Generated Narrative: Composition
Resource Composition (Language "de-CH")
CH ORF Urgent Notification Contact For This Documet: See above (urn:uuid:c25edd30-4206-440d-aeaa-4e27ffbb21b4)
CH ORF Urgent Notification Contact For The Response To This Document: See above (urn:uuid:2e5e9263-ef5f-41d0-bf46-74797451b149)
CH ORF Receiver: See above (urn:uuid:018977be-801c-46e6-81a8-daed933558fe)
status: final
type: Record artefact (SNOMED CT#419891008)
category: Order document (SNOMED CT#721963009)
date: 2023-06-13 11:51:44+0000
author: See above (urn:uuid:aa73b56c-7bf7-4465-8388-be59f5c35b91)
title: Order and Referral by Form
Generated Narrative: Patient
Resource Patient (Language "de-CH")
identifier: Medical record number/44.34.9472.1
name: Susanna Ufferer , Leidend (MAIDEN)
telecom: ph: 079 979 79 79, susanna@ufferer.ch
gender: female
birthDate: 1970-03-14
address: Musterweg 6a Zürich 8000 Schweiz
Generated Narrative: QuestionnaireResponse
Resource QuestionnaireResponse (Language "de-CH")
Profile: CH ORF QuestionnaireResponse
questionnaire: Order Referral Form
status: completed
item
linkId: order
text: Auftrag
item
linkId: order.placerOrderIdentifier
text: Auftragsnummer des Auftraggebers
answer
item
linkId: order.placerOrderIdentifierDomain
text: Identifier Domain der Auftragsnummer des Auftraggebers
answer
item
linkId: order.notificationContactDocument
text: Dringender Benachrichtigungskontakt für dieses Dokument
item
item
linkId: order.notificationContactDocumentResponse
text: Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument
item
item
linkId: order.priority
text: Auftragspriorität
answer
item
linkId: receiver
text: Empfänger
item
linkId: receiver.practitioner
text: Empfangende Person
item
item
item
item
item
item
item
linkId: receiver.organization
text: Empfangende Organisation
item
item
item
item
item
item
linkId: patient
text: Patient
item
linkId: patient.familyName
text: Name
answer
item
linkId: patient.maidenName
text: Ledigname
answer
item
linkId: patient.givenName
text: Vorname
answer
item
linkId: patient.localPid
text: Lokale Patienten-ID
answer
item
linkId: patient.localPidDomain
text: Lokale Patienten-ID Domain
answer
item
linkId: patient.birthDate
text: Geburtsdatum
answer
item
linkId: patient.gender
text: Geschlecht
answer
item
linkId: patient.phone
text: Telefon
answer
item
linkId: patient.email
text: E-Mail
answer
item
linkId: patient.streetAddressLine
text: Strasse, Hausnummer, Postfach etc.
answer
answer
item
linkId: patient.postalCode
text: PLZ
answer
item
linkId: patient.city
text: Ort
answer
item
linkId: patient.country
text: Land
answer
item
linkId: sender
text: Absender
item
linkId: sender.author
text: Verantwortlicher
item
item
Generated Narrative: ServiceRequest
Resource ServiceRequest (Language "de-CH")
identifier: Placer Identifier/60823
status: active
intent: order
priority: stat
subject: See above (urn:uuid:3a12ef44-6acd-4736-924c-cd60b311da50)
requester: See above (urn:uuid:aa73b56c-7bf7-4465-8388-be59f5c35b91)
Generated Narrative: Questionnaire
Resource Questionnaire "order-referral-form" Version "42" Updated "2023-06-12 21:11:39+0000" (Language "de-CH")
Information Source: #dQEVCLkxu8TKSXYI!
Profiles: CH ORF Questionnaire, SDCBaseQuestionnaire, Extractable Questionnaire - StructureMap, Populatable Questionnaire - Expression
Target structure map: OrfQrToBundle
Launch context resources
url
name
value: Patient (Details: http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext code patient = 'Patient', stated as 'null')
url
type
value: Patient
Launch context resources
url
name
value: User (Details: http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext code user = 'User', stated as 'User')
url
type
value: Practitioner
url
description
value: The practitioner that is to be used to pre-populate the form
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-order|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-practitioner-nametel|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-receiver|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-address|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-initiator|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-patient|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-familydoctor|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-requestedencounter|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-coverage|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-sender|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-receivercopy|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-appointment|1.1.0
Assembled From Questionnaire: http://fhir.ch/ig/ch-orf/Questionnaire/ch-orf-module-consent|1.1.0
url: http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form
version: 1.1.0-assembled
name: OrderReferralForm
title: Order Referral Form
status: active
subjectType: Patient
date: 2022-07-07
publisher: HL7 Switzerland
contact: HL7 Switzerland: https://www.hl7.ch/
jurisdiction: Switzerland (ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code#CH)
copyright: CC-BY-SA-4.0
item
linkId: order
text: Auftrag
type: group
required: true
item
linkId: order.authoredOn
text: Daum/Zeit der Auftragserteilung
type: dateTime
item
linkId: order.placerOrderIdentifier
text: Auftragsnummer des Auftraggebers
type: string
item
hidden: true
linkId: order.placerOrderIdentifierDomain
text: Identifier Domain der Auftragsnummer des Auftraggebers
type: string
item
linkId: order.fillerOrderIdentifier
text: Auftragsnummer des Auftragsempfängers
type: string
item
hidden: true
linkId: order.fillerOrderIdentifierDomain
text: Identifier Domain der Auftragsnummer des Auftragsempfängers
type: string
item
hidden: true
linkId: order.precedentDocumentIdentifier
text: Identifier des Vorgängerdokuments
type: string
item
linkId: order.notificationContactDocument
text: Dringender Benachrichtigungskontakt für dieses Dokument
type: group
item
item
linkId: order.notificationContactDocumentResponse
text: Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument
type: group
item
item
linkId: order.priority
text: Auftragspriorität
type: choice
answerOption
answerOption
answerOption
answerOption
item
linkId: receiver
text: Empfänger
type: group
item
linkId: receiver.practitioner
text: Empfangende Person
type: group
item
item
item
item
item
item
item
item
Variable:
'receiver.organization.'
