Questionnaire

This Questionnaire can be viewed via NLM Form Builder (use import from file and then select preview).

An example of a completed QuestionnaireResponse can be found on QuestionnaireResponse Proxy Access Request

Proxy Access Request

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Questionnaire

Table View

Questionnaire.id[0]NationalProxy-Questionnaire-ProxyAccessRequest-Example
Questionnaire.meta[0].versionId[0]52
Questionnaire.meta[0].lastUpdated[0]2024-08-30T13:36:50.663+00:00
Questionnaire.url[0]https://fhir.nhs.uk/England/Questionnaire/ProxyAccessRequest
Questionnaire.version[0]0.0.1-current
Questionnaire.name[0]Consent
Questionnaire.title[0]Questionnaire Proxy Access Request
Questionnaire.status[0]draft
Questionnaire.subjectType[0]RelatedPerson
Questionnaire.date[0]2024-07-12
Questionnaire.publisher[0]NHS England
Questionnaire.contact[0].telecom[0].system[0]url
Questionnaire.contact[0].telecom[0].value[0]https://www.ihe.net/ihe_domains/it_infrastructure/
Questionnaire.contact[1].telecom[0].system[0]email
Questionnaire.contact[1].telecom[0].value[0]iti@ihe.net
Questionnaire.contact[2].name[0]NHS England
Questionnaire.contact[2].telecom[0].system[0]email
Questionnaire.contact[2].telecom[0].value[0]iti@ihe.net
Questionnaire.description[0]A form to request access to health and care services on behalf of someone else.
Questionnaire.useContext[0].code[0].system[0]http://terminology.hl7.org/CodeSystem/usage-context-type
Questionnaire.useContext[0].code[0].code[0]task
Questionnaire.useContext[0].value[0].coding[0].system[0]http://snomed.info/sct
Questionnaire.useContext[0].value[0].coding[0].code[0]887031000000108
Questionnaire.useContext[0].value[0].coding[0].display[0]Consent for information sharing
Questionnaire.jurisdiction[0].coding[0].system[0]http://unstats.un.org/unsd/methods/m49/m49.htm
Questionnaire.jurisdiction[0].coding[0].code[0]001
Questionnaire.purpose[0]Add someone to your NHS account
Questionnaire.item[0].linkId[0]relatedPerson
Questionnaire.item[0].prefix[0]1
Questionnaire.item[0].text[0]Proxy details
Questionnaire.item[0].type[0]group
Questionnaire.item[0].required[0]True
Questionnaire.item[0].readOnly[0]False
Questionnaire.item[0].item[0].linkId[0]relatedPerson_identifier
Questionnaire.item[0].item[0].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#identifier
Questionnaire.item[0].item[0].prefix[0]1.1
Questionnaire.item[0].item[0].text[0]NHS number
Questionnaire.item[0].item[0].type[0]string
Questionnaire.item[0].item[0].required[0]True
Questionnaire.item[0].item[0].readOnly[0]False
Questionnaire.item[0].item[0].maxLength[0]10
Questionnaire.item[0].item[1].linkId[0]relatedPerson_name
Questionnaire.item[0].item[1].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#name
Questionnaire.item[0].item[1].prefix[0]1.2
Questionnaire.item[0].item[1].text[0]Name
Questionnaire.item[0].item[1].type[0]group
Questionnaire.item[0].item[1].required[0]False
Questionnaire.item[0].item[1].item[0].linkId[0]relatedPerson_name_first
Questionnaire.item[0].item[1].item[0].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#name.given
Questionnaire.item[0].item[1].item[0].prefix[0]1.2.1
Questionnaire.item[0].item[1].item[0].text[0]First name
Questionnaire.item[0].item[1].item[0].type[0]string
Questionnaire.item[0].item[1].item[0].required[0]True
Questionnaire.item[0].item[1].item[0].repeats[0]False
Questionnaire.item[0].item[1].item[0].readOnly[0]False
Questionnaire.item[0].item[1].item[1].linkId[0]relatedPerson_name_family
Questionnaire.item[0].item[1].item[1].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#name.family
Questionnaire.item[0].item[1].item[1].prefix[0]1.2.2
Questionnaire.item[0].item[1].item[1].text[0]Last name
Questionnaire.item[0].item[1].item[1].type[0]string
Questionnaire.item[0].item[1].item[1].required[0]True
Questionnaire.item[0].item[1].item[1].repeats[0]False
Questionnaire.item[0].item[1].item[1].readOnly[0]False
Questionnaire.item[0].item[2].linkId[0]relatedPerson_birthDate
Questionnaire.item[0].item[2].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#birthDate
Questionnaire.item[0].item[2].prefix[0]1.3
Questionnaire.item[0].item[2].text[0]Date of birth
Questionnaire.item[0].item[2].type[0]date
Questionnaire.item[0].item[2].required[0]False
Questionnaire.item[0].item[2].repeats[0]False
Questionnaire.item[0].item[2].readOnly[0]False
Questionnaire.item[0].item[3].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[0].item[3].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[0].item[3].extension[0].value[0].coding[0].code[0]drop-down
Questionnaire.item[0].item[3].extension[0].value[0].coding[0].display[0]Drop down
Questionnaire.item[0].item[3].linkId[0]relatedPerson_basisForAccess
Questionnaire.item[0].item[3].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#relationship
Questionnaire.item[0].item[3].code[0].system[0]http://snomed.info/sct
Questionnaire.item[0].item[3].code[0].code[0]722011000000106
Questionnaire.item[0].item[3].code[0].display[0]Relationship (qualifier value)
Questionnaire.item[0].item[3].prefix[0]1.4
Questionnaire.item[0].item[3].text[0]Basis for Access
Questionnaire.item[0].item[3].type[0]choice
Questionnaire.item[0].item[3].required[0]True
Questionnaire.item[0].item[3].repeats[0]False
Questionnaire.item[0].item[3].readOnly[0]False
Questionnaire.item[0].item[3].answerOption[0].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[3].answerOption[0].value[0].code[0]PRN
Questionnaire.item[0].item[3].answerOption[0].value[0].display[0]Parent
Questionnaire.item[0].item[3].answerOption[1].value[0].system[0]https://fhir.hl7.org.uk/CodeSystem/UKCore-AdditionalPersonRelationshipRole
Questionnaire.item[0].item[3].answerOption[1].value[0].code[0]Personal
Questionnaire.item[0].item[3].answerOption[1].value[0].display[0]Personal relationship with the patient
Questionnaire.item[0].item[3].answerOption[2].value[0].system[0]https://fhir.nhs.uk/STU3/CodeSystem/RARecord-ProxyRole-1
Questionnaire.item[0].item[3].answerOption[2].value[0].code[0]002
Questionnaire.item[0].item[3].answerOption[2].value[0].display[0]Best interest decision made on behalf of the patient (Mental Capacity Act 2005)
Questionnaire.item[0].item[4].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[0].item[4].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[0].item[4].extension[0].value[0].coding[0].code[0]drop-down
Questionnaire.item[0].item[4].extension[0].value[0].coding[0].display[0]Drop down
