<Questionnaire xmlns="http://hl7.org/fhir">
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  <language value="en" />
  <contained>
    <Library>
      <id value="liquid" />
      <status value="active" />
      <type>
        <coding>
          <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/library-types" />
          <code value="qr-narrative-liquid" />
        </coding>
      </type>
      <description value="HTML with embedded [FHIRPath Liquid](https://confluence.hl7.org/spaces/FHIR/pages/66938964/FHIR+Liquid+Profile) that is intended to be executed against QuestionnaireResponses based on this Questionnaire." />
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        <contentType value="text/html" />
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          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_gender" />
      <text value="Gender:" />
      <type value="choice" />
      <required value="true" />
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender" />
          <code value="male" />
          <display value="Male" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender" />
          <code value="female" />
          <display value="Female" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/administrative-gender" />
          <code value="other" />
          <display value="Other" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="HN PC" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_hc_pc" />
      <text value="HN PC:" />
      <type value="string" />
      <maxLength value="2" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="HN" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_hc_number" />
      <text value="HN:" />
      <type value="string" />
      <maxLength value="10" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/minLength">
        <valueInteger value="10" />
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="HN VC" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_hc_vc" />
      <text value="HN VC:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Address" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_address_line1" />
      <text value="Address (Line 1):" />
      <type value="string" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Address Line 2" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_address_line2" />
      <text value="Address (Line 2):" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="City" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_address_city" />
      <text value="City:" />
      <type value="string" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Province" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_address_province" />
      <text value="Province:" />
      <type value="string" />
      <required value="true" />
      <maxLength value="2" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="postalcode1" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='patient_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid Canadian postal code in the format A1A 1A1." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Postal Code" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_address_postalcode" />
      <text value="Postal Code:" />
      <type value="string" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="phone1" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='patient_phone_mobile').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Mobile #" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_phone_mobile" />
      <text value="Mobile #:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="phone2" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='patient_phone_home').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Home #" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_phone_home" />
      <text value="Home #:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="phone3" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='patient_phone_business').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Business #" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_phone_business" />
      <text value="Business #:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="email1" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='patient_email').answer.all(value.matches('(?:[a-z0-9!#$%&amp;'*+/=?^_`{|}~-]+(?:\.[a-z0-9!#$%&amp;'*+/=?^_`{|}~-]+)*|\&quot;(?:[\x01-\x08\x0b\x0c\x0e-\x1f\x21\x23-\x5b\x5d-\x7f]|\\[\x01-\x09\x0b\x0c\x0e-\x7f])*\&quot;)@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\\[(?:(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9]))\\.){3}(?:(2(5[0-5]|[0-4][0-9])|1[0-9][0-9]|[1-9]?[0-9])|[a-z0-9-]*[a-z0-9]:(?:[\x01-\x08\x0b\x0c\x0e-\x1f\x21-\x5a\x53-\x7f]|\\[\x01-\x09\x0b\x0c\x0e-\x7f])+)\])'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid email address." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Email" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="patient_email" />
      <text value="Email:" />
      <type value="string" />
    </item>
  </item>
  <item>
    <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
      <valueCodeableConcept>
        <coding>
          <system value="http://hl7.org/fhir/questionnaire-item-control" />
          <code value="list" />
          <display value="List" />
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
      <extension url="sortIndex">
        <valuePositiveInt value="2" />
      </extension>
      <extension url="text">
        <valueString value="[Optional] Additional Patient Information" />
      </extension>
      <extension url="listSeparator">
        <valueString>
          <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;" />
          </extension>
        </valueString>
      </extension>
      <extension url="lastSeparator">
        <valueString>
          <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;" />
          </extension>
        </valueString>
      </extension>
      <extension url="style">
        <valueString value="font-weight:bold;text-decoration:underline;" />
      </extension>
      <extension url="groupItems">
        <valueBoolean value="false" />
      </extension>
    </extension>
    <linkId value="additionalinfo_header" />
    <text value="[Optional] Additional Patient Information">
      <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;" />
      </extension>
    </text>
    <type value="group" />
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
        <valueUrl value="https://tx.fhir.org/r4" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="radio-button" />
            <display value="Radio Button" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Sex assigned at birth" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_sexassignedatbirth" />
      <text value="Sex assigned at birth:" />
      <type value="choice" />
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA3-6" />
          <display value="Female" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA2-8" />
          <display value="Male" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="Intersex" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA4489-6" />
          <display value="Unknown" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
        <valueUrl value="https://tx.fhir.org/r4" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="radio-button" />
            <display value="Radio Button" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Pronouns" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_pronouns" />
      <text value="Pronouns:" />
      <type value="choice" />
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA29519-8" />
          <display value="She/Her" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA29518-0" />
          <display value="He/Him" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org" />
          <code value="LA29519-8" />
          <display value="They/Them" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="Other" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Other Pronouns" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_pronouns_other" />
      <text value="Other pronouns:" />
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_pronouns" />
        <operator value="=" />
        <answerCoding>
          <display value="Other" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
        <valueUrl value="https://tx.fhir.org/r4" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="radio-button" />