(linkIdPrefix)linkId: receiver.organization
text: Empfangende Organisation
type: group
item
item
item
item
item
item
item
linkId: initiator
text: Initiant dieser Anmeldung
type: group
item
linkId: initiator.legalrelation
text: Juristische Beziehung zum Patienten
type: choice
answerOption
answerOption
item
linkId: initiator.personalrelation
text: Persönliche Beziehung zum Patienten?
type: choice
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
item
linkId: initiator.practitionerRole
text: Gesundheitsfachperson oder -organisation
type: group
item
item
item
linkId: initiator.relatedPerson
text: Andere Person
type: group
item
item
item
item
item
item
item
item
item
Variable:
'patient.'
(linkIdPrefix)Variable:
%patient.address
(address)linkId: patient
text: Patient
type: group
required: true
item
initial.exists().not():
%patient.name.where(use='official').family
linkId: patient.familyName
text: Name
type: string
item
initial.exists().not():
%patient.name.where(use='maiden').family
linkId: patient.maidenName
text: Ledigname
type: string
item
initial.exists().not():
%patient.name.where(use='official').given
linkId: patient.givenName
text: Vorname
type: string
item
initial.exists().not():
%patient.identifier.where(type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MR').exists()).value
linkId: patient.localPid
text: Lokale Patienten-ID
type: string
item
hidden: true
linkId: patient.localPidDomain
text: Lokale Patienten-ID Domain
type: string
item
initial.exists().not():
%patient.birthDate
linkId: patient.birthDate
text: Geburtsdatum
type: date
item
initial.exists().not():
%questionnaire.repeat(item).where(linkId='patient.gender').answerOption.valueCoding.where(code=%patient.gender)
linkId: patient.gender
text: Geschlecht
type: choice
answerOption
answerOption
answerOption
item
initial.exists().not():
%patient.maritalStatus
linkId: patient.maritalStatus
text: Zivilstand
type: choice
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
answerOption
item
initial.exists().not():
%patient.telecom.where(system='phone').value
linkId: patient.phone
text: Telefon
type: string
repeats: true
item
initial.exists().not():
%patient.telecom.where(system='email').value
linkId: patient.email
text: E-Mail
type: string
item
initial.exists().not():
%address.line
linkId: patient.streetAddressLine
text: Strasse, Hausnummer, Postfach etc.
