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{
  "resourceType": "Questionnaire",
  "id": "9cc3ae17-359c-4df6-be26-01e977b705aa",
  "meta": {
    "versionId": "51",
    "lastUpdated": "2021-08-17T19:00:37.248+00:00",
    "source": "#rJ8UcUundwJOCOyw"
  },
  "identifier": [
    {
      "use": "official",
      "system": "http://health.gov.on.ca/sadie/fhir/ValueSet/ODSP-Questionnaires",
      "value": "ADLI"
    }
  ],
  "name": "Activities of Daily Living Index",
  "title": "Activities of Daily Living Index",
  "status": "draft",
  "experimental": false,
  "subjectType": [
    "Patient"
  ],
  "useContext": [
    {
      "code": {
        "system": "https://health.gov.on.ca/sadie/fhir/CodeSystem/FlexForms-Internal",
        "version": "1.0",
        "code": "DefaultPartition"
      },
      "valueCodeableConcept": {
        "text": "DefaultPartition"
      }
    }
  ],
  "effectivePeriod": {
    "start": "2021-07-14T04:00:00Z"
  },
  "code": [
    {
      "code": "DocumentType",
      "display": "DDP"
    },
    {
      "code": "DocumentSubType",
      "display": "ADLI"
    }
  ],
  "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": "General",
      "type": "group",
      "required": false,
      "repeats": false,
      "readOnly": false,
      "item": [
        {
          "linkId": "0.1",
          "text": "Health Care Professional Details",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "0.1.1",
              "text": "Profession",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 100
            }
          ]
        },
        {
          "linkId": "0.2",
          "text": "Applicant's Social Assistance Identification",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "0.2.1",
              "text": "Important: Member ID and referral ID are provided to ODSP applicants by their caseworkers. The ID’s can be found at the top of your applicant’s paper Disability Determination Package Forms. If your patient does not have an applicant started with the ministry, you cannot complete this form.",
              "type": "display",
              "required": false,
              "repeats": false,
              "readOnly": false
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/regex",
                  "valueString": "[0-9]*"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/minLength",
                  "valueInteger": 9
                }
              ],
              "linkId": "odsp-member-id",
              "definition": "https://www.hl7.org/fhir/patient-definitions.html#Patient.identifier[1].value",
              "text": "Member ID (9 digits)",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 9
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/regex",
                  "valueString": "[0-9]*"
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/minLength",
                  "valueInteger": 12
                }
              ],
              "linkId": "odsp-referral-id",
              "definition": "https://www.hl7.org/fhir/servicerequest-definitions.html#ServiceRequest.identifier[1].value",
              "text": "Referral ID (16 digits)",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 16
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                  "valueBoolean": true
                }
              ],
              "linkId": "details",
              "definition": "https://www.hl7.org/fhir/servicerequest-definitions.html#ServiceRequest.orderDetail[0].text",
              "type": "string",
              "initial": [
                {
                  "valueString": "Activities of Daily Living Index"
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                  "valueBoolean": true
                },
                {
                  "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
                  "valueExpression": {
                    "description": "ODSP Referral Id",
                    "language": "text/fhirpath",
                    "expression": "%context.item.where(linkId='0').item.where(linkId='0.2').item.where(linkId='odsp-referral-id').answer.valueString"
                  }
                }
              ],
              "linkId": "additional-details",
              "definition": "https://www.hl7.org/fhir/servicerequest-definitions.html#ServiceRequest.orderDetail[1].text",
              "type": "string"
            }
          ]
        },
        {
          "linkId": "0.3",
          "text": "Applicant Forms",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "0.3.1",
              "text": "With your patient’s consent, you may upload their Consent to the Release of Medical and Related Information form.",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "help",
                            "display": "Help-Button"
                          }
                        ],
                        "text": "Help-Button"
                      }
                    }
                  ],
                  "linkId": "0.3.1-help",
                  "text": "Very important: Please ensure that your patient has completed the form, as missing information may impact adjudication timelines.",
                  "type": "display"
                }
              ]
            },
            {
              "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": 20
                }
              ],
              "linkId": "0.3.2",
              "text": "Attach your patient’s consent form.",
              "type": "attachment",
              "enableWhen": [
                {
                  "question": "0.3.1",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": false,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.3.2-DocumentType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "DDP"
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.3.2-DocumentSubType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "Consent"
                    }
                  ]
                }
              ]
            },
            {
              "linkId": "0.3.3",
              "text": "With your patient’s consent, you may upload their Self Report form.",
              "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": 20
                }
              ],
              "linkId": "0.3.4",