Questionnaire.item[0].item[4].linkId[0]relatedPerson_relationship
Questionnaire.item[0].item[4].definition[0]http://hl7.org/fhir/StructureDefinition/RelatedPerson#relationship
Questionnaire.item[0].item[4].code[0].system[0]http://snomed.info/sct
Questionnaire.item[0].item[4].code[0].code[0]722011000000106
Questionnaire.item[0].item[4].code[0].display[0]Relationship (qualifier value)
Questionnaire.item[0].item[4].prefix[0]1.5
Questionnaire.item[0].item[4].text[0]Relationship
Questionnaire.item[0].item[4].type[0]choice
Questionnaire.item[0].item[4].required[0]True
Questionnaire.item[0].item[4].repeats[0]False
Questionnaire.item[0].item[4].readOnly[0]False
Questionnaire.item[0].item[4].answerOption[0].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[4].answerOption[0].value[0].code[0]PRN
Questionnaire.item[0].item[4].answerOption[0].value[0].display[0]Parent
Questionnaire.item[0].item[4].answerOption[1].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[4].answerOption[1].value[0].code[0]CHILD
Questionnaire.item[0].item[4].answerOption[1].value[0].display[0]Child
Questionnaire.item[0].item[4].answerOption[2].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[4].answerOption[2].value[0].code[0]SPS
Questionnaire.item[0].item[4].answerOption[2].value[0].display[0]Partner, wife or husband
Questionnaire.item[0].item[4].answerOption[3].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[4].answerOption[3].value[0].code[0]FAMMEMB
Questionnaire.item[0].item[4].answerOption[3].value[0].display[0]Other family member
Questionnaire.item[0].item[4].answerOption[4].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[4].answerOption[4].value[0].code[0]FRND
Questionnaire.item[0].item[4].answerOption[4].value[0].display[0]Friend, neighbour or housemate
Questionnaire.item[0].item[4].answerOption[5].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleClass
Questionnaire.item[0].item[4].answerOption[5].value[0].code[0]CAREGIVER
Questionnaire.item[0].item[4].answerOption[5].value[0].display[0]Paid carer or support worker
Questionnaire.item[0].item[4].answerOption[6].value[0].system[0]http://terminology.hl7.org/CodeSystem/v3-RoleCode
Questionnaire.item[0].item[4].answerOption[6].value[0].code[0]SIGOTHR
Questionnaire.item[0].item[4].answerOption[6].value[0].display[0]Other
Questionnaire.item[0].item[5].linkId[0]9759901615580
Questionnaire.item[0].item[5].prefix[0]1.6
Questionnaire.item[0].item[5].text[0]Relationship - Further information
Questionnaire.item[0].item[5].type[0]string
Questionnaire.item[0].item[5].required[0]False
Questionnaire.item[0].item[5].repeats[0]False
Questionnaire.item[0].item[5].readOnly[0]False
Questionnaire.item[0].item[5].maxLength[0]2000
Questionnaire.item[1].linkId[0]parentalApplicationSupplementaryDetails
Questionnaire.item[1].prefix[0]2
Questionnaire.item[1].text[0]Parental Application Supplementary Details
Questionnaire.item[1].type[0]group
Questionnaire.item[1].required[0]False
Questionnaire.item[1].readOnly[0]False
Questionnaire.item[1].item[0].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].code[0]radio-button
Questionnaire.item[1].item[0].extension[0].value[0].coding[0].display[0]Radio Button
Questionnaire.item[1].item[0].linkId[0]parentalApplicationSupplementaryDetails_evidenceOfResponsibility
Questionnaire.item[1].item[0].prefix[0]2.1
Questionnaire.item[1].item[0].text[0]Evidence of parental responsibility
Questionnaire.item[1].item[0].type[0]choice
Questionnaire.item[1].item[0].required[0]True
Questionnaire.item[1].item[0].repeats[0]False
Questionnaire.item[1].item[0].readOnly[0]False
Questionnaire.item[1].item[0].answerOption[0].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[0].value[0].code[0]BRTH
Questionnaire.item[1].item[0].answerOption[0].value[0].display[0]Birth certificate
Questionnaire.item[1].item[0].answerOption[1].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[1].value[0].code[0]ADPT
Questionnaire.item[1].item[0].answerOption[1].value[0].display[0]Adoption certificate
Questionnaire.item[1].item[0].answerOption[2].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[2].value[0].code[0]PRNA
Questionnaire.item[1].item[0].answerOption[2].value[0].display[0]Court-witnessed parental responsibility agreement
Questionnaire.item[1].item[0].answerOption[3].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[3].value[0].code[0]SPRNA
Questionnaire.item[1].item[0].answerOption[3].value[0].display[0]Court-witnessed step-parent parental responsibility agreement
Questionnaire.item[1].item[0].answerOption[4].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[4].value[0].code[0]PORD
Questionnaire.item[1].item[0].answerOption[4].value[0].display[0]Parental order
Questionnaire.item[1].item[0].answerOption[5].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[5].value[0].code[0]SGORD
Questionnaire.item[1].item[0].answerOption[5].value[0].display[0]Special guardianship order
Questionnaire.item[1].item[0].answerOption[6].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[6].value[0].code[0]OTHCOURT
Questionnaire.item[1].item[0].answerOption[6].value[0].display[0]Other court order
Questionnaire.item[1].item[0].answerOption[7].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[0].answerOption[7].value[0].code[0]OTHR
Questionnaire.item[1].item[0].answerOption[7].value[0].display[0]Other
Questionnaire.item[1].item[1].linkId[0]parentalApplicationSupplementaryDetails_evidenceOfResponsibilityMoreinfo
Questionnaire.item[1].item[1].prefix[0]2.2
Questionnaire.item[1].item[1].text[0]Evidence of responsibility - Further Information
Questionnaire.item[1].item[1].type[0]string
Questionnaire.item[1].item[1].enableWhen[0].question[0]parentalApplicationSupplementaryDetails_evidenceOfResponsibility
Questionnaire.item[1].item[1].enableWhen[0].operator[0]=
Questionnaire.item[1].item[1].enableWhen[0].answer[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility
Questionnaire.item[1].item[1].enableWhen[0].answer[0].code[0]OTHR
Questionnaire.item[1].item[1].enableWhen[0].answer[0].display[0]Other
Questionnaire.item[1].item[1].enableBehavior[0]all
Questionnaire.item[1].item[1].required[0]False
Questionnaire.item[1].item[1].repeats[0]False
Questionnaire.item[1].item[1].readOnly[0]False
Questionnaire.item[1].item[1].maxLength[0]2000
Questionnaire.item[1].item[2].linkId[0]parentalApplicationSupplementaryDetails_isCurrentAddressConfirmed
Questionnaire.item[1].item[2].prefix[0]2.3
Questionnaire.item[1].item[2].text[0]Is current address confirmed?
