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-PheobeSmithamYPAForm-Example
Example of a filled Young Person Assent Form.
| QuestionnaireResponse |
| id : QuestionnaireResponse-RoD-PheobeSmithamYPAForm-Example |
| questionnaire : https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-YoungPersonAssentForm-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 : declarationResponse |
| text : Please indicate your choices below by ticking the appropriate box: |
| item |
| linkId : consentQuestion1 |
| text : 1. Have you read information or has someone explained the research to you? |
| answer |
| value : True |
| item |
| linkId : consentQuestion2 |
| text : 2. Have you asked all the questions you want? |
| answer |
| value : True |
| item |
| linkId : consentQuestion3 |
| text : 3. Have you had your questions answered in a way you understand? |
| answer |
| value : True |
| item |
| linkId : consentQuestion4 |
| text : 4. Do you understand it’s OK to say you don’t want to take part – but that your parent(s), or guardian who look after you, will make the final choice? |
| answer |
| value : True |
| item |
| linkId : consentQuestion5 |
| text : 5. Are you happy to take part? |
| answer |
| value : True |
| item |
| linkId : isRemoteConsentTrue |
| text : Assent obtained remotely, no participant signature |
| answer |
| value : True |
{
"questionnaire": "https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-YoungPersonAssentForm-Example",
],
},
},
}
},
}
},
{
{
},
{
},
{
]
},
{
}
]
},
{
{
]
},
{
]
},
{
]
},
{
"text": "4. Do you understand it’s OK to say you don’t want to take part – but that your parent(s), or guardian who look after you, will make the final choice?",
]
},
{
]
}
]
},
{
]
}
]
}
</basedOn>
<questionnaire value="https://fhir.nhs.uk/Questionnaire/Questionnaire-RoD-YoungPersonAssentForm-Example" />
</identifier>
</subject>
</identifier>
</author>
</identifier>
</source>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
<text value="4. Do you understand it’s OK to say you don’t want to take part – but that your parent(s), or guardian who look after you, will make the final choice?" />
</answer>
</item>
</answer>
</item>
</item>
</answer>
</item>
</QuestionnaireResponse>