Women for FHIR

Heavy Menstrual Bleeding Implementation Guide
0.1.0 - Draft

Please note, this guide is currently under development and subject to change.

Specialist Referral Form

Questionnaire

To view a rendered version of this form with the FHIR Questionnaire Viewer by LHC-Forms:
Open the Questionnaire in the Simplifier project, click on Tools (top right), and select Open with LHC-Forms – R4 Questionnaire.

Questionnaire
Questionnaire.id[0]SpecialistReferralQuestionnaire
Questionnaire.meta[0].versionId[0]1
Questionnaire.meta[0].lastUpdated[0]2025-06-01T10:00:00+02:00
Questionnaire.meta[0].profile[0]http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire
Questionnaire.url[0]https://simplifier.net/guide/hmb-fhir-ig/Questionnaire/specialist-referral-questionnaire
Questionnaire.name[0]SpecialistReferralQuestionnaire
Questionnaire.title[0]Specialist Referral Questionnaire
Questionnaire.status[0]draft
Questionnaire.experimental[0]True
Questionnaire.description[0]FHIR Questionnaire to refer a patient to a specialist
Questionnaire.item[0].linkId[0]1
Questionnaire.item[0].text[0]TBD
Questionnaire.item[0].type[0]group
Questionnaire.item[0].item[0].linkId[0]1.1
Questionnaire.item[0].item[0].text[0]Date
Questionnaire.item[0].item[0].type[0]date
Questionnaire.item[0].item[0].required[0]True
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="SpecialistReferralQuestionnaire" />
<meta>
<versionId value="1" />
<lastUpdated value="2025-06-01T10:00:00.000+02:00" />
<profile value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire" />
</meta>
<url value="https://simplifier.net/guide/hmb-fhir-ig/Questionnaire/specialist-referral-questionnaire" />
<name value="SpecialistReferralQuestionnaire" />
<title value="Specialist Referral Questionnaire" />
<status value="draft" />
<experimental value="true" />
<description value="FHIR Questionnaire to refer a patient to a specialist" />
<item>
<linkId value="1" />
<text value="TBD" />
<type value="group" />
<item>
<linkId value="1.1" />
<text value="Date" />
<type value="date" />
<required value="true" />
</item>
</item>
</Questionnaire>
{
"resourceType": "Questionnaire",
"id": "SpecialistReferralQuestionnaire",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire"
],
"versionId": "1",
"lastUpdated": "2025-06-01T10:00:00.000+02:00"
},
"url": "https://simplifier.net/guide/hmb-fhir-ig/Questionnaire/specialist-referral-questionnaire",
"name": "SpecialistReferralQuestionnaire",
"title": "Specialist Referral Questionnaire",
"status": "draft",
"experimental": true,
"description": "FHIR Questionnaire to refer a patient to a specialist",
"item": [
{
"linkId": "1",
"text": "TBD",
"type": "group",
"item": [
{
"linkId": "1.1",
"text": "Date",
"type": "date",
"required": true
}
]
}
]
}

QuestionnaireResponse

QuestionnaireResponse
QuestionnaireResponse.id[0]SpecialistReferralQuestionnaireResponseEmmaClark
QuestionnaireResponse.meta[0].versionId[0]1
QuestionnaireResponse.meta[0].lastUpdated[0]2025-06-01T10:00:00+02:00
QuestionnaireResponse.questionnaire[0]https://simplifier.net/guide/hmb-fhir-ig/Questionnaire/specialist-referral-questionnaire
QuestionnaireResponse.status[0]in-progress
QuestionnaireResponse.item[0].linkId[0]1
QuestionnaireResponse.item[0].text[0]TBD
QuestionnaireResponse.item[0].item[0].linkId[0]1.1
QuestionnaireResponse.item[0].item[0].text[0]Date
QuestionnaireResponse.item[0].item[0].answer[0].value[0]2025-05-29
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
<id value="SpecialistReferralQuestionnaireResponseEmmaClark" />
<meta>
<versionId value="1" />
<lastUpdated value="2025-06-01T10:00:00.000+02:00" />
</meta>
<questionnaire value="https://simplifier.net/guide/hmb-fhir-ig/Questionnaire/specialist-referral-questionnaire" />
<status value="in-progress" />
<item>
<linkId value="1" />
<text value="TBD" />
<item>
<linkId value="1.1" />
<text value="Date" />
<answer>
<valueDate value="2025-05-29" />
</answer>
</item>
</item>
</QuestionnaireResponse>
{
"resourceType": "QuestionnaireResponse",
"id": "SpecialistReferralQuestionnaireResponseEmmaClark",
"meta": {
"versionId": "1",
"lastUpdated": "2025-06-01T10:00:00.000+02:00"
},
"questionnaire": "https://simplifier.net/guide/hmb-fhir-ig/Questionnaire/specialist-referral-questionnaire",
"status": "in-progress",
"item": [
{
"linkId": "1",
"text": "TBD",
"item": [
{
"linkId": "1.1",
"text": "Date",
"answer": [
{
"valueDate": "2025-05-29"
}
]
}
]
}
]
}