QuestionnaireResponse-RoD-Example

Example of a filled RoD Form.

QuestionnaireResponse
{
    "resourceType": "QuestionnaireResponse",
    "id": "QuestionnaireResponse-RoD-Example",
    "questionnaire": "https://fhir.nhs.uk/Questionnaire/NHSDigital-Questionnaire-Genomics-Example",
    "status": "completed",
    "subject": {
        "reference": "Patient/Patient-LindsaySorrell-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307946"
        }
    },
    "authored": "2023-08-21",
    "author": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/sds-role-profile-id",
            "value": "9999999996"
        },
        "display": "Test AHP"
    },
    "source": {
        "reference": "Patient/Patient-LindsaySorrell-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307946"
        }
    },
    "item":  [
        {
            "linkId": "patientDetails",
            "text": "Patient Details",
            "item":  [
                {
                    "linkId": "givenName",
                    "text": "First Name",
                    "answer":  [
                        {
                            "valueString": "Lindsay"
                        }
                    ]
                },
                {
                    "linkId": "familyName",
                    "text": "Last Name",
                    "answer":  [
                        {
                            "valueString": "Sorrell"
                        }
                    ]
                },
                {
                    "linkId": "nhs_Number",
                    "text": "NHS number (or postcode if not not known)",
                    "answer":  [
                        {
                            "valueString": "944 9307 946"
                        }
                    ]
                },
                {
                    "linkId": "birthDate",
                    "text": "Date of Birth",
                    "answer":  [
                        {
                            "valueDate": "2011-04-12"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "declaration4",
            "text": "Confirmation of Your Genomic Test and Research Choices",
            "item":  [
                {
                    "linkId": "confirmation",
                    "text": "I confirm that I have had the opportunity to discuss information about genomic testing, I agree to the genomic test, and my research choice is indicated below.",
                    "item":  [
                        {
                            "linkId": "researchConfirmation1",
                            "text": "I have discussed taking part in the National Genomic Research Library. If your answer to A is NO then please ignore B and sign directly below",
                            "answer":  [
                                {
                                    "valueBoolean": true
                                }
                            ]
                        },
                        {
                            "linkId": "researchConfirmation2",
                            "text": "I agree that my data and remainder sample may contribute to the National Genomic Research Library",
                            "answer":  [
                                {
                                    "valueBoolean": true
                                }
                            ]
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "isRespondentAttorney",
            "text": "Are you completing this form on behalf of someone?",
            "answer":  [
                {
                    "valueBoolean": false
                }
            ]
        },
        {
            "linkId": "patientValidation",
            "text": "Patient Validation",
            "item":  [
                {
                    "linkId": "patientNamecombined",
                    "text": "Patient Name",
                    "answer":  [
                        {
                            "valueString": "Mr. Lindsay Sorrell"
                        }
                    ]
                },
                {
                    "linkId": "patientSignature",
                    "text": "Signature",
                    "answer":  [
                        {
                            "valueString": "NA"
                        }
                    ]
                },
                {
                    "linkId": "datePatientCompletedForm",
                    "text": "Date",
                    "answer":  [
                        {
                            "valueDateTime": "2023-08-21"
                        }
                    ]
                }
            ]
        },
        {
            "linkId": "declaration5",
            "text": "Healthcare professional use only",
            "item":  [
                {
                    "linkId": "healthcareProfessional",
                    "text": "To be completed by the healthcare professional recording the patient’s choices.",
                    "item":  [
                        {
                            "linkId": "patientCategory",
                            "text": "Patient category",
                            "answer":  [
                                {
                                    "valueCoding": {
                                        "system": "https://fhir.nhs.uk/CodeSystem/patient-choice-category-genomics",
                                        "code": "adult-own-choice",
                                        "display": "Adult(made their own choice)"
                                    }
                                }
                            ]
                        },
                        {
                            "linkId": "testType",
                            "text": "Test type",
                            "answer":  [
                                {
                                    "valueCoding": {
                                        "system": "https://fhir.nhs.uk/CodeSystem/test-type-genomics",
                                        "code": "RID-WGS",
                                        "display": "Rare and Inherited Diseases - WGS"
                                    }
                                }
                            ]
                        },
                        {
                            "linkId": "remoteConsent",
                            "text": "Remote consent, recorded remotely by clinician, no patient signature",
                            "answer":  [
                                {
                                    "valueBoolean": true
                                }
                            ]
                        },
                        {
                            "linkId": "responsibleClinician",
                            "text": "Responsible clinician",
                            "answer":  [
                                {
                                    "valueString": "Dr Hazel Smith"
                                }
                            ]
                        },
                        {
                            "linkId": "patientMRN",
                            "text": "Hospital number",
                            "answer":  [
                                {
                                    "valueString": "RWT14789"
                                }
                            ]
                        },
                        {
                            "linkId": "healthcareProfessionalName",
                            "text": "Healthcare professional name",
                            "answer":  [
                                {
                                    "valueString": "Test AHP"