              "text": "Attach your patient’s Self Report form.",
              "type": "attachment",
              "enableWhen": [
                {
                  "question": "0.3.3",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "enableBehavior": "any",
              "required": false,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.3.4-DocumentType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "DDP"
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "0.3.4-DocumentSubType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "Self Report"
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "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": "1",
      "text": "Applicant",
      "type": "group",
      "required": false,
      "repeats": false,
      "readOnly": false,
      "item": [
        {
          "linkId": "1.1",
          "text": "Applicant's Information",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "1.1.1",
              "type": "group",
              "repeats": false,
              "item": [
                {
                  "linkId": "1.1.1.1",
                  "text": "Specify the requested patient information:",
                  "type": "display",
                  "required": false,
                  "repeats": false,
                  "readOnly": false
                },
                {
                  "linkId": "patient-first-name",
                  "definition": "https://www.hl7.org/fhir/patient-definitions.html#Patient.name.given",
                  "text": "First Name",
                  "type": "string",
                  "required": true,
                  "repeats": false,
                  "readOnly": false,
                  "maxLength": 100
                },
                {
                  "linkId": "1.1.1.2",
                  "text": "Middle Initial",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "maxLength": 2
                },
                {
                  "linkId": "patient-last-name",
                  "definition": "https://www.hl7.org/fhir/patient-definitions.html#Patient.name.family",
                  "text": "Last Name",
                  "type": "string",
                  "required": true,
                  "repeats": false,
                  "readOnly": false,
                  "maxLength": 100
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/maxValue",
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "today()"
                          }
                        }
                      ]
                    }
                  ],
                  "linkId": "patient-date-of-birth",
                  "definition": "https://www.hl7.org/fhir/patient-definitions.html#Patient.birthDate",
                  "text": "Date of Birth",
                  "type": "date",
                  "required": true,
                  "repeats": false,
                  "readOnly": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "1.2",
          "text": "Applicant's Current Address",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "1.2.1",
              "text": "Unit Number",
              "type": "string",
              "required": false,
              "repeats": false,
              "readOnly": false,
              "maxLength": 10
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/regex",
                  "valueString": "[0-9]*"
                }
              ],
              "linkId": "1.2.2",
              "text": "Street Number",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 10
            },
            {
              "linkId": "1.2.3",
              "text": "Street Name",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 25
            },
            {
              "linkId": "1.2.4",
              "text": "City/Town",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 25
            },
            {
              "linkId": "1.2.5",
              "text": "Province",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 25
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/minLength",
                  "valueInteger": 6
                },
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/regex",
                  "valueString": "[A-Za-z][0-9][A-Za-z][0-9][A-Za-z][0-9]"
                }
              ],
              "linkId": "1.2.6",
              "text": "Postal Code",
              "type": "string",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "maxLength": 6
            }
          ]
        }
      ]
    },
    {
      "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": "2",
      "text": "Form",
      "type": "group",
      "required": false,
      "repeats": false,
      "readOnly": false,
      "item": [
        {
          "linkId": "2.1",
          "text": "Activities of Daily Living Index (ADLI)",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "2.1.1",
              "text": "This section consists of a list of activities that seeks to understand the impact of the presenting impairments on the applicant's restrictions.",
              "type": "display",
              "required": false,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "help",
                            "display": "Help-Button"
                          }
                        ],
                        "text": "Help-Button"
                      }
                    }
                  ],
                  "linkId": "2.1.1-help",
                  "text": "Completing the rating scale information helps the ministry understand the direct impact of the impairments and restrictions within the Health Status Report on the applicant’s current ability to perform and carry out each activity.",
                  "type": "display",
                  "required": false,
                  "repeats": false,
                  "readOnly": false
                }
              ]
            },
            {
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept": {
                    "coding": [
                      {
                        "system": "http://hl7.org/fhir/questionnaire-item-control",
                        "code": "table",
                        "display": "Group table"
                      }
                    ],
