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{
  "resourceType": "Questionnaire",
  "url": "https://fhir.nottinghamshire.gov.uk/STU3/Questionnaire/RSC-Questionnaire-InitialSafeguardingContact",
  "version": "0.0.1",
  "name": "Questionnaire-InitialSafegaurdingContact",
  "title": "Questionnaire-InitialSafegaurdingContact",
  "status": "draft",
  "date": "2021-07-22T14:00:00+00:00",
  "publisher": "NottsCC",
  "description": "Initial Safegaurding Contact is used by Emergency Service and Health and Care Agencies to refer safegaurding concerns to the Loacal Authority",
  "purpose": "Initial Safegaurding Contact is used by Emergency Service and Health and Care Agencies to refer safegaurding concerns to the Loacal Authority",
  "item": [
    {
      "linkId": "1",
      "text": "General",
      "type": "group",
      "item": [
        {
          "linkId": "1.1",
          "text": "Referral Type",
          "type": "text"
        },
        {
          "linkId": "1.2",
          "text": "Referring Organisation",
          "type": "text"
        },
        {
          "linkId": "1.3",
          "text": "Contact Name",
          "type": "text"
        },
        {
          "linkId": "1.4",
          "text": "Contact Email",
          "type": "text"
        },
        {
          "linkId": "1.5",
          "text": "Contact Phone",
          "type": "text"
        },
        {
          "linkId": "1.6",
          "text": "Date/Time of Referral",
          "type": "dateTime"
        },
        {
          "linkId": "1.7",
          "text": "Rationale for Referral",
          "type": "text"
        },
        {
          "linkId": "1.8",
          "text": "Incident Number / ID",
          "type": "text"
        },
        {
          "linkId": "1.9",
          "text": "Incident Description",
          "type": "text"
        },
        {
          "linkId": "1.10",
          "text": "Date / Time of Incident",
          "type": "dateTime"
        },
        {
          "linkId": "1.11",
          "text": "Location of Incident",
          "type": "text"
        },
        {
          "linkId": "1.12",
          "text": "Attending Persons",
          "type": "text"
        },
        {
          "linkId": "1.13",
          "text": "Other Involved Agencies",
          "type": "text",
          "repeats": true
        }
      ]
    },
    {
      "linkId": "2",
      "text": "People Involved",
      "type": "group",
      "repeats": true,
      "item": [
        {
          "linkId": "2.1",
          "text": "Name",
          "type": "text"
        },
        {
          "linkId": "2.2",
          "text": "NHS Number",
          "type": "text"
        },
        {
          "linkId": "2.3",
          "text": "Date of Birth",
          "type": "dateTime"
        },
        {
          "linkId": "2.4",
          "text": "Age at time of event",
          "type": "text"
        },
        {
          "linkId": "2.5",
          "text": "Category",
          "type": "text"
        },
        {
          "linkId": "2.6",
          "text": "Relationship to victim/subject",
          "type": "text"
        },
        {
          "linkId": "2.7",
          "text": "Relation to other",
          "type": "text"
        },
        {
          "linkId": "2.8",
          "text": "Involvement",
          "type": "text"
        },
        {
          "linkId": "2.9",
          "text": "Employment",
          "type": "text"
        },
        {
          "linkId": "2.10",
          "text": "Address",
          "type": "text"
        },
        {
          "linkId": "2.11",
          "text": "Postcode",
          "type": "text"
        },
        {
          "linkId": "2.12",
          "text": "Home Phone",
          "type": "text"
        },
        {
          "linkId": "2.13",
          "text": "Mobile Phone",
          "type": "text"
        },
        {
          "linkId": "2.14",
          "text": "Email",
          "type": "text"
        },
        {
          "linkId": "2.15",
          "text": "SAFE Telephone Numbers (if recorded)",
          "type": "text"
        },
        {
          "linkId": "2.16",
          "text": "Other contact details",
          "type": "text"
        },
        {
          "linkId": "2.17",
          "text": "Preferred means of contact",
          "type": "text"
        },
        {
          "linkId": "2.18",
          "text": "Ethnicity",
          "type": "text"
        },
        {
          "linkId": "2.19",
          "text": "Gender",
          "type": "text"
        },
        {
          "linkId": "2.20",
          "text": "Relevant aggravating factors",
          "type": "text"
        },
        {
          "linkId": "2.21",
          "text": "GP name",
          "type": "text"
        },
        {
          "linkId": "2.22",
          "text": "GP ODS code",
          "type": "text"
        },
        {
          "linkId": "2.23",
          "text": "GP surgery",
          "type": "text"
        },
        {
          "linkId": "2.24",
          "text": "GP address",
          "type": "text"
        },
        {
          "linkId": "2.25",
          "text": "GP telephone",
          "type": "text"
        },
        {
          "linkId": "2.26",
          "text": "School",
          "type": "text"
        },
        {
          "linkId": "2.27",
          "text": "Present at time of the incident?",
          "type": "text"
        },
        {
          "linkId": "2.28",
          "text": "Welfare check of children made?",
          "type": "text"
        },
        {
          "linkId": "2.29",
          "text": "Any communication barriers?",
          "type": "text"
        },
        {
          "linkId": "2.30",
          "text": "Interpreter required?",
          "type": "text"
        },
        {
          "linkId": "2.31",
          "text": "Are there any passport/legal status issues?",
          "type": "text"
        },
        {
          "linkId": "2.32",
          "text": "Any other comments?",
          "type": "text"
        }
      ]
    },
    {
      "linkId": "3",
      "text": "Additional Information",
      "type": "group",
      "repeats": true,
      "item": [
        {
          "linkId": "3.1",
          "text": "Question",
          "type": "text"
        },
        {
          "linkId": "3.2",
          "text": "Answer",
          "type": "text"
        }
      ]
    }
  ]
}

name : Questionnaire-InitialSafegaurdingContact

{

}