type: string
repeats: true
item
initial.exists().not():
%address.postalCode
linkId: patient.postalCode
text: PLZ
type: string
item
initial.exists().not():
%address.city
linkId: patient.city
text: Ort
type: string
item
initial.exists().not():
%address.country
linkId: patient.country
text: Land
type: string
item
initial.exists().not():
%patient.communication.where(preferred=true).language.coding
linkId: patient.languageOfCorrespondence
text: Korrespondenzsprache
type: choice
answerValueSet: DocumentEntry.languageCode
item
Variable:
%patient.contact
(contact)linkId: patient.contactperson
text: Kontaktperson
type: group
repeats: true
item
item
item
item
item
item
linkId: familydoctor
text: Hausarzt
type: group
item
item
item
linkId: requestedEncounter
text: Patientenaufnahme
type: group
item
linkId: requestedEncounter.class
text: Voraussichtlich: Ambulant / Stationär / Notfall
type: choice
answerOption
answerOption
answerOption
item
linkId: requestedEncounter.desiredAccommodation
text: Zimmerkategorie
type: choice
answerOption
answerOption
answerOption
item
linkId: coverage
text: Kostenträger
type: group
item
linkId: coverage.beneficiary
text: Begünstigter (Patient)
type: group
item
item
linkId: coverage.kvg
text: Krankenkasse (nach KVG)
type: group
item
item
item
linkId: coverage.uvg
text: Unfallversicherung (nach UVG)
type: group
item
item
item
linkId: coverage.vvg
text: Zusatzversicherung (nach VVG)
type: group
item
item
item
linkId: coverage.iv
text: Invalidenversicherung (IV)
type: group
item
item
linkId: coverage.mv
text: Militärversicherung (MV)
type: group
item
item
linkId: coverage.self
text: Selbstzahler
type: group
item
item
item
item
linkId: coverage.other
text: Anderer Kostenträger
type: group
item
item
item
item
linkId: sender
text: Absender
type: group
required: true
item
Variable:
PractitionerRole?practitioner={{%user.id}}
(senderPractitionerRoles)Variable:
%senderPractitionerRoles.entry[0].resource
(senderPractitionerRole)Variable:
Organization?_id={{%senderPractitionerRole.organization.reference}}
(senderOrganizations)Variable:
%senderOrganizations.entry[0].resource
(senderOrganization)Variable:
%senderOrganization.address
(address)linkId: sender.author
text: Verantwortlicher
type: group
required: true
item
item
item
linkId: sender.dataenterer
text: Erfasser
type: group
item
item
linkId: receiverCopy
text: Kopieempfänger (Kopie dieses Auftrags und aller daraus resultierenden Resultate)
type: group
item
linkId: receiverCopy.practitionerRole
text: Gesundheitsfachperson oder -organisation
type: group
repeats: true
item
item
item
linkId: receiverCopy.patient
text: Patient selbst
type: boolean
item
linkId: receiverCopy.relatedPerson
text: Andere Person
type: group
repeats: true
item
item
item
item
item
item
item
item
item
linkId: antecedentEpisodeOfCare
text: Vorgängiger Aufenthalt in Spital / Heim
type: group
item
linkId: antecedentEpisodeOfCare.start
text: Von
type: dateTime
item
linkId: antecedentEpisodeOfCare.end
text: Bis
type: dateTime
item
Variable:
'antecedentEpisodeOfCare.managingOrganization.'
(linkIdPrefix)linkId: antecedentEpisodeOfCare.managingOrganization
text: Spital /Heim
type: group
item
item
item
item
item
item
linkId: appointment
text: Ort und Zeit der Durchführung der angeforderten Leistung
type: group
repeats: true
item
Variable:
'appointment.location.'
(linkIdPrefix)linkId: appointment.location
text: Ort der Durchführung
type: group
item
item
item
item
item
item
item
item
linkId: appointment.requestedPeriod
text: Datum und Zeit, wann der Termin bevorzugt geplant werden soll
type: group
item
item
item
linkId: appointment.status
text: Status
type: choice
required: true
answerOption
answerOption
answerOption
item
linkId: appointment.patientInstruction
text: Patienteninformation für diesen Termin
type: string
item
linkId: consent
text: Einverständniserklärung
type: group
item
linkId: patient.consent.statement
text: Ist der Patient über die Anmeldung informiert und explizit einverstanden?
type: choice
answerOption
answerOption
item
item
linkId: note
text: Bemerkungen
type: group
repeats: true
Items
- LinkId Text Type * note.text Kommentar string
Generated Narrative: PractitionerRole
Resource PractitionerRole (Language "de-CH")
practitioner: See above (urn:uuid:12a25f9f-1df1-46f5-9bea-524291d3bee1)
Generated Narrative: Practitioner
Resource Practitioner (Language "de-CH")
name: Frederica Iller
telecom: ph: 044 503 44 44, f.iller@univerityhospital.ch
Generated Narrative: PractitionerRole
Resource PractitionerRole (Language "de-CH")
practitioner: See above (urn:uuid:1ff4c57a-6454-4c7e-af57-7062bec59b70)
Generated Narrative: Practitioner
Resource Practitioner (Language "de-CH")
name: Paul Lacer
telecom: ph: 044 987 65 43, p.lacer@regionalhospital.ch
Generated Narrative: PractitionerRole
Resource PractitionerRole (Language "de-CH")
practitioner: See above (urn:uuid:6a864e84-6707-4b73-96ae-4b94a8964ae3)
organization: See above (urn:uuid:2a9a5035-4423-44a3-a4df-8d64cceac6ec)
Generated Narrative: Practitioner
Resource Practitioner (Language "de-CH")
identifier: GLN/7601000618306
name: Frederica Iller
telecom: ph: 044 503 44 44, f.iller@universityhospital.ch
Generated Narrative: Organization
Resource Organization (Language "de-CH")
name: University Hospital
address: Uniweg 33 Radiology Zürich 8000 Schweiz
Generated Narrative: PractitionerRole
Resource PractitionerRole (Language "de-CH")
practitioner: See above (urn:uuid:4af9ebaf-cd14-446f-9af3-b27b2352f894)
organization: See above (urn:uuid:ae7cfef9-c8ee-474d-9bc0-6ee2e0f53b9a)
Generated Narrative: Practitioner
Resource Practitioner (Language "de-CH")
identifier: GLN/7601000050717
name: Paul Lacer
telecom: ph: 044 987 65 43, p.lacer@regionalhospital.ch