            <display value="Radio Button" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Preferred language" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_preferredlanguage" />
      <text value="Preferred language:" />
      <type value="choice" />
      <required value="false" />
      <answerOption>
        <valueCoding>
          <system value="urn:ietf:bcp:47" />
          <code value="en" />
          <display value="English" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="urn:ietf:bcp:47" />
          <code value="fr" />
          <display value="French" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="Other" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Specify" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_preferredlanguage_specify" />
      <text value="Specify:" />
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_preferredlanguage" />
        <operator value="=" />
        <answerCoding>
          <display value="Other" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Translator required" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_preferredlanguage_translatorrequired" />
      <text value="Translator required">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <enableWhen>
        <question value="additionalinfo_preferredlanguage" />
        <operator value="=" />
        <answerCoding>
          <display value="Other" />
        </answerCoding>
      </enableWhen>
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Translator Required" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Preferred name" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_preferredname_select" />
      <text value="Preferred name">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Preferred Name" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Preferred Name:" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_preferredname" />
      <text value="Prefered name String">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_preferredname_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Preferred Name" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
        <valueUrl value="https://tx.fhir.org/r4" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="radio-button" />
            <display value="Radio Button" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Best method of contact" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_bestmethodofcontact" />
      <text value="Best method of contact:" />
      <type value="choice" />
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-system" />
          <code value="phone" />
          <display value="Mobile" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-system" />
          <code value="phone" />
          <display value="Home" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-system" />
          <code value="phone" />
          <display value="Business" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://hl7.org/fhir/contact-point-system" />
          <code value="email" />
          <display value="Email" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Voicemails acceptable" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression">
        <valueExpression>
          <language value="text/fhirpath" />
          <expression value="%resource.repeat(item).where(linkId = 'additionalinfo_bestmethodofcontact').answer.value.where(display.lower() = 'home' or display.lower() = 'mobile' or display.lower() = 'business').exists()" />
        </valueExpression>
      </extension>
      <linkId value="additionalinfo_bestmethodofcontact_voicemails" />
      <text value="Voicemails acceptable">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <enableBehavior value="any" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Voicemails acceptable" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
        <valueUrl value="https://tx.fhir.org/r4" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Alternate contact" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_alternatecontact_select" />
      <text value="Alternate contact">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Alternate contact" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Name" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_alternatecontact_name" />
      <text value="Name:" />
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Alternate contact" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="phone4" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='additionalinfo_alternatecontact_phone').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Alternate contact phone #" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_alternatecontact_phone" />
      <text value="Alternate contact phone #:" />
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Alternate contact" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Relationship" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_alternatecontact_relationship" />
      <text value="Relationship:" />
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Alternate contact" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="radio-button" />
            <display value="Radio Button" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Is Alternate contact the appointment booking contact?" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_alternatecontact_bookingcontact" />
      <text value="Is Alternate contact the appointment booking contact?:" />
      <type value="choice" />
      <enableWhen>
        <question value="additionalinfo_alternatecontact_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Alternate contact" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
      <answerOption>
        <valueCoding>
          <display value="Yes" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="No" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Unsafe contact persons (do not speak with)" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_unsafecontacts_select" />
      <text value="Unsafe contact persons (do not speak with)">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Unsafe contact persons (do not speak with)" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Only speak with patient directly" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_unsafecontacts_speakwithpatientdirectly" />
      <text value="Only speak with patient directly">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <enableWhen>
        <question value="additionalinfo_unsafecontacts_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Unsafe contact persons (do not speak with)" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
          <extension url="style">
            <valueString value="font-weight:bold;" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Only speak with patient directly" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Do not speak with:" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_unsafecontacts_donotspeakwith" />
      <text value="Do not speak with:" />
      <type value="string" />
      <enableWhen>
        <question value="additionalinfo_unsafecontacts_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Unsafe contact persons (do not speak with)" />
        </answerCoding>
      </enableWhen>
      <enableBehavior value="all" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Accessibility concerns or disability" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_accessibilityconcernsordisability_selectt" />
      <text value="Accessibility concerns or disability">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Accessibility concerns or disability" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Specific" />
        </extension>
        <extension url="listSeparator">
          <valueString value=";" />
        </extension>
        <extension url="lastSeparator">
          <valueString value="and" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
      </extension>
      <linkId value="additionalinfo_accessibilityconcernsordisability" />
      <text value="Accessibility concerns Options">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
          <valueString value="&lt;br/&gt;" />
        </extension>
      </text>
      <type value="choice" />
      <enableWhen>
        <question value="additionalinfo_accessibilityconcernsordisability_selectt" />
        <operator value="=" />
        <answerCoding>
          <display value="Accessibility concerns or disability" />
        </answerCoding>
      </enableWhen>
      <repeats value="true" />
