{% for currentItem in QuestionnaireResponse.item.where((linkId = 'questionnaire')) %}{% if currentItem.linkId = 'questionnaire' %}{% for currentItem in currentItem.item.where((linkId = 'section89975948') or (linkId = 'section47452923') or (linkId = 'section20479968')) %}{% if currentItem.linkId = 'section89975948' %}{% for currentItem in currentItem.item.where() %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section47452923' %}{% for currentItem in currentItem.item.where((linkId = 'section35521488') or (linkId = 'section38344247') or (linkId = 'section72063455')) %}{% if currentItem.linkId = 'section35521488' %}{% for currentItem in currentItem.item.where((linkId = 'section76158872') or (linkId = 'section25321155')) %}{% if currentItem.linkId = 'section76158872' %}{% for currentItem in currentItem.item.where() %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section25321155' %}Si votre patient est en situation de crise et a besoin d’une aide immédiate:
{% for currentItem in currentItem.item.where() %}{% 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 = 'section38344247' %}Consentement {% for currentItem in currentItem.item.where((linkId = 'item34143726' and answer.exists()) or (linkId = 'section32071016')) %}{% if currentItem.linkId = 'item34143726' %}{% if currentItem.answer.exists() %}Le patient est-il au courant de cet aiguillage et consent-il à participer: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section32071016' %}{% for currentItem in currentItem.item.where((linkId = 'item31741452' and answer.exists()) or (linkId = 'section65500470')) %}{% if currentItem.linkId = 'item31741452' %}{% if currentItem.answer.exists() %}Le patient est-il apte à consentir au traitement: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% if answer.value.code = 'Inconnu' %}Inconnu{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section65500470' %}Mandataire spécial/Procureur au soin de la personne/Tuteur et curateur public
{% for currentItem in currentItem.item.where((linkId = 'item47490306' and answer.exists()) or (linkId = 'item22491526' and answer.exists())) %}{% if currentItem.linkId = 'item47490306' %}{% if currentItem.answer.exists() %}Nom: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item22491526' %}{% if currentItem.answer.exists() %}Numéro de téléphone: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 %}
{% endif %}{% if currentItem.linkId = 'section72063455' %}{% for currentItem in currentItem.item.where((linkId = 'section61809637') or (linkId = 'section47535656') or (linkId = 'section62444278') or (linkId = 'section42308970') or (linkId = 'section44169758') or (linkId = 'section55467446') or (linkId = 'section35428278') or (linkId = 'section46900844') or (linkId = 'section25707508') or (linkId = 'section82740575') or (linkId = 'section80630026') or (linkId = 'section16934864')) %}{% if currentItem.linkId = 'section61809637' %}Renseignements sur le patient {% for currentItem in currentItem.item.where((linkId = 'item53251990' and answer.exists()) or (linkId = 'item22100237' and answer.exists()) or (linkId = 'item67884924' and answer.exists()) or (linkId = 'item44359558' and answer.exists()) or (linkId = 'item69600178' and answer.exists()) or (linkId = 'item35202059' and answer.exists()) or (linkId = 'item76640929' and answer.exists()) or (linkId = 'item55030899' and answer.exists()) or (linkId = 'item42679017' and answer.exists()) or (linkId = 'item74434619' and answer.exists()) or (linkId = 'item10326813' and answer.exists()) or (linkId = 'item20877941' and answer.exists()) or (linkId = 'item98979066' and answer.exists()) or (linkId = 'item29802281' and answer.exists()) or (linkId = 'item81292217' and answer.exists()) or (linkId = 'item90253663' and answer.exists())) %}{% if currentItem.linkId = 'item53251990' %}{% if currentItem.answer.exists() %}Principale langue parlée: {% for answer in currentItem.answer %}{% if answer.value.code = 'Anglais' %}Anglais{% endif %}{% if answer.value.code = 'Français' %}Français{% endif %}{% if answer.value.code = 'Autre' %}Autre{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item22100237' %}{% if currentItem.answer.exists() %}Veuillez préciser: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item67884924' %}{% if currentItem.answer.exists() %}Francophone: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% if %resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Français') %}
{% if %resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Français') %}Francophone: Oui{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'item44359558' %}{% if currentItem.answer.exists() %}Besoin de services en français: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% if %resource.repeat(item).where(linkId='item67884924').answer.exists(value = 'Oui') %}
{% if %resource.repeat(item).where(linkId='item67884924').answer.exists(value = 'Oui') %}Besoin de services en français: Non{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'item69600178' %}{% if currentItem.answer.exists() %}Besoin d’un interprète: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item35202059' %}{% if currentItem.answer.exists() %}Numéro de téléphone préféré: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item76640929' %}{% if currentItem.answer.exists() %}Le patient accepte-t-il d’être contacté par courriel: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item55030899' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Courriel: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item42679017' %}{% if currentItem.answer.exists() %}Situation de logement: {% for answer in currentItem.answer %}{% if answer.value.code = 'Seul(e)' %}Seul(e){% endif %}{% if answer.value.code = 'Avec un(e) conjoint(e)/membre de la famille' %}Avec un(e) conjoint(e)/membre de la famille{% endif %}{% if answer.value.code = 'Logement supervisé' %}Logement supervisé{% endif %}{% if answer.value.code = 'Foyer d’accueil' %}Foyer d’accueil{% endif %}{% if answer.value.code = 'Résidence' %}Résidence{% endif %}{% if answer.value.code = 'Sans domicile fixe' %}Sans domicile fixe{% endif %}{% if answer.value.code = 'Autre' %}Autre{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item74434619' %}{% if currentItem.answer.exists() %}Veuillez préciser: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item10326813' %}{% if currentItem.answer.exists() %}Le patient a-t-il accès à la technologie pour recevoir des soins virtuels: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% if answer.value.code = 'Incertain' %}Incertain{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item20877941' %}{% if currentItem.answer.exists() %}Veuillez fournir tout commentaire/renseignement supplémentaire: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item98979066' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = 'Homme' %}Homme{% endif %}{% if answer.value.code = 'Femme' %}Femme{% endif %}{% if answer.value.code = 'Genre queer' %}Genre queer{% endif %}{% if answer.value.code = 'Intersexué(e)' %}Intersexué(e){% endif %}{% if answer.value.code = 'Non binaire' %}Non binaire{% endif %}{% if answer.value.code = 'En questionnement' %}En questionnement{% endif %}{% if answer.value.code = 'Transsexuel(le)' %}Transsexuel(le){% endif %}{% if answer.value.code = 'Bispirituel(le)' %}Bispirituel(le){% endif %}{% if answer.value.code = 'Inconnu' %}Inconnu{% endif %}{% if answer.value.code = 'Refuse de répondre' %}Refuse de répondre{% endif %}{% if answer.value.code = 'Autre' %}Autre{% endif %}{% endfor %}{% endcapture %}Genre: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item29802281' %}{% if currentItem.answer.exists() %}Veuillez préciser: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item81292217' %}{% if currentItem.answer.exists() %}Pharmacie préférée: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item90253663' %}{% if currentItem.answer.exists() %}Continuerez-vous de fournir des soins à ce patient après son congé du programme auquel nous allons l’inscrir: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section47535656' %}Veuillez aiguiller directement les gens vers AccèsSMT (Est de l’Ontario)