Questionnaire.item[1].item[2].type[0]boolean
Questionnaire.item[1].item[2].required[0]True
Questionnaire.item[1].item[2].repeats[0]False
Questionnaire.item[1].item[2].readOnly[0]False
Questionnaire.item[1].item[3].linkId[0]parentalApplicationSupplementaryDetails_newAddress
Questionnaire.item[1].item[3].prefix[0]2.4
Questionnaire.item[1].item[3].text[0]New address
Questionnaire.item[1].item[3].type[0]group
Questionnaire.item[1].item[3].required[0]False
Questionnaire.item[1].item[3].repeats[0]False
Questionnaire.item[1].item[3].readOnly[0]False
Questionnaire.item[1].item[3].item[0].linkId[0]parentalApplicationSupplementaryDetails_line1
Questionnaire.item[1].item[3].item[0].definition[0]http://hl7.org/fhir/datatypes-definitions.html#Address.line
Questionnaire.item[1].item[3].item[0].prefix[0]2.4.1
Questionnaire.item[1].item[3].item[0].text[0]Address line 1
Questionnaire.item[1].item[3].item[0].type[0]string
Questionnaire.item[1].item[3].item[0].required[0]False
Questionnaire.item[1].item[3].item[0].readOnly[0]False
Questionnaire.item[1].item[3].item[1].linkId[0]parentalApplicationSupplementaryDetails_line2
Questionnaire.item[1].item[3].item[1].definition[0]http://hl7.org/fhir/datatypes-definitions.html#Address.line
Questionnaire.item[1].item[3].item[1].prefix[0]2.4.2
Questionnaire.item[1].item[3].item[1].text[0]Address line 2
Questionnaire.item[1].item[3].item[1].type[0]string
Questionnaire.item[1].item[3].item[1].required[0]False
Questionnaire.item[1].item[3].item[1].readOnly[0]False
Questionnaire.item[1].item[3].item[2].linkId[0]parentalApplicationSupplementaryDetails_line3
Questionnaire.item[1].item[3].item[2].definition[0]http://hl7.org/fhir/datatypes-definitions.html#Address.line
Questionnaire.item[1].item[3].item[2].prefix[0]2.4.3
Questionnaire.item[1].item[3].item[2].text[0]Address line 3
Questionnaire.item[1].item[3].item[2].type[0]string
Questionnaire.item[1].item[3].item[2].required[0]False
Questionnaire.item[1].item[3].item[2].readOnly[0]False
Questionnaire.item[1].item[3].item[3].linkId[0]parentalApplicationSupplementaryDetails_city
Questionnaire.item[1].item[3].item[3].definition[0]http://hl7.org/fhir/datatypes-definitions.html#Address.city
Questionnaire.item[1].item[3].item[3].prefix[0]2.4.4
Questionnaire.item[1].item[3].item[3].text[0]Town / City
Questionnaire.item[1].item[3].item[3].type[0]string
Questionnaire.item[1].item[3].item[3].required[0]False
Questionnaire.item[1].item[3].item[3].readOnly[0]False
Questionnaire.item[1].item[3].item[4].linkId[0]parentalApplicationSupplementaryDetails_district
Questionnaire.item[1].item[3].item[4].definition[0]http://hl7.org/fhir/datatypes-definitions.html#Address.district
Questionnaire.item[1].item[3].item[4].prefix[0]2.4.5
Questionnaire.item[1].item[3].item[4].text[0]County
Questionnaire.item[1].item[3].item[4].type[0]string
Questionnaire.item[1].item[3].item[4].required[0]False
Questionnaire.item[1].item[3].item[4].readOnly[0]False
Questionnaire.item[1].item[3].item[5].linkId[0]parentalApplicationSupplementaryDetails_postalCode
Questionnaire.item[1].item[3].item[5].definition[0]http://hl7.org/fhir/datatypes-definitions.html#Address.postalCode
Questionnaire.item[1].item[3].item[5].prefix[0]2.4.6
Questionnaire.item[1].item[3].item[5].text[0]Postcode
Questionnaire.item[1].item[3].item[5].type[0]string
Questionnaire.item[1].item[3].item[5].required[0]False
Questionnaire.item[1].item[3].item[5].readOnly[0]False
Questionnaire.item[1].item[4].linkId[0]parentalApplicationSupplementaryDetails_liveAtSameAddress
Questionnaire.item[1].item[4].prefix[0]2.5
Questionnaire.item[1].item[4].text[0]Do adult and child live at the same address?
Questionnaire.item[1].item[4].type[0]boolean
Questionnaire.item[1].item[4].required[0]True
Questionnaire.item[1].item[4].repeats[0]False
Questionnaire.item[1].item[4].readOnly[0]False
Questionnaire.item[1].item[5].linkId[0]parentalApplicationSupplementaryDetails_canChildConsent
Questionnaire.item[1].item[5].prefix[0]2.6
Questionnaire.item[1].item[5].text[0]Can the child consent?
Questionnaire.item[1].item[5].type[0]boolean
Questionnaire.item[1].item[5].required[0]False
Questionnaire.item[1].item[5].repeats[0]False
Questionnaire.item[1].item[5].readOnly[0]False
Questionnaire.item[1].item[6].linkId[0]parentalApplicationSupplementaryDetails_reasonNoChildConsent
Questionnaire.item[1].item[6].prefix[0]2.7
Questionnaire.item[1].item[6].text[0]Reason the child cannot consent?
