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{
  "resourceType": "Questionnaire",
  "id": "b2e24662-0ee1-4c95-9088-7be895d97c99",
  "meta": {
    "profile": [
      "http://health.gov.on.ca/sadie/fhir/StructureDefinition/FlexForm"
    ]
  },
  "text": {
    "status": "empty",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">No human-readable text provided in this case.</div>"
  },
  "url": "http://health.gov.on.ca/sadie/fhir/FlexForm/ODSP-ADDITIONAL",
  "identifier": [
    {
      "use": "official",
      "system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
      "value": "ODSP-ADDITIONAL"
    }
  ],
  "version": "1.0.0",
  "name": "ODSP_Additional_Medical_Information",
  "title": "Additional Medical Information",
  "status": "active",
  "experimental": false,
  "subjectType": [
    "Patient"
  ],
  "publisher": "ODSP",
  "effectivePeriod": {
    "start": "2021-01-01T05:00:00Z"
  },
  "code": [
    {
      "system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
      "code": "DocumentType",
      "display": "DDP"
    },
    {
      "system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal-Complete",
      "code": "DocumentSubType",
      "display": "ADDITIONAL"
    }
  ],
  "item": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://hl7.org/fhir/questionnaire-item-control",
                "code": "header",
                "display": "Header"
              }
            ],
            "text": "Header"
          }
        }
      ],
      "linkId": "0",
      "text": "Additional Medical Information",
      "type": "group",
      "required": false,
      "repeats": false,
      "readOnly": false,
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory",
              "valueCode": "display-in-progress"
            }
          ],
          "linkId": "attachment_error_guide_additional",
          "text": "If you encounter an upload error or failure, please try again or fax the attachment to the Disability Adjudication Unit at 416-326-3374. The fax must include the client's first and last name, Member ID and Referral ID on the document or fax cover page.",
          "type": "display",
          "required": false,
          "repeats": false,
          "readOnly": false
        },
        {
          "linkId": "0.1",
          "text": "Additional Medical Information",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "0.0.1",
              "text": "Do you have a \"Consent to the Release of Medical and Related Information\" form to attach?",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/msword"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/rtf"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "image/tiff"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/pdf"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "image/gif"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/maxSize",
                  "valueDecimal": 10
                }
              ],
              "linkId": "0.0.1-attachment",
              "text": "Attachments",
              "type": "attachment",
              "enableWhen": [
                {
                  "question": "0.0.1",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": true,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.0.1-DocumentType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "DDP"
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.0.1-DocumentSubType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "Consent"
                    }
                  ]
                }
              ]
            },
            {
              "linkId": "0.1.1",
              "text": "Do you have any medical information you wish to attach?",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/vnd.openxmlformats-officedocument.wordprocessingml.document"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/msword"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/rtf"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "image/tiff"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "application/pdf"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/mimeType",
                  "valueCode": "image/gif"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/maxSize",
                  "valueDecimal": 10
                }
              ],
              "linkId": "0.1.1-attachment",
              "text": "Attachments",
              "type": "attachment",
              "enableWhen": [
                {
                  "question": "0.1.1",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": true,
              "repeats": true,
              "readOnly": false,
              "item": [
                {
                  "linkId": "0.1.1-categories",
                  "text": "Attachment Categories",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-AttachmentCategories"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.1.1-DocumentType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "AMI"
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.1.1-DocumentSubType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "Regular or IR AMI"
                    }
                  ]
                }
              ]
            },
            {
              "linkId": "0.1.2",
              "text": "Notes",
              "type": "text",
              "required": false,
              "repeats": false,
              "readOnly": false,
              "maxLength": 2000,
              "enableBehavior": "any",
              "enableWhen": [
                {
                  "question": "0.0.1",
                  "operator": "=",
                  "answerBoolean": true
                },
                {
                  "question": "0.1.1",
                  "operator": "=",
                  "answerBoolean": true
                }
              ]
            },
            {
              "linkId": "0.1.3",
              "text": "Notes",
              "type": "text",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 2000,
              "enableBehavior": "all",
              "enableWhen": [
                {
                  "question": "0.0.1",
                  "operator": "=",
                  "answerBoolean": false
                },
                {
                  "question": "0.1.1",
                  "operator": "=",
                  "answerBoolean": false
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}

name : ODSP_Additional_Medical_Information

{

}