{% endif %}{% if currentItem.linkId = 'section62444278' %}Détails de la demande Gériatrie {% for currentItem in currentItem.item.where((linkId = 'section25363119') or (linkId = 'section22510543') or (linkId = 'section83789698')) %}{% if currentItem.linkId = 'section25363119' %}Raisons de l’aiguillage {% for currentItem in currentItem.item.where((linkId = 'item90686790' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item20817558' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item7783840' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item64934451' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item94072441' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item81001366' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section58580704')) %}{% if currentItem.linkId = 'item90686790' %}Diagnostic / clarification de diagnostic{% endif %}{% if currentItem.linkId = 'item20817558' %}Gestion du sevrage / stabilisation avec un traitement par agoniste des opiacés{% endif %}{% if currentItem.linkId = 'item7783840' %}Traitement pour un problème de toxicomanie / recommandations de traitement{% endif %}{% if currentItem.linkId = 'item64934451' %}Recommandations de médicaments / revue des médicaments{% endif %}{% if currentItem.linkId = 'item94072441' %}Traitement pour un problème de santé mentale / recommandations de traitement{% endif %}{% if currentItem.linkId = 'item81001366' %}Gestion des comportements réactifs{% endif %}{% if currentItem.linkId = 'section58580704' %}{% for currentItem in currentItem.item.where((linkId = 'item55217085' and answer.exists())) %}{% if currentItem.linkId = 'item55217085' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Autre: {{answer}}{% 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 currentItem.linkId = 'section22510543' %}Coordonnées pour fixer un rendez-vous
{% for currentItem in currentItem.item.where((linkId = 'item75905997' and answer.exists()) or (linkId = 'item33250019' and answer.exists())) %}{% if currentItem.linkId = 'item75905997' %}{% if currentItem.answer.exists() %}Nom: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item33250019' %}{% if currentItem.answer.exists() %}Numéro de téléphone: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section83789698' %}Autres détails pertinents
{% for currentItem in currentItem.item.where((linkId = 'item94306248' and answer.exists()) or (linkId = 'item95635663' and answer.exists())) %}{% if currentItem.linkId = 'item94306248' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Détails des raisons de l’aiguillage: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item95635663' %}{% if currentItem.answer.exists() %}Antécédents: {% 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 currentItem.linkId = 'section42308970' %}Détails de la demande Enfants/jeunes {% for currentItem in currentItem.item.where((linkId = 'section25383964') or (linkId = 'section77958278') or (linkId = 'section39875921') or (linkId = 'section30474379')) %}{% if currentItem.linkId = 'section25383964' %}Raisons de l’aiguillage {% for currentItem in currentItem.item.where((linkId = 'item41822197' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item73936819' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item89687517' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item64944709' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item35048963' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item67814819' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item48440940' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item5510019' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item65514873' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item94206719' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item28424670' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item80603308' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item12159999' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item32002193' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item85037680' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section39087239')) %}{% if currentItem.linkId = 'item41822197' %}Diagnostic / clarification de diagnostic{% endif %}{% if currentItem.linkId = 'item73936819' %}Gestion du sevrage / stabilisation avec un traitement par agoniste des opiacés{% endif %}{% if currentItem.linkId = 'item89687517' %}Traitement pour un problème de toxicomanie / recommandations de traitement{% endif %}{% if currentItem.linkId = 'item64944709' %}Recommandations de médicaments / revue des médicaments{% endif %}{% if currentItem.linkId = 'item35048963' %}Traitement pour un problème de santé mentale / recommandations de traitement{% endif %}{% if currentItem.linkId = 'item67814819' %}Automutilation{% endif %}{% if currentItem.linkId = 'item48440940' %}Agressivité et violence envers les autres{% endif %}{% if currentItem.linkId = 'item5510019' %}Victime de violence{% endif %}{% if currentItem.linkId = 'item65514873' %}Idées suicidaires / tentatives de suicide{% endif %}{% if currentItem.linkId = 'item94206719' %}Conflit familial, y compris des difficultés dans la relation parent-enfant{% endif %}{% if currentItem.linkId = 'item28424670' %}Problèmes d’estime de soi{% endif %}{% if currentItem.linkId = 'item80603308' %}Problèmes scolaires{% endif %}{% if currentItem.linkId = 'item12159999' %}Identité de genre / orientation sexuelle{% endif %}{% if currentItem.linkId = 'item32002193' %}Difficulté à contrôler ses émotions{% endif %}{% if currentItem.linkId = 'item85037680' %}Traumatisme{% endif %}{% if currentItem.linkId = 'section39087239' %}{% for currentItem in currentItem.item.where((linkId = 'item91657692' and answer.exists())) %}{% if currentItem.linkId = 'item91657692' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Autre: {{answer}}{% 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 currentItem.linkId = 'section77958278' %}Diagnostic / problème présenté {% for currentItem in currentItem.item.where((linkId = 'item77452728' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item39727284' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section15028140') or (linkId = 'item59458865' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item22412314' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section97282068') or (linkId = 'item48664374' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section18023648') or (linkId = 'item28514649' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section19342376') or (linkId = 'item10093168' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item89336505' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item80287888' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item13730026' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item80474498' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section654059')) %}{% if currentItem.linkId = 'item77452728' %}Dépression{% endif %}{% if currentItem.linkId = 'item39727284' %}Trouble bipolaire{% endif %}{% if currentItem.linkId = 'section15028140' %}{% for currentItem in currentItem.item.where((linkId = 'item70701164' and answer.exists())) %}{% if currentItem.linkId = 'item70701164' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Trouble(s) anxieux: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item59458865' %}Trouble obsessionnel-compulsif{% endif %}{% if currentItem.linkId = 'item22412314' %}Trouble de stress post-traumatique{% endif %}{% if currentItem.linkId = 'section97282068' %}Schizophrénie / psychose: {% for currentItem in currentItem.item.where((linkId = 'item35793003' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item98169383' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item3675958' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item77860442' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item68888897' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item54310787' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item72250062' and answer.exists())) %}{% if currentItem.linkId = 'item35793003' %}Pensées délirantes{% endif %}{% if currentItem.linkId = 'item98169383' %}Hallucinations{% endif %}{% if currentItem.linkId = 'item3675958' %}Pensées / comportements désorganisés{% endif %}{% if currentItem.linkId = 'item77860442' %}Déclin fonctionnel{% endif %}{% if currentItem.linkId = 'item68888897' %}Apathie{% endif %}{% if currentItem.linkId = 'item54310787' %}Perte de motivation{% endif %}{% if currentItem.linkId = 'item72250062' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}{{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %}, {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item48664374' %}Toxicomanie / dépendance{% endif %}{% if currentItem.linkId = 'section18023648' %}{% for currentItem in currentItem.item.where((linkId = 'item43893506' and answer.exists())) %}{% if currentItem.linkId = 'item43893506' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Trouble de la personnalité: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item28514649' %}Trouble alimentaire{% endif %}{% if currentItem.linkId = 'section19342376' %}{% for currentItem in currentItem.item.where((linkId = 'item68951342' and answer.exists()) or (linkId = 'section51669044') or (linkId = 'section26047194')) %}{% if currentItem.linkId = 'item68951342' %}{% if currentItem.answer.exists() %}Votre patient est-il prêt à recevoir de l’aide pour son trouble alimentaire: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section51669044' %}Symptômes: {% for currentItem in currentItem.item.where((linkId = 'section71725034') or (linkId = 'section41984059') or (linkId = 'section1548573') or (linkId = 'section67917308') or (linkId = 'section60725777') or (linkId = 'section35404355')) %}{% if currentItem.linkId = 'section71725034' %}Restriction alimentaire ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item94042306' and answer.exists()) or (linkId = 'item19565954' and answer.exists())) %}{% if currentItem.linkId = 'item94042306' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item19565954' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section41984059' %}Frénésie alimentaire / hyperphagie ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item89638911' and answer.exists()) or (linkId = 'item52049471' and answer.exists())) %}{% if currentItem.linkId = 'item89638911' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item52049471' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section1548573' %}Vomissements ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item9112540' and answer.exists()) or (linkId = 'item72352704' and answer.exists())) %}{% if currentItem.linkId = 'item9112540' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item72352704' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section67917308' %}Laxatifs ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item30125933' and answer.exists()) or (linkId = 'item87235538' and answer.exists())) %}{% if currentItem.linkId = 'item30125933' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item87235538' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section60725777' %}Diurétiques ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item94382781' and answer.exists()) or (linkId = 'item10709888' and answer.exists())) %}{% if currentItem.linkId = 'item94382781' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item10709888' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section35404355' %}Ipéca / pilules amaigrissantes ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item32920931' and answer.exists()) or (linkId = 'item92829072' and answer.exists())) %}{% if currentItem.linkId = 'item32920931' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item92829072' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section26047194' %}Documents justificatifs
{% for currentItem in currentItem.item.where((linkId = 'item96265798' and answer.exists()) or (linkId = 'item84364384' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'item96265798' %}{% if currentItem.answer.exists() %}Résultats des examens de laboratoire (potassium, hémoglobine, électrocardiogramme): {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item84364384' %}Résultats ci-joints (potassium, hémoglobine, électrocardiogramme){% 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 = 'item10093168' %}Trouble neurodéveloppemental{% endif %}{% if currentItem.linkId = 'item89336505' %}Trouble déficitaire de l’attention avec hyperactivité{% endif %}{% if currentItem.linkId = 'item80287888' %}Trouble / problèmes de comportement{% endif %}{% if currentItem.linkId = 'item13730026' %}Difficulté à gérer les facteurs de stress de la vie{% endif %}{% if currentItem.linkId = 'item80474498' %}Trouble du sommeil{% endif %}{% if currentItem.linkId = 'section654059' %}{% for currentItem in currentItem.item.where((linkId = 'item97447269' and answer.exists())) %}{% if currentItem.linkId = 'item97447269' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Autre: {{answer}}{% 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 currentItem.linkId = 'section39875921' %}Renseignements sur les parents / tuteurs
{% for currentItem in currentItem.item.where((linkId = 'section49780474') or (linkId = 'section41688168') or (linkId = 'item39570112' and answer.exists()) or (linkId = 'item68700431' and answer.exists()) or (linkId = 'item57168635' and answer.exists()) or (linkId = 'item53094760' and answer.exists()) or (linkId = 'section81851903')) %}{% if currentItem.linkId = 'section49780474' %}Parent / tuteur 1:
{% for currentItem in currentItem.item.where((linkId = 'item12021825' and answer.exists()) or (linkId = 'item28080466' and answer.exists()) or (linkId = 'item87046010' and answer.exists()) or (linkId = 'item25729500' and answer.exists())) %}{% if currentItem.linkId = 'item12021825' %}{% if currentItem.answer.exists() %}Nom: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item28080466' %}{% if currentItem.answer.exists() %}Relation avec le patient: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item87046010' %}{% if currentItem.answer.exists() %}Adresse: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item25729500' %}{% if currentItem.answer.exists() %}Numéro de tél.: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section41688168' %}Parent / tuteur 2:
{% for currentItem in currentItem.item.where((linkId = 'item92193935' and answer.exists()) or (linkId = 'item24852225' and answer.exists()) or (linkId = 'item90386906' and answer.exists()) or (linkId = 'item1853238' and answer.exists())) %}{% if currentItem.linkId = 'item92193935' %}{% if currentItem.answer.exists() %}Nom: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item24852225' %}{% if currentItem.answer.exists() %}Relation avec le patient: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item90386906' %}{% if currentItem.answer.exists() %}Address: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item1853238' %}{% if currentItem.answer.exists() %}Numéro de tél.: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item39570112' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = 'Parent 1' %}Parent 1{% endif %}{% if answer.value.code = 'Parent 2' %}Parent 2{% endif %}{% if answer.value.code = 'Garde conjointe' %}Garde conjointe{% endif %}{% if answer.value.code = 'Autre' %}Autre{% endif %}{% endfor %}{% endcapture %}Who has custody: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item68700431' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}{{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item57168635' %}{% if currentItem.answer.exists() %}Cas géré par la Société d’aide à l’enfance: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item53094760' %}{% if currentItem.answer.exists() %}Contact: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section81851903' %}Coordonnées pour fixer un rendez-vous
{% for currentItem in currentItem.item.where((linkId = 'item16355724' and answer.exists()) or (linkId = 'item26875064' and answer.exists())) %}{% if currentItem.linkId = 'item16355724' %}{% if currentItem.answer.exists() %}Nom: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item26875064' %}{% if currentItem.answer.exists() %}Numéro de téléphone: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section30474379' %}Autres détails pertinents
{% for currentItem in currentItem.item.where((linkId = 'item45619268' and answer.exists()) or (linkId = 'item79029357' and answer.exists())) %}{% if currentItem.linkId = 'item45619268' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Détails des raisons de l’aiguillage: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item79029357' %}{% if currentItem.answer.exists() %}Antécédents: {% 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 currentItem.linkId = 'section44169758' %}Détails de la demande Adultes {% for currentItem in currentItem.item.where((linkId = 'section74309636') or (linkId = 'section68930005') or (linkId = 'section33533705')) %}{% if currentItem.linkId = 'section74309636' %}Raisons de l’aiguillage {% for currentItem in currentItem.item.where((linkId = 'item75512976' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item7665406' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item28409703' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item6660334' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item93970593' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section93522950')) %}{% if currentItem.linkId = 'item75512976' %}Diagnostic / clarification de diagnostic{% endif %}{% if currentItem.linkId = 'item7665406' %}Recommandations de médicaments / revue des médicaments{% endif %}{% if currentItem.linkId = 'item28409703' %}Traitement pour un problème de santé mentale / recommandations de traitement{% endif %}{% if currentItem.linkId = 'item6660334' %}Traitement pour un problème de toxicomanie / recommandations de traitement{% endif %}{% if currentItem.linkId = 'item93970593' %}Gestion du sevrage / stabilisation avec un traitement par agoniste des opiacés{% endif %}{% if currentItem.linkId = 'section93522950' %}{% for currentItem in currentItem.item.where((linkId = 'item52682575' and answer.exists())) %}{% if currentItem.linkId = 'item52682575' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Autre: {{answer}}{% 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 currentItem.linkId = 'section68930005' %}Diagnostic / problème présenté {% for currentItem in currentItem.item.where((linkId = 'item80118709' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item84138704' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section24771134') or (linkId = 'item50658526' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item27761130' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section42110192') or (linkId = 'item71728972' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section64556902') or (linkId = 'item99992061' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section88334295') or (linkId = 'item2356348' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item47953947' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item43437113' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item19133749' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item46418991' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item86471184' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section30991256')) %}{% if currentItem.linkId = 'item80118709' %}Dépression{% endif %}{% if currentItem.linkId = 'item84138704' %}Trouble bipolaire{% endif %}{% if currentItem.linkId = 'section24771134' %}{% for currentItem in currentItem.item.where((linkId = 'item62480832' and answer.exists())) %}{% if currentItem.linkId = 'item62480832' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Trouble(s) anxieux: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item50658526' %}Trouble obsessionnel-compulsif{% endif %}{% if currentItem.linkId = 'item27761130' %}Trouble de stress post-traumatique{% endif %}{% if currentItem.linkId = 'section42110192' %}Schizophrénie / psychose: {% for currentItem in currentItem.item.where((linkId = 'item3006542' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item77871641' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item84505679' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item627555' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item27211257' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item37290313' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item31986211' and answer.exists())) %}{% if currentItem.linkId = 'item3006542' %}Pensées délirantes{% endif %}{% if currentItem.linkId = 