                    "text": "Group table"
                  }
                }
              ],
              "linkId": "2.1.2",
              "type": "group",
              "repeats": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-displayCategory",
                      "valueCode": "display"
                    }
                  ],
                  "linkId": "2.1.2.1",
                  "text": "Rating Scale",
                  "type": "choice",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClass"
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.2",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.2.1",
                      "text": "Bladder control",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.2').item.where(linkId='2.1.2.2.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.2').item.where(linkId='2.1.2.2.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.2').item.where(linkId='2.1.2.2.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.2.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.3",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.3.1",
                      "text": "Bowel control",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.3').item.where(linkId='2.1.2.3.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.3').item.where(linkId='2.1.2.3.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.3').item.where(linkId='2.1.2.3.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.3.2",
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                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.21').item.where(linkId='2.1.2.21.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.21').item.where(linkId='2.1.2.21.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.21').item.where(linkId='2.1.2.21.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.21.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.22",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.22.1",
                      "text": "Managing medication (if applicable)",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.22').item.where(linkId='2.1.2.22.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.22').item.where(linkId='2.1.2.22.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.22').item.where(linkId='2.1.2.22.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.22.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.23",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.23.1",
                      "text": "Communication using phone, text, email etc.",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.23').item.where(linkId='2.1.2.23.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.23').item.where(linkId='2.1.2.23.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.23').item.where(linkId='2.1.2.23.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.23.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.24",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.24.1",
                      "text": "Cognitive based activities (i.e., reading, writing, understand or following simple instructions)",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.24').item.where(linkId='2.1.2.24.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.24').item.where(linkId='2.1.2.24.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.24').item.where(linkId='2.1.2.24.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.24.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.25",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.25.1",
                      "text": "Safety: ability to maintain personal safety",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.25').item.where(linkId='2.1.2.25.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.25').item.where(linkId='2.1.2.25.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.25').item.where(linkId='2.1.2.25.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.25.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.26",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.26.1",
                      "text": "Social interactions (get along with others, maintains social boundaries)",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.26').item.where(linkId='2.1.2.26.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.26').item.where(linkId='2.1.2.26.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.26').item.where(linkId='2.1.2.26.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.26.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "gtable",
                            "display": "Group gtable"
                          }
                        ],
                        "text": "Group gtable"
                      }
                    }
                  ],
                  "linkId": "2.1.2.27",
                  "type": "group",
                  "repeats": false,
                  "item": [
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                          "valueCodeableConcept": {
                            "coding": [
                              {
                                "system": "http://hl7.org/fhir/questionnaire-item-control",
                                "code": "radio-button",
                                "display": "Radio Button"
                              }
                            ],
                            "text": "Radio Button"
                          }
                        },
                        {
                          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
                          "valueCode": "horizontal"
                        }
                      ],
                      "linkId": "2.1.2.27.1",
                      "text": "Hobbies/taking part in activities for relaxation or pleasure",
                      "type": "choice",
                      "required": true,
                      "repeats": false,
                      "readOnly": false,
                      "answerValueSet": "http://health.on.ca/sadie/fhir/ValueSet/HSR-SymptomClassCodes"
                    },
                    {
                      "extension": [
                        {
                          "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