Questionnaire.item[1].item[6].type[0]string
Questionnaire.item[1].item[6].enableWhen[0].question[0]parentalApplicationSupplementaryDetails_canChildConsent
Questionnaire.item[1].item[6].enableWhen[0].operator[0]=
Questionnaire.item[1].item[6].enableWhen[0].answer[0]False
Questionnaire.item[1].item[6].enableBehavior[0]all
Questionnaire.item[1].item[6].required[0]False
Questionnaire.item[1].item[6].repeats[0]False
Questionnaire.item[1].item[6].readOnly[0]False
Questionnaire.item[2].linkId[0]patient
Questionnaire.item[2].prefix[0]3
Questionnaire.item[2].text[0]Patient details
Questionnaire.item[2].type[0]group
Questionnaire.item[2].required[0]True
Questionnaire.item[2].item[0].linkId[0]patient_identifier
Questionnaire.item[2].item[0].definition[0]http://hl7.org/fhir/StructureDefinition/Patient#identifier
Questionnaire.item[2].item[0].prefix[0]3.1
Questionnaire.item[2].item[0].text[0]NHS number
Questionnaire.item[2].item[0].type[0]string
Questionnaire.item[2].item[0].required[0]True
Questionnaire.item[2].item[0].repeats[0]False
Questionnaire.item[2].item[0].readOnly[0]False
Questionnaire.item[2].item[0].maxLength[0]10
Questionnaire.item[2].item[1].linkId[0]patient_name
Questionnaire.item[2].item[1].definition[0]http://hl7.org/fhir/StructureDefinition/Patient#name
Questionnaire.item[2].item[1].prefix[0]3.2
Questionnaire.item[2].item[1].text[0]Name
Questionnaire.item[2].item[1].type[0]group
Questionnaire.item[2].item[1].required[0]False
Questionnaire.item[2].item[1].item[0].linkId[0]patient_name_first
Questionnaire.item[2].item[1].item[0].definition[0]http://hl7.org/fhir/StructureDefinition/Patient#name.given
Questionnaire.item[2].item[1].item[0].prefix[0]3.2.1
Questionnaire.item[2].item[1].item[0].text[0]First name
Questionnaire.item[2].item[1].item[0].type[0]string
Questionnaire.item[2].item[1].item[0].required[0]True
Questionnaire.item[2].item[1].item[0].repeats[0]False
Questionnaire.item[2].item[1].item[0].readOnly[0]False
Questionnaire.item[2].item[1].item[1].linkId[0]patient_name_family
Questionnaire.item[2].item[1].item[1].definition[0]http://hl7.org/fhir/StructureDefinition/Patient#name.family
Questionnaire.item[2].item[1].item[1].prefix[0]3.2.2
Questionnaire.item[2].item[1].item[1].text[0]Last name
Questionnaire.item[2].item[1].item[1].type[0]string
Questionnaire.item[2].item[1].item[1].required[0]True
Questionnaire.item[2].item[1].item[1].repeats[0]False
Questionnaire.item[2].item[1].item[1].readOnly[0]False
Questionnaire.item[2].item[2].linkId[0]patient_birthDate
Questionnaire.item[2].item[2].definition[0]http://hl7.org/fhir/StructureDefinition/Patient#birthDate
Questionnaire.item[2].item[2].prefix[0]3.3
Questionnaire.item[2].item[2].text[0]Date of birth
Questionnaire.item[2].item[2].type[0]date
Questionnaire.item[2].item[2].required[0]False
Questionnaire.item[2].item[2].repeats[0]False
Questionnaire.item[2].item[2].readOnly[0]False
Questionnaire.item[3].linkId[0]requestedAccess
Questionnaire.item[3].prefix[0]4
Questionnaire.item[3].text[0]Requested access
Questionnaire.item[3].type[0]group
Questionnaire.item[3].required[0]True
Questionnaire.item[3].item[0].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[3].item[0].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[3].item[0].extension[0].value[0].coding[0].code[0]check-box
Questionnaire.item[3].item[0].extension[0].value[0].coding[0].display[0]Check-box
Questionnaire.item[3].item[0].linkId[0]requestedAccess_accessLevel
Questionnaire.item[3].item[0].prefix[0]4.1
Questionnaire.item[3].item[0].text[0]Requested access level
Questionnaire.item[3].item[0].type[0]choice
Questionnaire.item[3].item[0].required[0]True
Questionnaire.item[3].item[0].repeats[0]True
Questionnaire.item[3].item[0].readOnly[0]False
Questionnaire.item[3].item[0].answerOption[0].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[0].answerOption[0].value[0].code[0]APPT
Questionnaire.item[3].item[0].answerOption[0].value[0].display[0]Appointment Booking
Questionnaire.item[3].item[0].answerOption[1].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[0].answerOption[1].value[0].code[0]CNTCT
Questionnaire.item[3].item[0].answerOption[1].value[0].display[0]Contacting Surgery
Questionnaire.item[3].item[0].answerOption[2].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[0].answerOption[2].value[0].code[0]RECRD
Questionnaire.item[3].item[0].answerOption[2].value[0].display[0]Medical Records Access
Questionnaire.item[3].item[0].answerOption[3].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[0].answerOption[3].value[0].code[0]TEST
Questionnaire.item[3].item[0].answerOption[3].value[0].display[0]Test Results
Questionnaire.item[3].item[0].answerOption[4].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[0].answerOption[4].value[0].code[0]VACC
Questionnaire.item[3].item[0].answerOption[4].value[0].display[0]Vaccination Records
Questionnaire.item[3].item[0].answerOption[5].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[0].answerOption[5].value[0].code[0]PRESCR
Questionnaire.item[3].item[0].answerOption[5].value[0].display[0]Request and manage repeat prescriptions
Questionnaire.item[3].item[1].linkId[0]requestedAccess_accessLevelMoreinfo
Questionnaire.item[3].item[1].prefix[0]4.2
Questionnaire.item[3].item[1].text[0]Requested access level - further information
Questionnaire.item[3].item[1].type[0]string
Questionnaire.item[3].item[1].enableWhen[0].question[0]requestedAccess_accessLevel
Questionnaire.item[3].item[1].enableWhen[0].operator[0]=
Questionnaire.item[3].item[1].enableWhen[0].answer[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess
Questionnaire.item[3].item[1].enableWhen[0].answer[0].code[0]RECRD
Questionnaire.item[3].item[1].enableWhen[0].answer[0].display[0]Medical Records Access
Questionnaire.item[3].item[1].enableBehavior[0]all
Questionnaire.item[3].item[1].required[0]False
Questionnaire.item[3].item[1].repeats[0]False
Questionnaire.item[3].item[1].readOnly[0]False
Questionnaire.item[3].item[1].maxLength[0]2000
Questionnaire.item[3].item[2].extension[0].url[0]http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
Questionnaire.item[3].item[2].extension[0].value[0].coding[0].system[0]http://hl7.org/fhir/questionnaire-item-control
Questionnaire.item[3].item[2].extension[0].value[0].coding[0].code[0]check-box
Questionnaire.item[3].item[2].extension[0].value[0].coding[0].display[0]Check-box
Questionnaire.item[3].item[2].linkId[0]requestedAccess_reasonsForAccess
Questionnaire.item[3].item[2].prefix[0]4.3
Questionnaire.item[3].item[2].text[0]Reason for access
Questionnaire.item[3].item[2].type[0]choice
Questionnaire.item[3].item[2].required[0]False
Questionnaire.item[3].item[2].repeats[0]True
Questionnaire.item[3].item[2].readOnly[0]False
Questionnaire.item[3].item[2].answerOption[0].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[0].value[0].code[0]COMB
Questionnaire.item[3].item[2].answerOption[0].value[0].display[0]Communication Barriers
Questionnaire.item[3].item[2].answerOption[1].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[1].value[0].code[0]MHEA
Questionnaire.item[3].item[2].answerOption[1].value[0].display[0]Mental Health Condition
Questionnaire.item[3].item[2].answerOption[2].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[2].value[0].code[0]PHYS
Questionnaire.item[3].item[2].answerOption[2].value[0].display[0]Physical Condition
Questionnaire.item[3].item[2].answerOption[3].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[3].value[0].code[0]PRAC