'item77871641' %}Hallucinations{% endif %}{% if currentItem.linkId = 'item84505679' %}Pensées / comportements désorganisés{% endif %}{% if currentItem.linkId = 'item627555' %}Déclin fonctionnel{% endif %}{% if currentItem.linkId = 'item27211257' %}Apathie{% endif %}{% if currentItem.linkId = 'item37290313' %}Perte de motivation{% endif %}{% if currentItem.linkId = 'item31986211' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Autre: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %}, {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item71728972' %}Toxicomanie / dépendance{% endif %}{% if currentItem.linkId = 'section64556902' %}{% for currentItem in currentItem.item.where((linkId = 'item64762825' and answer.exists())) %}{% if currentItem.linkId = 'item64762825' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Trouble de la personnalité: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item99992061' %}Trouble alimentaire{% endif %}{% if currentItem.linkId = 'section88334295' %}{% for currentItem in currentItem.item.where((linkId = 'item20123230' and answer.exists()) or (linkId = 'section91852048') or (linkId = 'section17551649')) %}{% if currentItem.linkId = 'item20123230' %}{% if currentItem.answer.exists() %}Votre patient est-il prêt à recevoir de l’aide pour son trouble alimentaire: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section91852048' %}Symptômes: {% for currentItem in currentItem.item.where((linkId = 'section55770179') or (linkId = 'section51255713') or (linkId = 'section72829055') or (linkId = 'section12225867') or (linkId = 'section86887923') or (linkId = 'section8936068')) %}{% if currentItem.linkId = 'section55770179' %}Restriction alimentaire ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item87799750' and answer.exists()) or (linkId = 'item66113446' and answer.exists())) %}{% if currentItem.linkId = 'item87799750' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item66113446' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section51255713' %}Frénésie alimentaire / hyperphagie ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item64698719' and answer.exists()) or (linkId = 'item34926111' and answer.exists())) %}{% if currentItem.linkId = 'item64698719' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item34926111' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section72829055' %}Vomissements ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item33365833' and answer.exists()) or (linkId = 'item39335449' and answer.exists())) %}{% if currentItem.linkId = 'item33365833' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item39335449' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section12225867' %}Laxatifs ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item7330151' and answer.exists()) or (linkId = 'item19916884' and answer.exists())) %}{% if currentItem.linkId = 'item7330151' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item19916884' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section86887923' %}Diurétiques ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item43117195' and answer.exists()) or (linkId = 'item69932235' and answer.exists())) %}{% if currentItem.linkId = 'item43117195' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item69932235' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section8936068' %}Ipéca / pilules amaigrissantes ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item61063463' and answer.exists()) or (linkId = 'item17414590' and answer.exists())) %}{% if currentItem.linkId = 'item61063463' %}{% if currentItem.answer.exists() %}Fréquence par jour: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item17414590' %}{% if currentItem.answer.exists() %}Fréquence par semaine: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section17551649' %}Documents justificatifs
{% for currentItem in currentItem.item.where((linkId = 'item19786921' and answer.exists()) or (linkId = 'item95170223' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'item19786921' %}{% if currentItem.answer.exists() %}Résultats des examens de laboratoire (potassium, hémoglobine, électrocardiogramme): {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item95170223' %}Résultats ci-joints (potassium, hémoglobine, électrocardiogramme){% 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 = 'item2356348' %}Démence{% endif %}{% if currentItem.linkId = 'item47953947' %}Trouble neurodéveloppemental{% endif %}{% if currentItem.linkId = 'item43437113' %}Trouble déficitaire de l’attention avec hyperactivité{% endif %}{% if currentItem.linkId = 'item19133749' %}Trouble / problèmes de comportement{% endif %}{% if currentItem.linkId = 'item46418991' %}Difficulté à gérer les facteurs de stress de la vie{% endif %}{% if currentItem.linkId = 'item86471184' %}Trouble du sommeil{% endif %}{% if currentItem.linkId = 'section30991256' %}{% for currentItem in currentItem.item.where((linkId = 'item90158318' and answer.exists())) %}{% if currentItem.linkId = 'item90158318' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Autre: {{answer}}{% 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 currentItem.linkId = 'section33533705' %}Autres détails pertinents
{% for currentItem in currentItem.item.where((linkId = 'item89857237' and answer.exists()) or (linkId = 'item98249284' and answer.exists())) %}{% if currentItem.linkId = 'item89857237' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Détails des raisons de l’aiguillage: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item98249284' %}{% if currentItem.answer.exists() %}Antécédents: {% 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 currentItem.linkId = 'section55467446' %}Toxicomanie / dépendance
{% for currentItem in currentItem.item.where((linkId = 'item15213756' and answer.exists()) or (linkId = 'section31036662')) %}{% if currentItem.linkId = 'item15213756' %}{% if currentItem.answer.exists() %}Le patient consomme-t-il de l’alcool ou des drogues une fois par semaine ou plus souvent: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section31036662' %}{% for currentItem in currentItem.item.where((linkId = 'item99112655' and answer.exists()) or (linkId = 'item70587319' and answer.exists()) or (linkId = 'item97592021' and answer.exists()) or (linkId = 'item62861577' and answer.exists()) or (linkId = 'section41095308')) %}{% if currentItem.linkId = 'item99112655' %}{% if currentItem.answer.exists() %}Le patient passe-t-il beaucoup de temps à se procurer, à consommer ou à se remettre des effets de l’alcool ou des drogues: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item70587319' %}{% if currentItem.answer.exists() %}Le patient continue-t-il de consommer de l’alcool ou des drogues, même si cela lui cause des problèmes: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item97592021' %}{% if currentItem.answer.exists() %}Le patient éprouve-t-il des problèmes de sevrage ou consomme-t-il d’autres substances pour en gérer les effets: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item62861577' %}{% if currentItem.answer.exists() %}Le patient est-il intéressé à recevoir une aide pour son problème de toxicomanie/dépendance: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section41095308' %}Substance(s) {% for