                                }
                            ]
                        },
                        {
                            "linkId": "healthcareProfessionalSignature",
                            "text": "Signature",
                            "answer":  [
                                {
                                    "valueString": "Dr. Hazel Smith"
                                }
                            ]
                        },
                        {
                            "linkId": "datehealthcareProfessionalCompletedForm",
                            "text": "Date",
                            "answer":  [
                                {
                                    "valueDateTime": "2023-08-21"
                                }
                            ]
                        }
                    ]
                }
            ]
        }
    ]
}
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
    <id value="QuestionnaireResponse-RoD-Example" />
    <questionnaire value="https://fhir.nhs.uk/Questionnaire/NHSDigital-Questionnaire-Genomics-Example" />
    <status value="completed" />
    <subject>
        <reference value="Patient/Patient-LindsaySorrell-Example" />
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9449307946" />
        </identifier>
    </subject>
    <authored value="2023-08-21" />
    <author>
        <identifier>
            <system value="https://fhir.nhs.uk/Id/sds-role-profile-id" />
            <value value="9999999996" />
        </identifier>
        <display value="Test AHP" />
    </author>
    <source>
        <reference value="Patient/Patient-LindsaySorrell-Example" />
        <identifier>
            <system value="https://fhir.nhs.uk/Id/nhs-number" />
            <value value="9449307946" />
        </identifier>
    </source>
    <item>
        <linkId value="patientDetails" />
        <text value="Patient Details" />
        <item>
            <linkId value="givenName" />
            <text value="First Name" />
            <answer>
                <valueString value="Lindsay" />
            </answer>
        </item>
        <item>
            <linkId value="familyName" />
            <text value="Last Name" />
            <answer>
                <valueString value="Sorrell" />
            </answer>
        </item>
        <item>
            <linkId value="nhs_Number" />
            <text value="NHS number (or postcode if not not known)" />
            <answer>
                <valueString value="944 9307 946" />
            </answer>
        </item>
        <item>
            <linkId value="birthDate" />
            <text value="Date of Birth" />
            <answer>
                <valueDate value="2011-04-12" />
            </answer>
        </item>
    </item>
    <item>
        <linkId value="declaration4" />
        <text value="Confirmation of Your Genomic Test and Research Choices" />
        <item>
            <linkId value="confirmation" />
            <text value="I confirm that I have had the opportunity to discuss information about genomic testing, I agree to the genomic test, and my research choice is indicated below." />
            <item>
                <linkId value="researchConfirmation1" />
                <text value="I have discussed taking part in the National Genomic Research Library. If your answer to A is NO then please ignore B and sign directly below" />
                <answer>
                    <valueBoolean value="true" />
                </answer>
            </item>
            <item>
                <linkId value="researchConfirmation2" />
                <text value="I agree that my data and remainder sample may contribute to the National Genomic Research Library" />
                <answer>
                    <valueBoolean value="true" />
                </answer>
            </item>
        </item>
    </item>
    <item>
        <linkId value="isRespondentAttorney" />
        <text value="Are you completing this form on behalf of someone?" />
        <answer>
            <valueBoolean value="false" />
        </answer>
    </item>
    <item>
        <linkId value="patientValidation" />
        <text value="Patient Validation" />
        <item>
            <linkId value="patientNamecombined" />
            <text value="Patient Name" />
            <answer>
                <valueString value="Mr. Lindsay Sorrell" />
            </answer>
        </item>
        <item>
            <linkId value="patientSignature" />
            <text value="Signature" />
            <answer>
                <valueString value="NA" />
            </answer>
        </item>
        <item>
            <linkId value="datePatientCompletedForm" />
            <text value="Date" />
            <answer>
                <valueDateTime value="2023-08-21" />
            </answer>
        </item>
    </item>
    <item>
        <linkId value="declaration5" />
        <text value="Healthcare professional use only" />
        <item>
            <linkId value="healthcareProfessional" />
            <text value="To be completed by the healthcare professional recording the patient’s choices." />
            <item>
                <linkId value="patientCategory" />
                <text value="Patient category" />
                <answer>
                    <valueCoding>
                        <system value="https://fhir.nhs.uk/CodeSystem/patient-choice-category-genomics" />
                        <code value="adult-own-choice" />
                        <display value="Adult(made their own choice)" />
                    </valueCoding>
                </answer>
            </item>
            <item>
                <linkId value="testType" />
                <text value="Test type" />
                <answer>
                    <valueCoding>
                        <system value="https://fhir.nhs.uk/CodeSystem/test-type-genomics" />
                        <code value="RID-WGS" />
                        <display value="Rare and Inherited Diseases - WGS" />
                    </valueCoding>
                </answer>
            </item>
            <item>
                <linkId value="remoteConsent" />
                <text value="Remote consent, recorded remotely by clinician, no patient signature" />
                <answer>
                    <valueBoolean value="true" />
                </answer>
            </item>
            <item>
                <linkId value="responsibleClinician" />
                <text value="Responsible clinician" />
                <answer>
                    <valueString value="Dr Hazel Smith" />
                </answer>
            </item>
            <item>
                <linkId value="patientMRN" />
                <text value="Hospital number" />
                <answer>
                    <valueString value="RWT14789" />
                </answer>
            </item>
            <item>
                <linkId value="healthcareProfessionalName" />
                <text value="Healthcare professional name" />
                <answer>
                    <valueString value="Test AHP" />
                </answer>
            </item>
            <item>
                <linkId value="healthcareProfessionalSignature" />
                <text value="Signature" />
                <answer>
                    <valueString value="Dr. Hazel Smith" />
                </answer>
            </item>
            <item>
                <linkId value="datehealthcareProfessionalCompletedForm" />
                <text value="Date" />
                <answer>
                    <valueDateTime value="2023-08-21" />
                </answer>
            </item>
        </item>
    </item>
</QuestionnaireResponse>