Questionnaire.item[3].item[2].answerOption[3].value[0].display[0]Practical Reasons
Questionnaire.item[3].item[2].answerOption[4].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[4].value[0].code[0]TECH
Questionnaire.item[3].item[2].answerOption[4].value[0].display[0]Technical Barriers
Questionnaire.item[3].item[2].answerOption[5].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[5].value[0].code[0]NEUR
Questionnaire.item[3].item[2].answerOption[5].value[0].display[0]Neurodiverse
Questionnaire.item[3].item[2].answerOption[6].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[6].value[0].code[0]LRN
Questionnaire.item[3].item[2].answerOption[6].value[0].display[0]Learning Disability
Questionnaire.item[3].item[2].answerOption[7].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[7].value[0].code[0]OTHR
Questionnaire.item[3].item[2].answerOption[7].value[0].display[0]Other
Questionnaire.item[3].item[2].answerOption[8].value[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[2].answerOption[8].value[0].code[0]NotSpecified
Questionnaire.item[3].item[2].answerOption[8].value[0].display[0]Prefer not to say
Questionnaire.item[3].item[3].linkId[0]requestedAccess_reasonsForAccessMoreinfo
Questionnaire.item[3].item[3].prefix[0]4.4
Questionnaire.item[3].item[3].text[0]Reason for access - further information
Questionnaire.item[3].item[3].type[0]string
Questionnaire.item[3].item[3].enableWhen[0].question[0]requestedAccess_reasonsForAccess
Questionnaire.item[3].item[3].enableWhen[0].operator[0]=
Questionnaire.item[3].item[3].enableWhen[0].answer[0].system[0]https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess
Questionnaire.item[3].item[3].enableWhen[0].answer[0].code[0]OTHR
Questionnaire.item[3].item[3].enableWhen[0].answer[0].display[0]Other
Questionnaire.item[3].item[3].enableBehavior[0]all
Questionnaire.item[3].item[3].required[0]False
Questionnaire.item[3].item[3].repeats[0]False
Questionnaire.item[3].item[3].readOnly[0]False
Questionnaire.item[3].item[3].maxLength[0]2000

XML View

<Questionnaire xmlns="http://hl7.org/fhir">
<id value="NationalProxy-Questionnaire-ProxyAccessRequest-Example" />
<meta>
<versionId value="52" />
<lastUpdated value="2024-08-30T13:36:50.663Z" />
</meta>
<url value="https://fhir.nhs.uk/England/Questionnaire/ProxyAccessRequest" />
<version value="0.0.1-current" />
<name value="Consent" />
<title value="Questionnaire Proxy Access Request" />
<status value="draft" />
<subjectType value="RelatedPerson" />
<date value="2024-07-12" />
<publisher value="NHS England" />
<contact>
<telecom>
<system value="url" />
<value value="https://www.ihe.net/ihe_domains/it_infrastructure/" />
</telecom>
</contact>
<contact>
<telecom>
<system value="email" />
<value value="iti@ihe.net" />
</telecom>
</contact>
<contact>
<name value="NHS England" />
<telecom>
<system value="email" />
<value value="iti@ihe.net" />
</telecom>
</contact>
<description value="A form to request access to health and care services on behalf of someone else." />
<useContext>
<code>
<system value="http://terminology.hl7.org/CodeSystem/usage-context-type" />
<code value="task" />
</code>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct" />
<code value="887031000000108" />
<display value="Consent for information sharing" />
</coding>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm" />
<code value="001" />
</coding>
</jurisdiction>
<purpose value="Add someone to your NHS account" />
<item>
<linkId value="relatedPerson" />
<prefix value="1" />
<text value="Proxy details" />
<type value="group" />
<required value="true" />
<readOnly value="false" />
<item>
<linkId value="relatedPerson_identifier" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#identifier" />
<prefix value="1.1" />
<text value="NHS number" />
<type value="string" />
<required value="true" />
<readOnly value="false" />
<maxLength value="10" />
</item>
<item>
<linkId value="relatedPerson_name" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#name" />
<prefix value="1.2" />
<text value="Name" />
<type value="group" />
<required value="false" />
<item>
<linkId value="relatedPerson_name_first" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#name.given" />
<prefix value="1.2.1" />
<text value="First name" />
<type value="string" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="relatedPerson_name_family" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#name.family" />
<prefix value="1.2.2" />
<text value="Last name" />
<type value="string" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
</item>
</item>
<item>
<linkId value="relatedPerson_birthDate" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#birthDate" />
<prefix value="1.3" />
<text value="Date of birth" />
<type value="date" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
</item>
<item>
<extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control" />
<code value="drop-down" />
<display value="Drop down" />
</coding>
</valueCodeableConcept>
</extension>
<linkId value="relatedPerson_basisForAccess" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#relationship" />
<code>
<system value="http://snomed.info/sct" />
<code value="722011000000106" />
<display value="Relationship (qualifier value)" />
</code>
<prefix value="1.4" />
<text value="Basis for Access" />
<type value="choice" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="PRN" />
<display value="Parent" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-AdditionalPersonRelationshipRole" />
<code value="Personal" />
<display value="Personal relationship with the patient" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/STU3/CodeSystem/RARecord-ProxyRole-1" />
<code value="002" />
<display value="Best interest decision made on behalf of the patient (Mental Capacity Act 2005)" />
</valueCoding>
</answerOption>
</item>
<item>
<extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control" />
<code value="drop-down" />
<display value="Drop down" />
</coding>
</valueCodeableConcept>
</extension>
<linkId value="relatedPerson_relationship" />
<definition value="http://hl7.org/fhir/StructureDefinition/RelatedPerson#relationship" />
<code>
<system value="http://snomed.info/sct" />
<code value="722011000000106" />
<display value="Relationship (qualifier value)" />
</code>
<prefix value="1.5" />
<text value="Relationship" />
<type value="choice" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="PRN" />
<display value="Parent" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="CHILD" />
<display value="Child" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="SPS" />
<display value="Partner, wife or husband" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="FAMMEMB" />
<display value="Other family member" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="FRND" />
<display value="Friend, neighbour or housemate" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleClass" />
<code value="CAREGIVER" />
<display value="Paid carer or support worker" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode" />
<code value="SIGOTHR" />
<display value="Other" />
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="9759901615580" />
<prefix value="1.6" />
<text value="Relationship - Further information" />
<type value="string" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
<maxLength value="2000" />
</item>
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails" />
<prefix value="2" />
<text value="Parental Application Supplementary Details" />
