{% for currentItem in QuestionnaireResponse.item.where((linkId = 'questionnaire')) %}{% if currentItem.linkId = 'questionnaire' %}Cardio Study Referral Form
{% for currentItem in currentItem.item.where((linkId = 'commonServices') or (linkId = 'clinicalInfoSec')) %}{% if currentItem.linkId = 'commonServices' %}
Cardiology Services/Common Indications/Clinical Information
{% for currentItem in currentItem.item.where((linkId = 'echoColourDopplerSec') or (linkId = 'treadmillStressEchoSec') or (linkId = 'leadECGSec') or (linkId = 'ambulatoryBPMonitoringSec') or (linkId = 'holterMonitoringSec') or (linkId = 'cardiologyConsultSec')) %}{% if currentItem.linkId = 'echoColourDopplerSec' %}{% for currentItem in currentItem.item.where((linkId = 'echoColourDopplerSpec')) %}{% if currentItem.linkId = 'echoColourDopplerSpec' %}2D Echo And Colour Dopper: {% for currentItem in currentItem.item.where((linkId = 'echoColourDoppler1' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler2' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler3' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler4' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler5' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler7' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler8' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler9' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler10' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler11' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler13' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler14' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler16' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler17' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler18' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler19' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'echoColourDoppler20' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'echoColourDoppler1' %}Heart Murmur{% endif %}{% if currentItem.linkId = 'echoColourDoppler2' %}Native Valvular Stenosis{% endif %}{% if currentItem.linkId = 'echoColourDoppler3' %}Native Valvular Regurgitation{% endif %}{% if currentItem.linkId = 'echoColourDoppler4' %}Known or Suspected MVP with MR{% endif %}{% if currentItem.linkId = 'echoColourDoppler5' %}Prosthetic Heart Valve(s){% endif %}{% if currentItem.linkId = 'echoColourDoppler7' %}Hypertension (Hypertensive Heart Disease){% endif %}{% if currentItem.linkId = 'echoColourDoppler8' %}Dyspnea-CHF (LV Function & RVSP){% endif %}{% if currentItem.linkId = 'echoColourDoppler9' %}Dyspnea-CHF (with preserved EF){% endif %}{% if currentItem.linkId = 'echoColourDoppler10' %}Dyspnea-CHF (with reduced EF){% endif %}{% if currentItem.linkId = 'echoColourDoppler11' %}Pulmonary Disease (RV Function & RVSP){% endif %}{% if currentItem.linkId = 'echoColourDoppler13' %}Chest Pain (CAD){% endif %}{% if currentItem.linkId = 'echoColourDoppler14' %}CAD (Post MI/Intervention){% endif %}{% if currentItem.linkId = 'echoColourDoppler16' %}Aortopathy (Thoracic Aortic Disease){% endif %}{% if currentItem.linkId = 'echoColourDoppler17' %}Pericardial Disease/Effusion{% endif %}{% if currentItem.linkId = 'echoColourDoppler18' %}Cardiac Source of Systemic Emboli{% endif %}{% if currentItem.linkId = 'echoColourDoppler19' %}Arrhythmias (Atrial Fib-Flutter){% endif %}{% if currentItem.linkId = 'echoColourDoppler20' %}Arrhythmias (Syncope/Palpitations){% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %} and {% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'treadmillStressEchoSec' %}{% for currentItem in currentItem.item.where((linkId = 'treadmillStressEchoSpec')) %}{% if currentItem.linkId = 'treadmillStressEchoSpec' %}Treadmill Stress Echo: {% for currentItem in currentItem.item.where((linkId = 'treadmillStressEcho1' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho2' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho3' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho4' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho5' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho6' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho7' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'treadmillStressEcho8' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'treadmillStressEcho1' %}Screening for CAD (Moderate-High risk for CAD){% endif %}{% if currentItem.linkId = 'treadmillStressEcho2' %}Screening for CAD (Chest Pain on the Background of Multiple