<status value="active" /> <description value="Sample questionnaire using all questions from the Catalyst Problem Gambling Required Data Form" /> <purpose value="To serve as a model to build required MHA Gambling questionnaires." /> <item> <linkId value="Q1" /> <text value="Reason for Seeking Help With Gambling Behaviour" /> <type value="choice" /> <required value="true" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-help-seeking-reason" /> </item> <item> <linkId value="Q2" /> <text value="Number of Months Life Negatively Affected by Gambling Behaviour" /> <type value="integer" /> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="1" /> </answerCoding> </enableWhen> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="2" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> </item> <item> <linkId value="Q3" /> <text value="Length of Time Since Last Gambling Activity (Days)" /> <type value="integer" /> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="1" /> </answerCoding> </enableWhen> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="2" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> </item> <item> <linkId value="Q4" /> <text value="Sequence of Gambling Problem Identification" /> <type value="choice" /> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="1" /> </answerCoding> </enableWhen> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="2" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/sequence-of-gambling-problem" /> </item> <item> <linkId value="Q5" /> <text value="Primary Gambling Activity in the last 12 months" /> <type value="choice" /> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="1" /> </answerCoding> </enableWhen> <enableWhen> <question value="Q1" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/fhir/CodeSystem/gambling-help-seeking-reason" /> <code value="2" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year" /> <item> <linkId value="Q5-a" /> <text value="Primary Gambling Activity Frequency in last 12 months" /> <type value="choice" /> <enableWhen> <question value="Q5" /> <operator value="exists" /> <answerBoolean value="true" /> </enableWhen> <required value="true" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-frequency" /> </item> <item> <linkId value="Q5-b" /> <text value="Primary Gambling Location in last 12 months" /> <type value="choice" /> <enableWhen> <question value="Q5-a" /> <operator value="exists" /> <answerBoolean value="true" /> </enableWhen> <required value="true" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-location" /> </item> <item> <linkId value="Q5-c" /> <text value="Primary Gambling Location Frequency in last 12 months" /> <type value="choice" /> <enableWhen> <question value="Q5-b" /> <operator value="exists" /> <answerBoolean value="true" /> </enableWhen> <required value="true" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-frequency" /> </item> </item> <item> <linkId value="Q6" /> <text value="Additional Gambling Activity in the last 12 months" /> <type value="choice" /> <repeats value="true" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-activities-in-last-year" /> <item> <linkId value="Q6-a" /> <text value="Additional Gambling Activity Frequency in last 12 months" /> <type value="choice" /> <enableWhen> <question value="Q6" /> <operator value="exists" /> <answerBoolean value="true" /> </enableWhen> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-frequency" /> </item> <item> <linkId value="Q6-b" /> <text value="Additional Gambling Location in last 12 months" /> <type value="choice" /> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-location" /> </item> <item> <linkId value="Q6-c" /> <text value="Additional Gambling Location Frequency in last 12 months" /> <type value="choice" /> <enableWhen> <question value="Q6-b" /> <operator value="exists" /> <answerBoolean value="true" /> </enableWhen> <answerValueSet value="http://ontariohealth.ca/fhir/ValueSet/gambling-frequency" /> </item> </item> <item> <linkId value="Q7" /> <text value="Percentage of Time Spent Gambling by Jurisdiction" /> <type value="group" /> <item> <linkId value="Q7-a" /> <text value="Percentage of Time Spent Gambling in Ontario" /> <type value="integer" /> </item> <item> <linkId value="Q7-b" /> <text value="Percentage of Time Spent Gambling in another province" /> <type value="integer" /> </item> <item> <linkId value="Q7-c" /> <text value="Percentage of Time Spent Gambling Outside of Canada" /> <type value="integer" /> </item> </item> </Questionnaire>