<type value="group" />
<required value="false" />
<readOnly value="false" />
<item>
<extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control" />
<code value="radio-button" />
<display value="Radio Button" />
</coding>
</valueCodeableConcept>
</extension>
<linkId value="parentalApplicationSupplementaryDetails_evidenceOfResponsibility" />
<prefix value="2.1" />
<text value="Evidence of parental responsibility" />
<type value="choice" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="BRTH" />
<display value="Birth certificate" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="ADPT" />
<display value="Adoption certificate" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="PRNA" />
<display value="Court-witnessed parental responsibility agreement" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="SPRNA" />
<display value="Court-witnessed step-parent parental responsibility agreement" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="PORD" />
<display value="Parental order" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="SGORD" />
<display value="Special guardianship order" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="OTHCOURT" />
<display value="Other court order" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="OTHR" />
<display value="Other" />
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_evidenceOfResponsibilityMoreinfo" />
<prefix value="2.2" />
<text value="Evidence of responsibility - Further Information" />
<type value="string" />
<enableWhen>
<question value="parentalApplicationSupplementaryDetails_evidenceOfResponsibility" />
<operator value="=" />
<answerCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility" />
<code value="OTHR" />
<display value="Other" />
</answerCoding>
</enableWhen>
<enableBehavior value="all" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
<maxLength value="2000" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_isCurrentAddressConfirmed" />
<prefix value="2.3" />
<text value="Is current address confirmed?" />
<type value="boolean" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_newAddress" />
<prefix value="2.4" />
<text value="New address" />
<type value="group" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
<item>
<linkId value="parentalApplicationSupplementaryDetails_line1" />
<definition value="http://hl7.org/fhir/datatypes-definitions.html#Address.line" />
<prefix value="2.4.1" />
<text value="Address line 1" />
<type value="string" />
<required value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_line2" />
<definition value="http://hl7.org/fhir/datatypes-definitions.html#Address.line" />
<prefix value="2.4.2" />
<text value="Address line 2" />
<type value="string" />
<required value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_line3" />
<definition value="http://hl7.org/fhir/datatypes-definitions.html#Address.line" />
<prefix value="2.4.3" />
<text value="Address line 3" />
<type value="string" />
<required value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_city" />
<definition value="http://hl7.org/fhir/datatypes-definitions.html#Address.city" />
<prefix value="2.4.4" />
<text value="Town / City" />
<type value="string" />
<required value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_district" />
<definition value="http://hl7.org/fhir/datatypes-definitions.html#Address.district" />
<prefix value="2.4.5" />
<text value="County" />
<type value="string" />
<required value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_postalCode" />
<definition value="http://hl7.org/fhir/datatypes-definitions.html#Address.postalCode" />
<prefix value="2.4.6" />
<text value="Postcode" />
<type value="string" />
<required value="false" />
<readOnly value="false" />
</item>
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_liveAtSameAddress" />
<prefix value="2.5" />
<text value="Do adult and child live at the same address?" />
<type value="boolean" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_canChildConsent" />
<prefix value="2.6" />
<text value="Can the child consent?" />
<type value="boolean" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="parentalApplicationSupplementaryDetails_reasonNoChildConsent" />
<prefix value="2.7" />
<text value="Reason the child cannot consent?" />
<type value="string" />
<enableWhen>
<question value="parentalApplicationSupplementaryDetails_canChildConsent" />
<operator value="=" />
<answerBoolean value="false" />
</enableWhen>
<enableBehavior value="all" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
</item>
</item>
<item>
<linkId value="patient" />
<prefix value="3" />
<text value="Patient details" />
<type value="group" />
<required value="true" />
<item>
<linkId value="patient_identifier" />
<definition value="http://hl7.org/fhir/StructureDefinition/Patient#identifier" />
<prefix value="3.1" />
<text value="NHS number" />
<type value="string" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
<maxLength value="10" />
</item>
<item>
<linkId value="patient_name" />
<definition value="http://hl7.org/fhir/StructureDefinition/Patient#name" />
<prefix value="3.2" />
<text value="Name" />
<type value="group" />
<required value="false" />
<item>
<linkId value="patient_name_first" />
<definition value="http://hl7.org/fhir/StructureDefinition/Patient#name.given" />
<prefix value="3.2.1" />
<text value="First name" />
<type value="string" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
</item>
<item>
<linkId value="patient_name_family" />
<definition value="http://hl7.org/fhir/StructureDefinition/Patient#name.family" />
<prefix value="3.2.2" />
<text value="Last name" />
<type value="string" />
<required value="true" />
<repeats value="false" />
<readOnly value="false" />
</item>
</item>
<item>
<linkId value="patient_birthDate" />
<definition value="http://hl7.org/fhir/StructureDefinition/Patient#birthDate" />
<prefix value="3.3" />
<text value="Date of birth" />
<type value="date" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
</item>
</item>
<item>
<linkId value="requestedAccess" />
<prefix value="4" />
<text value="Requested access" />
<type value="group" />
<required value="true" />
<item>
<extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control" />
<code value="check-box" />
<display value="Check-box" />
</coding>
</valueCodeableConcept>
</extension>
<linkId value="requestedAccess_accessLevel" />
<prefix value="4.1" />
<text value="Requested access level" />
<type value="choice" />
<required value="true" />
<repeats value="true" />
<readOnly value="false" />
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="APPT" />
<display value="Appointment Booking" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="CNTCT" />
<display value="Contacting Surgery" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="RECRD" />
<display value="Medical Records Access" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="TEST" />
<display value="Test Results" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="VACC" />
<display value="Vaccination Records" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="PRESCR" />
<display value="Request and manage repeat prescriptions" />
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="requestedAccess_accessLevelMoreinfo" />
<prefix value="4.2" />
<text value="Requested access level - further information" />
<type value="string" />
<enableWhen>
<question value="requestedAccess_accessLevel" />