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="129839007" />
          <display value="Falls risk" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="301621006" />
          <display value="Patient requires lift" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="105503008" />
          <display value="Wheelchair" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="15188001" />
          <display value="Hearing impaired" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="check-box" />
            <display value="Check-box" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Special considerations" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_specialconsiderations_select" />
      <text value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)">
        <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
          <valueString value="display:none;" />
        </extension>
      </text>
      <type value="choice" />
      <repeats value="true" />
      <answerOption>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/option-note-info">
          <extension url="text">
            <valueString value="Yes" />
          </extension>
        </extension>
        <valueCoding>
          <display value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)" />
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Details of special considerations" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="additionalinfo_specialconsiderations" />
      <text value="Details of special considerations:" />
      <type value="text" />
      <enableWhen>
        <question value="additionalinfo_specialconsiderations_select" />
        <operator value="=" />
        <answerCoding>
          <display value="Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)" />
        </answerCoding>
      </enableWhen>
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation">
        <valueCode value="horizontal" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="radio-button" />
            <display value="Radio Button" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Payer Type" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
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      <extension url="sortIndex">
        <valuePositiveInt value="15" />
      </extension>
      <extension url="text">
        <valueString value="Referrer's Information" />
      </extension>
      <extension url="listSeparator">
        <valueString>
          <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;" />
          </extension>
        </valueString>
      </extension>
      <extension url="lastSeparator">
        <valueString>
          <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
            <valueString value="&lt;br/&gt;" />
          </extension>
        </valueString>
      </extension>
      <extension url="style">
        <valueString value="font-weight:bold;text-decoration:underline;" />
      </extension>
      <extension url="groupItems">
        <valueBoolean value="false" />
      </extension>
    </extension>
    <linkId value="referrer_header" />
    <text value="Referrer's Information">
      <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="font-weight:bold;" />
      </extension>
    </text>
    <type value="group" />
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Site Name" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_sitename" />
      <text value="Site Name:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Address (Line 1)" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_address_line1" />
      <text value="Address (Line 1):" />
      <type value="string" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Address (Line 2)" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_address_line2" />
      <text value="Address (Line 2):" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="City" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_address_city" />
      <text value="City:" />
      <type value="string" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Province" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_address_province" />
      <text value="Province:" />
      <type value="string" />
      <required value="true" />
      <maxLength value="2" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="postalcode2" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='referrer_address_postalcode').answer.all(value.matches('^(?!.*[DFIOQU])[A-VXY][0-9][A-Z] ?[0-9][A-Z][0-9]$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Must be a valid Canadian postal code" />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Postal Code" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_address_postalcode" />
      <text value="Postal Code:" />
      <type value="string" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="phone5" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='referrer_phone').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Phone #" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_phone" />
      <text value="Phone #:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint">
        <extension url="key">
          <valueId value="phone6" />
        </extension>
        <extension url="severity">
          <valueCode value="error" />
        </extension>
        <extension url="expression">
          <valueExpression>
            <language value="text/fhirpath" />
            <expression value="%resource.repeat(item).where(linkId='referrer_fax').answer.all(value.matches('^(\+\d{1,2}\s?)?\(?\d{3}\)?[\s.-]?\d{3}[\s.-]?\d{4}$'))" />
          </valueExpression>
        </extension>
        <extension url="human">
          <valueString value="Please enter a valid north-american phone number.  e.g. XXX-XXX-XXXX." />
        </extension>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Fax #" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_fax" />
      <text value="Fax #:" />
      <type value="string" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Billing Number" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_billing" />
      <text value="Billing Number:" />
      <type value="integer" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Professional ID" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_professionalid" />
      <text value="Professional ID:" />
      <type value="integer" />
    </item>
    <item>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Signed" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_signature" />
      <text value="Signed:" />
      <type value="text" />
      <required value="true" />
    </item>
    <item>
      <extension url="http://hl7.org/fhir/StructureDefinition/preferredTerminologyServer">
        <valueUrl value="https://tx.fhir.org/r4" />
      </extension>
      <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control" />
            <code value="drop-down" />
            <display value="Drop down" />
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info">
        <extension url="text">
          <valueString value="Role" />
        </extension>
        <extension url="sameLine">
          <valueBoolean value="false" />
        </extension>
        <extension url="quoteAnswer">
          <valueBoolean value="false" />
        </extension>
        <extension url="style">
          <valueString value="font-weight:bold;" />
        </extension>
      </extension>
      <linkId value="referrer_role" />
      <text value="Role:" />
      <type value="choice" />
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="309398001" />
          <display value="Allied Health Professional" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="62247001" />
          <display value="Family Physician" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="449161006" />
          <display value="Physician Assistant" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="398130009" />
          <display value="Medical Student" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="106292003" />
          <display value="Nurse" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="224571005" />
          <display value="Nurse Practitioner" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="405277009" />
          <display value="Resident" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct" />
          <code value="69280009" />
          <display value="Specialist" />
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="Other" />
        </valueCoding>
      </answerOption>
    </item>
  </item>
</Questionnaire>