#74964007) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-radiological-behaviour-category | |
| elj6Pg | Radiologic Finding | 0..* | choice | Enable When: lnvhoA = Other (SNOMED CT#74964007) Value Set: | |
| _TA1qg | Mammogram Category | 0..1 | choice | Enable When: lnvhoA = Mammogram (SNOMED CT#71651007) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-mammogram-behaviour-category | |
| ItIxXA | Mammogram Finding | 0..1 | choice | Enable When: lnvhoA = Mammogram (SNOMED CT#71651007) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-mammogram-finding | |
| px_AOg | Ultrasound Category | 0..1 | choice | Enable When: lnvhoA = Ultrasound (SNOMED CT#16310003) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-ultrasound-behaviour-category | |
| sUvIZw | Ultrasound Finding | 0..1 | choice | Enable When: lnvhoA = Ultrasound (SNOMED CT#16310003) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-ultrasound-finding | |
 GwBa_g | Comments | 0..1 | text | Value Set: | |
| F4w9Qg | Tumours | 0..1 | group | Value Set: | |
 UqCacw | Count | 0..1 | integer | Value Set: | |
| heaiUg | Details | 0..* | group | Value Set: | |
| 3HHGaQ | Laterality | 0..1 | choice | | Definition: BodyStructure.locationQualifier.coding Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-laterality |
| MbjvjA | Structure | 0..1 | choice | Definition: BodyStructure.location.coding Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-topography | |
| YSLK3g | Clockface | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-clockface-position | |
 qOZSOg | Dispance from nipple (cm) | 0..1 | decimal | Value Set: | |
| CKHWag | Maximum dimension (cm) | 0..1 | decimal | Value Set: | |
| x2IbZQ | Length (cm) | 0..1 | decimal | Value Set: | |
| HFuV8w | Width (cm) | 0..1 | decimal | Value Set: | |
| CDwftQ | Depth (cm) | 0..1 | decimal | Value Set: | |
| jAFQFA | Specimens | 0..1 | group | Value Set: | |
| Bk07Cw | Count | 0..1 | integer | Value Set: | |
| vWnoqA | Details | 0..* | group | Value Set: | |
| kDEz3w | Category | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-specimen-category-biopsy-cytology |
| Pfx26w | Type | 0..1 | choice | Definition: Specimen.type.coding Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-small-diagnostic-specimen-type | |
| RqvyIA | Laterality | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-laterality |
| JletPA | Structure | 0..1 | choice | Definition: Specimen.collection.bodySite.coding Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-topography | |
| K-znEA | ProcedureType | 0..1 | choice | Definition: Specimen.collection.method.coding Enable When: Pfx26w = Specimen obtained by core needle biopsy (SNOMED CT#427558003) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-specimen-core-biopsy-procedure-type | |
| HxskzQ | ImageGuidance | 0..1 | choice | Definition: Specimen.collection.extension.value Enable When: Pfx26w = Specimen obtained by core needle biopsy (SNOMED CT#427558003) Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-procedure-image-guided-method | |
| GQ2SPA | Lymph nodes | 0..1 | group | Value Set: | |
| fj5O1Q | Number taken | 0..1 | integer | Value Set: | |
| wz0ezA | Number abnormal | 0..1 | integer | Value Set: | |
| x4KYCA | Comments | 0..1 | string | Value Set: | |
| aAQhMQ | Node Details | 0..* | group | Value Set: | |
| DWzM_A | Type | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-lymph-node-specimen-type-biopsy-excision |
| r82SQw | Laterality | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-laterality |
| ZKlnww | Structure | 0..1 | choice | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-lymphnode-breast | |
| YQV4mw | Procedure | 0..1 | choice | | Value Set: https://nzhts.digital.health.nz/fhir/ValueSet/canshare-breast-lymph-node-specimen-procedure-type |
| Documentation for this format | |||||