<operator value="=" />
<answerCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess" />
<code value="RECRD" />
<display value="Medical Records Access" />
</answerCoding>
</enableWhen>
<enableBehavior value="all" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
<maxLength value="2000" />
</item>
<item>
<extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control" />
<code value="check-box" />
<display value="Check-box" />
</coding>
</valueCodeableConcept>
</extension>
<linkId value="requestedAccess_reasonsForAccess" />
<prefix value="4.3" />
<text value="Reason for access" />
<type value="choice" />
<required value="false" />
<repeats value="true" />
<readOnly value="false" />
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="COMB" />
<display value="Communication Barriers" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="MHEA" />
<display value="Mental Health Condition" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="PHYS" />
<display value="Physical Condition" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="PRAC" />
<display value="Practical Reasons" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="TECH" />
<display value="Technical Barriers" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="NEUR" />
<display value="Neurodiverse" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="LRN" />
<display value="Learning Disability" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="OTHR" />
<display value="Other" />
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="NotSpecified" />
<display value="Prefer not to say" />
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="requestedAccess_reasonsForAccessMoreinfo" />
<prefix value="4.4" />
<text value="Reason for access - further information" />
<type value="string" />
<enableWhen>
<question value="requestedAccess_reasonsForAccess" />
<operator value="=" />
<answerCoding>
<system value="https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess" />
<code value="OTHR" />
<display value="Other" />
</answerCoding>
</enableWhen>
<enableBehavior value="all" />
<required value="false" />
<repeats value="false" />
<readOnly value="false" />
<maxLength value="2000" />
</item>
</item>
</Questionnaire>

JSON View

{
"resourceType": "Questionnaire",
"id": "NationalProxy-Questionnaire-ProxyAccessRequest-Example",
"meta": {
"versionId": "52",
"lastUpdated": "2024-08-30T13:36:50.663Z"
},
"url": "https://fhir.nhs.uk/England/Questionnaire/ProxyAccessRequest",
"version": "0.0.1-current",
"name": "Consent",
"title": "Questionnaire Proxy Access Request",
"status": "draft",
"subjectType": [
"RelatedPerson"
],
"date": "2024-07-12",
"publisher": "NHS England",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "https://www.ihe.net/ihe_domains/it_infrastructure/"
}
]
},
{
"telecom": [
{
"system": "email",
"value": "iti@ihe.net"
}
]
},
{
"name": "NHS England",
"telecom": [
{
"system": "email",
"value": "iti@ihe.net"
}
]
}
],
"description": "A form to request access to health and care services on behalf of someone else.",
"useContext": [
{
"code": {
"system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code": "task"
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "887031000000108",
"display": "Consent for information sharing"
}
]
}
}
],
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001"
}
]
}
],
"purpose": "Add someone to your NHS account",
"item": [
{
"linkId": "relatedPerson",
"prefix": "1",
"text": "Proxy details",
"type": "group",
"required": true,
"readOnly": false,
"item": [
{
"linkId": "relatedPerson_identifier",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#identifier",
"prefix": "1.1",
"text": "NHS number",
"type": "string",
"required": true,
"readOnly": false,
"maxLength": 10
},
{
"linkId": "relatedPerson_name",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#name",
"prefix": "1.2",
"text": "Name",
"type": "group",
"required": false,
"item": [
{
"linkId": "relatedPerson_name_first",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#name.given",
"prefix": "1.2.1",
"text": "First name",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
},
{
"linkId": "relatedPerson_name_family",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#name.family",
"prefix": "1.2.2",
"text": "Last name",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
}
]
},
{
"linkId": "relatedPerson_birthDate",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#birthDate",
"prefix": "1.3",
"text": "Date of birth",
"type": "date",
"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": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "relatedPerson_basisForAccess",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#relationship",
"code": [
{
"system": "http://snomed.info/sct",
"code": "722011000000106",
"display": "Relationship (qualifier value)"
}
],
"prefix": "1.4",
"text": "Basis for Access",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerOption": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "PRN",
"display": "Parent"
}
},
{
"valueCoding": {
"system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-AdditionalPersonRelationshipRole",
"code": "Personal",
"display": "Personal relationship with the patient"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/STU3/CodeSystem/RARecord-ProxyRole-1",
"code": "002",
"display": "Best interest decision made on behalf of the patient (Mental Capacity Act 2005)"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "relatedPerson_relationship",
"definition": "http://hl7.org/fhir/StructureDefinition/RelatedPerson#relationship",
"code": [
{
"system": "http://snomed.info/sct",
"code": "722011000000106",
"display": "Relationship (qualifier value)"
}
],
"prefix": "1.5",
"text": "Relationship",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerOption": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "PRN",
"display": "Parent"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "CHILD",
"display": "Child"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "SPS",
"display": "Partner, wife or husband"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "FAMMEMB",
"display": "Other family member"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "FRND",
"display": "Friend, neighbour or housemate"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleClass",
"code": "CAREGIVER",
"display": "Paid carer or support worker"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "SIGOTHR",
"display": "Other"
}
}
]
},
{
"linkId": "9759901615580",
"prefix": "1.6",
"text": "Relationship - Further information",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false,
"maxLength": 2000
}
]
},
{
"linkId": "parentalApplicationSupplementaryDetails",
"prefix": "2",
"text": "Parental Application Supplementary Details",
"type": "group",
"required": false,
"readOnly": 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"
}
]
}
}
],
"linkId": "parentalApplicationSupplementaryDetails_evidenceOfResponsibility",
"prefix": "2.1",
"text": "Evidence of parental responsibility",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerOption": [
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "BRTH",
"display": "Birth certificate"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "ADPT",
"display": "Adoption certificate"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "PRNA",
"display": "Court-witnessed parental responsibility agreement"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "SPRNA",
