- Digital Referral Prescription Implementation Guide v1.1.0

Digital Referral Prescription Implementation Guide, published by eHealth Platform. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/referral/ and changes regularly. See the Directory of published versions
Questionnaire: BeQuestionnaireImagingAttentionConditions - XML Profile

XML representation of the be-questionnaire-imaging-attention-conditions questionnaire.
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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="be-questionnaire-imaging-attention-conditions"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire be-questionnaire-imaging-attention-conditions</b></p><a name="be-questionnaire-imaging-attention-conditions"> </a><a name="hcbe-questionnaire-imaging-attention-conditions"> </a><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="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"/> BeQuestionnaireImagingAttentionConditions</td><td 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 for capturing attention-worthy conditions relevant to diagnostic imaging requests (implants, pregnancy, diabetes, allergies, etc.)</td><td 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">https://www.ehealth.fgov.be/standards/fhir/drp/Questionnaire/be-questionnaire-imaging-attention-conditions#1.1.0</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.implants" 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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> implants</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Implants</td><td 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">Value Set: <a href="ValueSet-be-vs-implant-type.html">eReferral Implant Type</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_bck100.png)" id="item.implants-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_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"/> implants-other</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Other implant type</td><td 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..*</td><td style="vertical-align: top; text-align : var(--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">Enable When: <span><a href="#item.implants">implants</a> = Implant (SNOMED CT#40388003)</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_bck10.png)" id="item.pregnancy" 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-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> pregnancy</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Pregnancy</td><td 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-boolean">boolean</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"/></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.diabetes" 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-boolean.png" alt="." style="background-color: white; background-color: inherit" title="boolean" class="hierarchy"/> diabetes</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Diabetes</td><td 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-boolean">boolean</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"/></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.allergy-contrast-agent" 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-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> allergy-contrast-agent</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Allergy to contrast agent</td><td 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-boolean">boolean</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"/></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.metallic-debris" 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-boolean.png" alt="." style="background-color: white; background-color: inherit" title="boolean" class="hierarchy"/> metallic-debris</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Metallic debris</td><td 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-boolean">boolean</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"/></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.renal-dysfunction" 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-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> renal-dysfunction</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Renal dysfunction</td><td 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-boolean">boolean</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"/></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.other" 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-text.png" alt="." style="background-color: white; background-color: inherit" title="text" class="hierarchy"/> other</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; 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: 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"/></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_bck00.png)" id="item.none" 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-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="boolean" class="hierarchy"/> none</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">None</td><td 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-boolean">boolean</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"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/questionnaire-constraint">
    <extension url="key">
      <valueId value="attn-1"/>
    </extension>
    <extension url="severity">
      <valueCode value="error"/>
    </extension>
    <extension url="human">
      <valueString value="At least one attention condition must be answered"/>
    </extension>
    <extension url="expression">
      <valueString value="item.where(answer.exists()).exists()"/>
    </extension>
  </extension>
  <url
       value="https://www.ehealth.fgov.be/standards/fhir/drp/Questionnaire/be-questionnaire-imaging-attention-conditions"/>
  <version value="1.1.0"/>
  <name value="BeQuestionnaireImagingAttentionConditions"/>
  <title value="Imaging Attention Conditions Questionnaire"/>
  <status value="active"/>
  <date value="2026-08-24T13:29:24+00:00"/>
  <publisher value="eHealth Platform"/>
  <contact>
    <name value="eHealth Platform"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.ehealth.fgov.be/standards/fhir"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="support@be-ehealth-standards.atlassian.net"/>
    </telecom>
  </contact>
  <contact>
    <name value="Message Structure eHealth"/>
    <telecom>
      <system value="email"/>
      <value value="support@be-ehealth-standards.atlassian.net"/>
      <use value="work"/>
    </telecom>
  </contact>
  <description
               value="Questionnaire for capturing attention-worthy conditions relevant to diagnostic imaging requests (implants, pregnancy, diabetes, allergies, etc.)"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="BE"/>
      <display value="Belgium"/>
    </coding>
  </jurisdiction>
  <item>
    <linkId value="implants"/>
    <text value="Implants">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Implants"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Implantaten"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Implantate"/>
        </extension>
      </extension>
    </text>
    <type value="choice"/>
    <required value="false"/>
    <repeats value="true"/>
    <answerValueSet
                    value="https://www.ehealth.fgov.be/standards/fhir/drp/ValueSet/be-vs-implant-type"/>
    <item>
      <linkId value="implants-other"/>
      <text value="Other implant type">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="fr-BE"/>
          </extension>
          <extension url="content">
            <valueString value="Autre type d'implant"/>
          </extension>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="nl-BE"/>
          </extension>
          <extension url="content">
            <valueString value="Ander type implantaat"/>
          </extension>
        </extension>
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
          <extension url="lang">
            <valueCode value="de"/>
          </extension>
          <extension url="content">
            <valueString value="Sonstiger Implantattyp"/>
          </extension>
        </extension>
      </text>
      <type value="text"/>
      <enableWhen>
        <question value="implants"/>
        <operator value="="/>
        <answerCoding>
          <system value="http://snomed.info/sct"/>
          <code value="40388003"/>
        </answerCoding>
      </enableWhen>
      <required value="true"/>
      <repeats value="true"/>
    </item>
  </item>
  <item>
    <linkId value="pregnancy"/>
    <text value="Pregnancy">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Grossesse"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Zwangerschap"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Schwangerschaft"/>
        </extension>
      </extension>
    </text>
    <type value="boolean"/>
    <required value="false"/>
  </item>
  <item>
    <linkId value="diabetes"/>
    <text value="Diabetes">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Diabète"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Diabetes"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Diabetes"/>
        </extension>
      </extension>
    </text>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="allergy-contrast-agent"/>
    <text value="Allergy to contrast agent">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Allergie à l'agent de contraste"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Allergie voor contrastmiddel"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Allergie gegen Kontrastmittel"/>
        </extension>
      </extension>
    </text>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="metallic-debris"/>
    <text value="Metallic debris">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Débris métalliques"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Metaalfragment"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Metallischer Fremdkörper"/>
        </extension>
      </extension>
    </text>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="renal-dysfunction"/>
    <text value="Renal dysfunction">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Insuffisance rénale"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Nierinsufficiëntie"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Niereninsuffizienz"/>
        </extension>
      </extension>
    </text>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="other"/>
    <text value="Other">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Autre"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Andere"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Sonstiges"/>
        </extension>
      </extension>
    </text>
    <type value="text"/>
    <required value="false"/>
  </item>
  <item>
    <linkId value="none"/>
    <text value="None">
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="fr-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Aucun"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="nl-BE"/>
        </extension>
        <extension url="content">
          <valueString value="Geen"/>
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/translation">
        <extension url="lang">
          <valueCode value="de"/>
        </extension>
        <extension url="content">
          <valueString value="Kein"/>
        </extension>
      </extension>
    </text>
    <type value="boolean"/>
    <required value="true"/>
  </item>
</Questionnaire>