currentItem in currentItem.item.where((linkId = 'item59783904' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section37582687') or (linkId = 'item31581567' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section86149707') or (linkId = 'item64895139' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section26270926') or (linkId = 'item27329146' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section44869588') or (linkId = 'item69266901' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section45442584') or (linkId = 'item54944000' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section70704239') or (linkId = 'item11246286' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section31173566') or (linkId = 'item13659713' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section58084914') or (linkId = 'item93357619' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section51030762') or (linkId = 'item31412993' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section46170223') or (linkId = 'item9981176' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section28618465') or (linkId = 'item77781362' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section58276332') or (linkId = 'item12551278' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section53828476') or (linkId = 'item97087037' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section36627059') or (linkId = 'item70965381' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section16760639') or (linkId = 'item12746617' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section90020901') or (linkId = 'section44070320')) %}{% if currentItem.linkId = 'item59783904' %}Alcool{% endif %}{% if currentItem.linkId = 'section37582687' %}{% for currentItem in currentItem.item.where((linkId = 'item18207012' and answer.exists()) or (linkId = 'item66923904' and answer.exists())) %}{% if currentItem.linkId = 'item18207012' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item66923904' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item31581567' %}Amphétamines / autres stimulants{% endif %}{% if currentItem.linkId = 'section86149707' %}{% for currentItem in currentItem.item.where((linkId = 'item41923594' and answer.exists()) or (linkId = 'item4506979' and answer.exists())) %}{% if currentItem.linkId = 'item41923594' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item4506979' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item64895139' %}Barbituriques{% endif %}{% if currentItem.linkId = 'section26270926' %}{% for currentItem in currentItem.item.where((linkId = 'item30444070' and answer.exists()) or (linkId = 'item87777257' and answer.exists())) %}{% if currentItem.linkId = 'item30444070' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item87777257' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item27329146' %}Benzodiazépines{% endif %}{% if currentItem.linkId = 'section44869588' %}{% for currentItem in currentItem.item.where((linkId = 'item98921464' and answer.exists()) or (linkId = 'item94878573' and answer.exists())) %}{% if currentItem.linkId = 'item98921464' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item94878573' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item69266901' %}Cannabis{% endif %}{% if currentItem.linkId = 'section45442584' %}{% for currentItem in currentItem.item.where((linkId = 'item42613443' and answer.exists()) or (linkId = 'item36534623' and answer.exists())) %}{% if currentItem.linkId = 'item42613443' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item36534623' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item54944000' %}Cocaïne / crack{% endif %}{% if currentItem.linkId = 'section70704239' %}{% for currentItem in currentItem.item.where((linkId = 'item68149312' and answer.exists()) or (linkId = 'item39860160' and answer.exists())) %}{% if currentItem.linkId = 'item68149312' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item39860160' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item11246286' %}Ecstasy / MDMA{% endif %}{% if currentItem.linkId = 'section31173566' %}{% for currentItem in currentItem.item.where((linkId = 'item59301481' and answer.exists()) or (linkId = 'item4411100' and answer.exists())) %}{% if currentItem.linkId = 'item59301481' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item4411100' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item13659713' %}Colle / inhalants{% endif %}{% if currentItem.linkId = 'section58084914' %}{% for currentItem in currentItem.item.where((linkId = 'item64375724' and answer.exists()) or (linkId = 'item89770041' and answer.exists())) %}{% if currentItem.linkId = 'item64375724' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item89770041' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item93357619' %}Hallucinogènes{% endif %}{% if currentItem.linkId = 'section51030762' %}{% for currentItem in currentItem.item.where((linkId = 'item32256201' and answer.exists()) or (linkId = 'item81453479' and answer.exists())) %}{% if currentItem.linkId = 'item32256201' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item81453479' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item31412993' %}Héroïne / opium{% endif %}{% if currentItem.linkId = 'section46170223' %}{% for currentItem in currentItem.item.where((linkId = 'item21304239' and answer.exists()) or (linkId = 'item61886107' and answer.exists())) %}{% if currentItem.linkId = 'item21304239' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item61886107' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item9981176' %}Méthamphétamines (p. ex.: en cristaux){% endif %}{% if currentItem.linkId = 'section28618465' %}{% for currentItem in currentItem.item.where((linkId = 'item10766224' and answer.exists()) or (linkId = 'item33611918' and answer.exists())) %}{% if currentItem.linkId = 'item10766224' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item33611918' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item77781362' %}Autres substances psychoactives{% endif %}{% if currentItem.linkId = 'section58276332' %}{% for currentItem in currentItem.item.where((linkId = 'item54342245' and answer.exists()) or (linkId = 'item76088976' and answer.exists())) %}{% if currentItem.linkId = 'item54342245' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item76088976' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item12551278' %}Médicaments en vente libre{% endif %}{% if currentItem.linkId = 'section53828476' %}{% for currentItem in currentItem.item.where((linkId = 'item90127806' and answer.exists()) or (linkId = 'item94560130' and answer.exists())) %}{% if currentItem.linkId = 'item90127806' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item94560130' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item97087037' %}Codéine{% endif %}{% if currentItem.linkId = 'section36627059' %}{% for currentItem in currentItem.item.where((linkId = 'item98745804' and answer.exists()) or (linkId = 'item83681744' and answer.exists())) %}{% if currentItem.linkId = 'item98745804' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item83681744' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item70965381' %}Opiacés