                          "valueExpression": {
                            "language": "text/fhirpath",
                            "expression": "%context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.27').item.where(linkId='2.1.2.27.1').answer.valueCoding.code='1' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.27').item.where(linkId='2.1.2.27.1').answer.valueCoding.code='2' or %context.item.where(linkId='2').item.where(linkId='2.1').item.where(linkId='2.1.2').item.where(linkId='2.1.2.27').item.where(linkId='2.1.2.27.1').answer.valueCoding.code='3'"
                          }
                        }
                      ],
                      "linkId": "2.1.2.27.2",
                      "text": "Describe limitation, if needed",
                      "type": "text",
                      "required": false,
                      "repeats": false,
                      "readOnly": false,
                      "maxLength": 500
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "linkId": "2.2",
          "text": "Additional Services or Help",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "2.2.3",
              "text": "Does the applicant require assistive devices or equipment?",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "help",
                            "display": "Help-Button"
                          }
                        ],
                        "text": "Help-Button"
                      }
                    }
                  ],
                  "linkId": "2.2.3-help",
                  "text": "For example, cane, wheelchair, continuous positive airway pressure (CPAP)",
                  "type": "display"
                }
              ]
            },
            {
              "linkId": "2.2.4",
              "text": "Please provide details",
              "type": "text",
              "enableWhen": [
                {
                  "question": "2.2.3",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": false,
              "repeats": false,
              "readOnly": false,
              "maxLength": 1000
            },
            {
              "linkId": "2.2.5",
              "text": "Does the applicant require support services or resources?",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false,
              "item": [
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "coding": [
                          {
                            "system": "http://hl7.org/fhir/questionnaire-item-control",
                            "code": "help",
                            "display": "Help-Button"
                          }
                        ],
                        "text": "Help-Button"
                      }
                    }
                  ],
                  "linkId": "2.2.5-help",
                  "text": "For example, case management, developmental services, personal support worker",
                  "type": "display"
                }
              ]
            },
            {
              "linkId": "2.2.6",
              "text": "Please provide details",
              "type": "text",
              "enableWhen": [
                {
                  "question": "2.2.5",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": false,
              "repeats": false,
              "readOnly": false,
              "maxLength": 1000
            },
            {
              "linkId": "2.2.7",
              "text": "Does the applicant require a service or guide animal?",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false
            },
            {
              "linkId": "2.2.8",
              "text": "Please provide details",
              "type": "text",
              "enableWhen": [
                {
                  "question": "2.2.7",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": false,
              "repeats": false,
              "readOnly": false,
              "maxLength": 1000
            }
          ]
        },
        {
          "linkId": "2.3",
          "text": "Additional Details",
          "type": "group",
          "required": false,
          "repeats": false,
          "readOnly": false,
          "item": [
            {
              "linkId": "2.3.1",
              "text": "Is there any additional comments/information about the activities of daily living?",
              "type": "boolean",
              "required": true,
              "repeats": false,
              "readOnly": false
            },
            {
              "linkId": "2.3.2",
              "text": "Provide additional comments/information about activity of daily living",
              "type": "text",
              "enableWhen": [
                {
                  "question": "2.3.1",
                  "operator": "=",
                  "answerBoolean": true
                }
              ],
              "required": false,
              "repeats": false,
              "readOnly": false,
              "maxLength": 8000
            },
            {
              "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": 20
                }
              ],
              "linkId": "2.3.3",
              "text": "Attach any relevant documentation pertaining to additional comments/information about activities of daily living",
              "type": "attachment",
              "required": false,
              "repeats": true,
              "readOnly": false,
              "item": [
                {
                  "linkId": "2.3.3-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": "2.3.3-DocumentType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "AMI"
                    }
                  ]
                },
                {
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
                      "valueBoolean": true
                    }
                  ],
                  "linkId": "2.3.3-DocumentSubType",
                  "type": "string",
                  "required": false,
                  "repeats": false,
                  "readOnly": false,
                  "initial": [
                    {
                      "valueString": "Regular or IR AMI"
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}

name : Activities of Daily Living Index

{

}