Coronary risks){% endif %}{% if currentItem.linkId = 'treadmillStressEcho3' %}CAD (Follow-up Post Intervention){% endif %}{% if currentItem.linkId = 'treadmillStressEcho4' %}CAD (Follow-up on Medical Therapy){% endif %}{% if currentItem.linkId = 'treadmillStressEcho5' %}Exertional Dyspnea{% endif %}{% if currentItem.linkId = 'treadmillStressEcho6' %}Valvular Stenosis (Exercise Capacity and LV Contractile Reserve){% endif %}{% if currentItem.linkId = 'treadmillStressEcho7' %}Valvular Regurgitation (Exercise Capacity and LV Contractile Reserve){% endif %}{% if currentItem.linkId = 'treadmillStressEcho8' %}Provocable LVOT Obstruction{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %} and {% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'leadECGSec' %}{% for currentItem in currentItem.item.where((linkId = 'leadECG' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'leadECG' %}12 Lead ECG{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'ambulatoryBPMonitoringSec' %}{% for currentItem in currentItem.item.where((linkId = 'ambulatoryBPMonitoring' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'ambulatoryBPMonitoring' %}24 Hour Ambulatory Blood Pressure Monitoring{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'holterMonitoringSec' %}{% for currentItem in currentItem.item.where((linkId = 'holterMonitoringTime' and answer.exists()) or (linkId = 'holterMonitoringSpec')) %}{% if currentItem.linkId = 'holterMonitoringTime' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = '3 day' %}3 day{% endif %}{% if answer.value.code = '14 day' %}14 day{% endif %}{% endfor %}{% endcapture %}{{answer}} Holter Monitoring{% endif %}{% endif %}{% if currentItem.linkId = 'holterMonitoringSpec' %}: {% for currentItem in currentItem.item.where((linkId = 'holterMonitoring1' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring2' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring3' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring4' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring5' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring6' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring7' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring8' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring9' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring10' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring11' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'holterMonitoring12Type' and answer.exists())) %}{% if currentItem.linkId = 'holterMonitoring1' %}Abnormal ECG (AV Block, Bundle Brunch Block){% endif %}{% if currentItem.linkId = 'holterMonitoring2' %}Palpitations{% endif %}{% if currentItem.linkId = 'holterMonitoring3' %}Syncope/Presyncope{% endif %}{% if currentItem.linkId = 'holterMonitoring4' %}Post CVA/TIA{% endif %}{% if currentItem.linkId = 'holterMonitoring5' %}Dyspnea/Chest Pain{% endif %}{% if currentItem.linkId = 'holterMonitoring6' %}Weakness/Fatigue{% endif %}{% if currentItem.linkId = 'holterMonitoring7' %}Rule Out A-fib/Flutter{% endif %}{% if currentItem.linkId = 'holterMonitoring8' %}A-fib Rate control{% endif %}{% if currentItem.linkId = 'holterMonitoring9' %}Atrial Arrhythmia{% endif %}{% if currentItem.linkId = 'holterMonitoring10' %}Ventricular Arrhythmia{% endif %}{% if currentItem.linkId = 'holterMonitoring11' %}Medication Effect{% endif %}{% if currentItem.linkId = 'holterMonitoring12Type' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = 'VVI' %}VVI{% endif %}{% if answer.value.code = 'DDD' %}DDD{% endif %}{% endfor %}{% endcapture %}Pacemaker ({{answer}}){% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %} and {% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'cardiologyConsultSec' %}{% for currentItem in currentItem.item.where((linkId = 'cardiologyConsult' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'cardiologyConsultSpec')) %}{% if currentItem.linkId = 'cardiologyConsult' %}CARDIOLOGY CONSULT (first available){% endif %}{% if currentItem.linkId = 'cardiologyConsultSpec' %}{% for currentItem in currentItem.item.where() %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %} or {% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'clinicalInfoSec' %}
Clinical Info
{% for currentItem in currentItem.item.where((linkId = 'clinicalInfo' and answer.exists())) %}{% if currentItem.linkId = 'clinicalInfo' %}{% if currentItem.answer.exists() %} {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}