"display": "Court-witnessed step-parent parental responsibility agreement"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "PORD",
"display": "Parental order"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "SGORD",
"display": "Special guardianship order"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "OTHCOURT",
"display": "Other court order"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "OTHR",
"display": "Other"
}
}
]
},
{
"linkId": "parentalApplicationSupplementaryDetails_evidenceOfResponsibilityMoreinfo",
"prefix": "2.2",
"text": "Evidence of responsibility - Further Information",
"type": "string",
"enableWhen": [
{
"question": "parentalApplicationSupplementaryDetails_evidenceOfResponsibility",
"operator": "=",
"answerCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-EvidenceOfResponsibility",
"code": "OTHR",
"display": "Other"
}
}
],
"enableBehavior": "all",
"required": false,
"repeats": false,
"readOnly": false,
"maxLength": 2000
},
{
"linkId": "parentalApplicationSupplementaryDetails_isCurrentAddressConfirmed",
"prefix": "2.3",
"text": "Is current address confirmed?",
"type": "boolean",
"required": true,
"repeats": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_newAddress",
"prefix": "2.4",
"text": "New address",
"type": "group",
"required": false,
"repeats": false,
"readOnly": false,
"item": [
{
"linkId": "parentalApplicationSupplementaryDetails_line1",
"definition": "http://hl7.org/fhir/datatypes-definitions.html#Address.line",
"prefix": "2.4.1",
"text": "Address line 1",
"type": "string",
"required": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_line2",
"definition": "http://hl7.org/fhir/datatypes-definitions.html#Address.line",
"prefix": "2.4.2",
"text": "Address line 2",
"type": "string",
"required": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_line3",
"definition": "http://hl7.org/fhir/datatypes-definitions.html#Address.line",
"prefix": "2.4.3",
"text": "Address line 3",
"type": "string",
"required": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_city",
"definition": "http://hl7.org/fhir/datatypes-definitions.html#Address.city",
"prefix": "2.4.4",
"text": "Town / City",
"type": "string",
"required": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_district",
"definition": "http://hl7.org/fhir/datatypes-definitions.html#Address.district",
"prefix": "2.4.5",
"text": "County",
"type": "string",
"required": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_postalCode",
"definition": "http://hl7.org/fhir/datatypes-definitions.html#Address.postalCode",
"prefix": "2.4.6",
"text": "Postcode",
"type": "string",
"required": false,
"readOnly": false
}
]
},
{
"linkId": "parentalApplicationSupplementaryDetails_liveAtSameAddress",
"prefix": "2.5",
"text": "Do adult and child live at the same address?",
"type": "boolean",
"required": true,
"repeats": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_canChildConsent",
"prefix": "2.6",
"text": "Can the child consent?",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"linkId": "parentalApplicationSupplementaryDetails_reasonNoChildConsent",
"prefix": "2.7",
"text": "Reason the child cannot consent?",
"type": "string",
"enableWhen": [
{
"question": "parentalApplicationSupplementaryDetails_canChildConsent",
"operator": "=",
"answerBoolean": false
}
],
"enableBehavior": "all",
"required": false,
"repeats": false,
"readOnly": false
}
]
},
{
"linkId": "patient",
"prefix": "3",
"text": "Patient details",
"type": "group",
"required": true,
"item": [
{
"linkId": "patient_identifier",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#identifier",
"prefix": "3.1",
"text": "NHS number",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false,
"maxLength": 10
},
{
"linkId": "patient_name",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#name",
"prefix": "3.2",
"text": "Name",
"type": "group",
"required": false,
"item": [
{
"linkId": "patient_name_first",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#name.given",
"prefix": "3.2.1",
"text": "First name",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
},
{
"linkId": "patient_name_family",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#name.family",
"prefix": "3.2.2",
"text": "Last name",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
}
]
},
{
"linkId": "patient_birthDate",
"definition": "http://hl7.org/fhir/StructureDefinition/Patient#birthDate",
"prefix": "3.3",
"text": "Date of birth",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
}
]
},
{
"linkId": "requestedAccess",
"prefix": "4",
"text": "Requested access",
"type": "group",
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check-box"
}
]
}
}
],
"linkId": "requestedAccess_accessLevel",
"prefix": "4.1",
"text": "Requested access level",
"type": "choice",
"required": true,
"repeats": true,
"readOnly": false,
"answerOption": [
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "APPT",
"display": "Appointment Booking"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "CNTCT",
"display": "Contacting Surgery"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "RECRD",
"display": "Medical Records Access"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "TEST",
"display": "Test Results"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "VACC",
"display": "Vaccination Records"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "PRESCR",
"display": "Request and manage repeat prescriptions"
}
}
]
},
{
"linkId": "requestedAccess_accessLevelMoreinfo",
"prefix": "4.2",
"text": "Requested access level - further information",
"type": "string",
"enableWhen": [
{
"question": "requestedAccess_accessLevel",
"operator": "=",
"answerCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-RequestedAccess",
"code": "RECRD",
"display": "Medical Records Access"
}
}
],
"enableBehavior": "all",
"required": false,
"repeats": false,
"readOnly": false,
"maxLength": 2000
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check-box"
}
]
}
}
],
"linkId": "requestedAccess_reasonsForAccess",
"prefix": "4.3",
"text": "Reason for access",
"type": "choice",
"required": false,
"repeats": true,
"readOnly": false,
"answerOption": [
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "COMB",
"display": "Communication Barriers"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "MHEA",
"display": "Mental Health Condition"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "PHYS",
"display": "Physical Condition"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "PRAC",
"display": "Practical Reasons"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "TECH",
"display": "Technical Barriers"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "NEUR",
"display": "Neurodiverse"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "LRN",
"display": "Learning Disability"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "OTHR",
"display": "Other"
}
},
{
"valueCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "NotSpecified",
"display": "Prefer not to say"
}
}
]
},
{
"linkId": "requestedAccess_reasonsForAccessMoreinfo",
"prefix": "4.4",
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"type": "string",
"enableWhen": [
{
"question": "requestedAccess_reasonsForAccess",
"operator": "=",
"answerCoding": {
"system": "https://fhir.nhs.uk/CodeSystem/Proxy-Placeholder-ReasonForAccess",
"code": "OTHR",
"display": "Other"
}
}
],
"enableBehavior": "all",
"required": false,
"repeats": false,
"readOnly": false,
"maxLength": 2000
}
]
}
]
}