FHIR Genomics Implementation Guide

Notice

Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.

QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example

Example of a filled Consultee Declaration Form.

QuestionnaireResponse

id : QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example

questionnaire : https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-ConsulteeDeclarationForm-Example

status : completed

basedOn

reference : ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example

subject

identifier

system : https://fhir.nhs.uk/Id/nhs-number

value : 9449307539

display : A Patient

authored : 2024-01-25

author

type : PractitionerRole

identifier

system : https://fhir.nhs.uk/Id/sds-role-profile-id

value : 999999999999

source

type : PractitionerRole

identifier

system : https://fhir.nhs.uk/Id/sds-role-profile-id

value : 999999999999

item

linkId : patientDetails

text : Patient Details

item

linkId : givenName

text : First Name

answer

value : Phoebe

item

linkId : familyName

text : Last Name

answer

value : Smitham

item

linkId : nhs_Number

text : NHS number (or postcode if not not known)

answer

value : 9449307539

item

linkId : birthDate

text : Date of Birth

answer

value : 2013-09-27

item

linkId : confirmationOfDecision

text : Confirmation of decision

item

linkId : confirmation

text : I confirm that I have read and had the opportunity to discuss information about acting as a consultee for the person lacking capacity. My research choices are indicated below.

item

linkId : choiceConfirmation1

text : I have been consulted about this person’s participation in the National Genomic Research Library

answer

value : True

item

linkId : choiceConfirmation2

text : I am willing to accept the role of consultee for this person

answer

value : True

item

linkId : isRemoteConsentTrue

text : Consent obtained remotely, no consultee signature

answer

value : False

item

linkId : consulteeValidation

text : Consultee Validation

item

linkId : consulteeNamecombined

text : Your Name(i.e, the Consultee)

answer

value : James Goldsmith

item

linkId : dateConsulteeCompletedForm

text : Date

answer

value : 2023-09-15

item

linkId : consulteeSignature

text : Signature

answer

value : JamesG

item

linkId : healthcareProfessionalValidation

text : Healthcare professional use only

item

linkId : healthcareProfessional

text : To be completed by the healthcare professional recording the consultee’s choices.

item

linkId : healthcareProfessionalName

text : Healthcare professional name

answer

value : Mathew Arnold

item

linkId : healthcareProfessionalSignature

text : Signature

answer

value : MathewA

item

linkId : datehealthcareProfessionalCompletedForm

text : Date

answer

value : 2023-09-15

{
    "resourceType": "QuestionnaireResponse",
    "id": "QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example",
    "questionnaire": "https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-ConsulteeDeclarationForm-Example",
    "status": "completed",
    "basedOn":  [
        {
            "reference": "ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example"
        }
    ],
    "subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307539"
        },
        "display": "A Patient"
    },
    "authored": "2024-01-25",
    "author": {
        "type": "PractitionerRole",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
            "value": "999999999999"
        }
    },
    "source": {
        "type": "PractitionerRole",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
            "value": "999999999999"
        }
    },
    "item":  [
        {
            "linkId": "patientDetails",
            "text": "Patient Details",
            "item":  [
                {
                    "linkId": "givenName",
                    "text": "First Name",
                    "answer":  [
                        {
                            "valueString": "Phoebe"
                        }
                    ]
                },
                {
                    "linkId": "familyName",
                    "text": "Last Name",
                    "answer":  [
                        {
                            "valueString": "Smitham"
                        }
                    ]
                },
                {
                    "linkId": "nhs_Number",
                    "text": "NHS number (or postcode if not not known)",
                    "answer":  [
                        {
                            "valueString": "9449307539"
                        }
                    ]
                },
                {
                    "linkId": "birthDate",
                    "text": "Date of Birth",
                    "answer":  [
                        {
                            "valueDate": "2013-09-27"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "confirmationOfDecision",
            "text": "Confirmation of decision",
            "item":  [
                {
                    "linkId": "confirmation",
                    "text": "I confirm that I have read and had the opportunity to discuss information about acting as a consultee for the person lacking capacity. My research choices are indicated below.",
                    "item":  [
                        {
                            "linkId": "choiceConfirmation1",
                            "text": "I have been consulted about this person’s participation in the National Genomic Research Library",
                            "answer":  [
                                {
                                    "valueBoolean": true
                                }
                            ]
                        },
                        {
                            "linkId": "choiceConfirmation2",
                            "text": "I am willing to accept the role of consultee for this person",
                            "answer":  [
                                {
                                    "valueBoolean": true
                                }
                            ]
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "isRemoteConsentTrue",
            "text": "Consent obtained remotely, no consultee signature",
            "answer":  [
                {
                    "valueBoolean": false
                }
            ]
        },
        {
            "linkId": "consulteeValidation",
            "text": "Consultee Validation",
            "item":  [
                {
                    "linkId": "consulteeNamecombined",
                    "text": "Your Name(i.e, the Consultee)",
                    "answer":  [
                        {
                            "valueString": "James Goldsmith"
                        }
                    ]
                },
                {
                    "linkId": "dateConsulteeCompletedForm",
                    "text": "Date",
                    "answer":  [
                        {
                            "valueDateTime": "2023-09-15"
                        }
                    ]
                },
                {
                    "linkId": "consulteeSignature",
                    "text": "Signature",
                    "answer":  [
                        {
                            "valueString": "JamesG"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "healthcareProfessionalValidation",
            "text": "Healthcare professional use only",
            "item":  [
                {
                    "linkId": "healthcareProfessional",
                    "text": "To be completed by the healthcare professional recording the consultee’s choices.",
                    "item":  [
                        {
                            "linkId": "healthcareProfessionalName",
                            "text": "Healthcare professional name",
                            "answer":  [
                                {
                                    "valueString": "Mathew Arnold"
                                }
                            ]
                        },
                        {
                            "linkId": "healthcareProfessionalSignature",
                            "text": "Signature",
                            "answer":  [
                                {
                                    "valueString": "MathewA"
                                }
                            ]
                        },
                        {
                            "linkId": "datehealthcareProfessionalCompletedForm",
                            "text": "Date",
                            "answer":  [
                                {
                                    "valueDateTime": "2023-09-15"
                                }
                            ]
                        }
                    ]
                }
            ]
        }
    ]
}

<QuestionnaireResponse xmlns="http://hl7.org/fhir">
    <id value="QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example" />
    <basedOn>
        <reference value="ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example" />
    </basedOn>
    <questionnaire value="https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-ConsulteeDeclarationForm-Example" />
    <status value="completed" />
    <subject>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9449307539" />
        </identifier>
        <display value="A Patient" />
    </subject>
    <authored value="2024-01-25" />
    <author>
        <type value="PractitionerRole" />
        <identifier>
            <system value="https://fhir.nhs.uk/Id/sds-role-profile-id" />
            <value value="999999999999" />
        </identifier>
    </author>
    <source>
        <type value="PractitionerRole" />
        <identifier>
            <system value="https://fhir.nhs.uk/Id/sds-role-profile-id" />
            <value value="999999999999" />
        </identifier>
    </source>
    <item>
        <linkId value="patientDetails" />
        <text value="Patient Details" />
        <item>
            <linkId value="givenName" />
            <text value="First Name" />
            <answer>
                <valueString value="Phoebe" />
            </answer>
        </item>
        <item>
            <linkId value="familyName" />
            <text value="Last Name" />
            <answer>
                <valueString value="Smitham" />
            </answer>
        </item>
        <item>
            <linkId value="nhs_Number" />
            <text value="NHS number (or postcode if not not known)" />
            <answer>
                <valueString value="9449307539" />
            </answer>
        </item>
        <item>
            <linkId value="birthDate" />
            <text value="Date of Birth" />
            <answer>
                <valueDate value="2013-09-27" />
            </answer>
        </item>
    </item>
    <item>
        <linkId value="confirmationOfDecision" />
        <text value="Confirmation of decision" />
        <item>
            <linkId value="confirmation" />
            <text value="I confirm that I have read and had the opportunity to discuss information about acting as a consultee for the person lacking capacity. My research choices are indicated below." />
            <item>
                <linkId value="choiceConfirmation1" />
                <text value="I have been consulted about this person’s participation in the National Genomic Research Library" />
                <answer>
                    <valueBoolean value="true" />
                </answer>
            </item>
            <item>
                <linkId value="choiceConfirmation2" />
                <text value="I am willing to accept the role of consultee for this person" />
                <answer>
                    <valueBoolean value="true" />
                </answer>
            </item>
        </item>
    </item>
    <item>
        <linkId value="isRemoteConsentTrue" />
        <text value="Consent obtained remotely, no consultee signature" />
        <answer>
            <valueBoolean value="false" />
        </answer>
    </item>
    <item>
        <linkId value="consulteeValidation" />
        <text value="Consultee Validation" />
        <item>
            <linkId value="consulteeNamecombined" />
            <text value="Your Name(i.e, the Consultee)" />
            <answer>
                <valueString value="James Goldsmith" />
            </answer>
        </item>
        <item>
            <linkId value="dateConsulteeCompletedForm" />
            <text value="Date" />
            <answer>
                <valueDateTime value="2023-09-15" />
            </answer>
        </item>
        <item>
            <linkId value="consulteeSignature" />
            <text value="Signature" />
            <answer>
                <valueString value="JamesG" />
            </answer>
        </item>
    </item>
    <item>
        <linkId value="healthcareProfessionalValidation" />
        <text value="Healthcare professional use only" />
        <item>
            <linkId value="healthcareProfessional" />
            <text value="To be completed by the healthcare professional recording the consultee’s choices." />
            <item>
                <linkId value="healthcareProfessionalName" />
                <text value="Healthcare professional name" />
                <answer>
                    <valueString value="Mathew Arnold" />
                </answer>
            </item>
            <item>
                <linkId value="healthcareProfessionalSignature" />
                <text value="Signature" />
                <answer>
                    <valueString value="MathewA" />
                </answer>
            </item>
            <item>
                <linkId value="datehealthcareProfessionalCompletedForm" />
                <text value="Date" />
                <answer>
                    <valueDateTime value="2023-09-15" />
                </answer>
            </item>
        </item>
    </item>
</QuestionnaireResponse>

Notice

QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example

Propose a change to QuestionnaireResponse-RoD-ConsulteeDeclarationForm-Example