d’ordonnance{% endif %}{% if currentItem.linkId = 'section16760639' %}{% for currentItem in currentItem.item.where((linkId = 'item20229253' and answer.exists()) or (linkId = 'item66782972' and answer.exists())) %}{% if currentItem.linkId = 'item20229253' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item66782972' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item12746617' %}Stéroïdes{% endif %}{% if currentItem.linkId = 'section90020901' %}{% for currentItem in currentItem.item.where((linkId = 'item24302256' and answer.exists()) or (linkId = 'item35462422' and answer.exists())) %}{% if currentItem.linkId = 'item24302256' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item35462422' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section44070320' %}{% for currentItem in currentItem.item.where((linkId = 'item50789363' and answer.exists()) or (linkId = 'item46581955' and answer.exists()) or (linkId = 'item34170004' and answer.exists())) %}{% if currentItem.linkId = 'item50789363' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Autre: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item46581955' %}{% if currentItem.answer.exists() %}Quantité consommée: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item34170004' %}{% if currentItem.answer.exists() %}Fréquence: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}
{% endif %}{% if currentItem.linkId = 'section35428278' %}Risques
{% for currentItem in currentItem.item.where((linkId = 'item1131572' and answer.exists()) or (linkId = 'item57097806' and answer.exists()) or (linkId = 'item85423664' and answer.exists()) or (linkId = 'item90244509' and answer.exists()) or (linkId = 'item25263968' and answer.exists()) or (linkId = 'item9851311' and answer.exists()) or (linkId = 'item67727582' and answer.exists())) %}{% if currentItem.linkId = 'item1131572' %}{% if currentItem.answer.exists() %}Visites à l’urgence / hospitalisations pertinentes: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item57097806' %}{% if currentItem.answer.exists() %}Idées suicidaires / tentatives de suicide: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item85423664' %}{% if currentItem.answer.exists() %}Automutilation: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item90244509' %}{% if currentItem.answer.exists() %}Idées / menaces d’homicide: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item25263968' %}{% if currentItem.answer.exists() %}Comportement violent: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item9851311' %}{% if currentItem.answer.exists() %}Problèmes judiciaires: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item67727582' %}{% if currentItem.answer.exists() %}Victime de violence: {% for answer in currentItem.answer %}{% if answer.value.code = 'Non' %}Non{% endif %}{% if answer.value.code = 'Oui' %}Oui{% endif %}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section46900844' %}Traitements / soutiens actuels en santé mentale ou toxicomanie / dépendance
{% for currentItem in currentItem.item.where((linkId = 'item46740689' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item80275365' and answer.exists()) or (linkId = 'item41124283' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item33017003' and answer.exists()) or (linkId = 'item892559' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item83851630' and answer.exists()) or (linkId = 'item58118764' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item92728945' and answer.exists())) %}{% if currentItem.linkId = 'item46740689' %}Psychiatre{% endif %}{% if currentItem.linkId = 'item80275365' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item41124283' %}Psychologue{% endif %}{% if currentItem.linkId = 'item33017003' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item892559' %}Travailleur social / gestionnaire de cas{% endif %}{% if currentItem.linkId = 'item83851630' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item58118764' %}Autres organismes / programmes{% endif %}{% if currentItem.linkId = 'item92728945' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section25707508' %}Traitements / soutiens précédents en santé mentale ou toxicomanie / dépendance
{% for currentItem in currentItem.item.where((linkId = 'item77373658' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item51237322' and answer.exists()) or (linkId = 'item26506079' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item3956018' and answer.exists()) or (linkId = 'item67092060' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item783738' and answer.exists()) or (linkId = 'item33359111' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item43109241' and answer.exists())) %}{% if currentItem.linkId = 'item77373658' %}Psychiatre{% endif %}{% if currentItem.linkId = 'item51237322' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item26506079' %}Psychologue{% endif %}{% if currentItem.linkId = 'item3956018' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item67092060' %}Travailleur social / gestionnaire de cas{% endif %}{% if currentItem.linkId = 'item783738' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item33359111' %}Autres organismes / programmes{% endif %}{% if currentItem.linkId = 'item43109241' %}{% if currentItem.answer.exists() %}Détails: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section82740575' %}Alertes
{% for currentItem in currentItem.item.where((linkId = 'item69369569' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section40067287') or (linkId = 'section23519481')) %}{% if currentItem.linkId = 'item69369569' %}Enceinte / période post-partum{% endif %}{% if currentItem.linkId = 'section40067287' %}{% for currentItem in currentItem.item.where((linkId = 'item82360849' and answer.exists())) %}{% if currentItem.linkId = 'item82360849' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Allergies: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section23519481' %}{% for currentItem in currentItem.item.where((linkId = 'item69837220' and answer.exists())) %}{% if currentItem.linkId = 'item69837220' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Autre(s) alerte(s): {{answer}}{% 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 currentItem.linkId = 'section80630026' %}Profil cumulatif du patient
{% for currentItem in currentItem.item.where((linkId = 'section82537102') or (linkId = 'section45363302') or (linkId = 'section94430790')) %}{% if currentItem.linkId = 'section82537102' %}Problèmes actuels:
{% for currentItem in currentItem.item.where((linkId = 'item16201253' and answer.exists())) %}{% if currentItem.linkId = 'item16201253' %}{% 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 currentItem.linkId = 'section45363302' %}Antécédents médicaux:
{% for currentItem in currentItem.item.where((linkId = 'item25739934' and answer.exists())) %}{% if currentItem.linkId = 'item25739934' %}{% 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 currentItem.linkId = 'section94430790' %}Liste des médicaments actuels:
{% for currentItem in currentItem.item.where((linkId = 'item51211229' and answer.exists())) %}{% if currentItem.linkId = 'item51211229' %}{% 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 currentItem.linkId = 'section16934864' %}Supporting Documentation Attached {% for currentItem in currentItem.item.where((linkId = 'item65123098' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item65033221' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item9309258' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'item65123098' %}Profil cumulatif du patient{% endif %}{% if currentItem.linkId = 'item65033221' %}Liste des médicaments actuels{% endif %}{% if currentItem.linkId = 'item9309258' %}Résultats des examens de laboratoire pertinents{% 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 %}{% endif %}{% if currentItem.linkId = 'section20479968' %}{% for currentItem in currentItem.item.where((linkId = 'section24117073') or (linkId = 'section7327232') or (linkId = 'section67083359')) %}{% if currentItem.linkId = 'section24117073' %}{% for currentItem in currentItem.item.where((linkId = 'section80579193') or (linkId = 'section82774710')) %}{% if currentItem.linkId = 'section80579193' %}{% for currentItem in currentItem.item.where() %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section82774710' %}If your patient is in crisis and requires immediate help:
{% for currentItem in currentItem.item.where() %}{% 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 = 'section7327232' %}Consent {% for currentItem in currentItem.item.where((linkId = 'consent1' and answer.exists()) or (linkId = 'section93356971')) %}{% if currentItem.linkId = 'consent1' %}{% if currentItem.answer.exists() %}Is patient aware of and in agreement with this referral: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section93356971' %}{% for currentItem in currentItem.item.where((linkId = 'consent2' and answer.exists()) or (linkId = 'section23411132')) %}{% if currentItem.linkId = 'consent2' %}{% if currentItem.answer.exists() %}Is patient capable to consent to treatment: {% for answer in currentItem.answer %}{% if answer.value.code = 'N' %}N{% endif %}{% if answer.value.code = 'Y' %}Y{% endif %}{% if answer.value.code = 'Unknown' %}Unknown{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section23411132' %}Substitute Decision Maker/Power of Attorney/Public Guardian & Trustee
{% for currentItem in currentItem.item.where((linkId = 'item46990902' and answer.exists()) or (linkId = 'item25445618' and answer.exists())) %}{% if currentItem.linkId = 'item46990902' %}{% if currentItem.answer.exists() %}Name: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item25445618' %}{% if currentItem.answer.exists() %}Telephone: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 %}
{% endif %}{% if currentItem.linkId = 'section67083359' %}{% for currentItem in currentItem.item.where((linkId = 'section19247319') or (linkId = 'section42718029') or (linkId = 'section26493963') or (linkId = 'section69847124') or (linkId = 'section6772368') or (linkId = 'alertsSection') or (linkId = 'riskIssueSection') or (linkId = 'section50848440') or (linkId = 'section56633689') or (linkId = 'section60045200') or (linkId = 'section21033319') or (linkId = 'section57590463')) %}{% if currentItem.linkId = 'section19247319' %}Patient Information {% for currentItem in currentItem.item.where((linkId = 'lang' and answer.exists()) or (linkId = 'item69641905' and answer.exists()) or (linkId = 'francophone' and answer.exists()) or (linkId = 'item97277940' and answer.exists()) or (linkId = 'interpreterServices' and answer.exists()) or (linkId = 'item8684758' and answer.exists()) or (linkId = 'item89989692' and answer.exists()) or (linkId = 'item90635821' and answer.exists()) or (linkId = 'ptLivingSituation' and answer.exists()) or (linkId = 'ptLivingSituationOther' and answer.exists()) or (linkId = 'item92766213' and answer.exists()) or (linkId = 'item60373042' and answer.exists()) or (linkId = 'item47156976' and answer.exists()) or (linkId = 'item95522413' and answer.exists()) or (linkId = 'item46201687' and answer.exists()) or (linkId = 'item87562344' and answer.exists())) %}{% if currentItem.linkId = 'lang' %}{% if currentItem.answer.exists() %}Main spoken language: {% for answer in currentItem.answer %}{% if answer.value.code = 'English' %}English{% endif %}{% if answer.value.code = 'French' %}French{% endif %}{% if answer.value.code = 'Other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item69641905' %}{% if currentItem.answer.exists() %}Please specify: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'francophone' %}{% if currentItem.answer.exists() %}Francophone: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% if %resource.repeat(item).where(linkId='lang').answer.exists(value = 'French') %}
{% if %resource.repeat(item).where(linkId='lang').answer.exists(value = 'French') %}Francophone: Yes{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'item97277940' %}{% if currentItem.answer.exists() %}French language services required: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% if %resource.repeat(item).where(linkId='francophone').answer.exists(value = 'Y') %}
{% if %resource.repeat(item).where(linkId='francophone').answer.exists(value = 'Y') %}French language services required: No{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'interpreterServices' %}{% if currentItem.answer.exists() %}Interpreter required: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item8684758' %}{% if currentItem.answer.exists() %}Preferred phone number: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item89989692' %}{% if currentItem.answer.exists() %}Does patient consent to being contacted via email: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item90635821' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Email Address: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'ptLivingSituation' %}{% if currentItem.answer.exists() %}Living Situation: {% for answer in currentItem.answer %}{% if answer.value.code = 'Alone' %}Alone{% endif %}{% if answer.value.code = 'With Family/Spouse' %}With Family/Spouse{% endif %}{% if answer.value.code = 'Supportive Housing' %}Supportive Housing{% endif %}{% if answer.value.code = 'Foster Home' %}Foster Home{% endif %}{% if answer.value.code = 'Residence' %}Residence{% endif %}{% if answer.value.code = 'No Fixed Address' %}No Fixed Address{% endif %}{% if answer.value.code = 'Other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'ptLivingSituationOther' %}{% if currentItem.answer.exists() %}Specify Other: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item92766213' %}{% if currentItem.answer.exists() %}Does patient have access to technology for virtual care: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% if answer.value.code = 'NotSure' %}Not sure{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item60373042' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Additional details/information: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item47156976' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = 'Male' %}Male{% endif %}{% if answer.value.code = 'Female' %}Female{% endif %}{% if answer.value.code = 'Gender queer' %}Gender queer{% endif %}{% if answer.value.code = 'Intersex' %}Intersex{% endif %}{% if answer.value.code = 'Nonbinary' %}Nonbinary{% endif %}{% if answer.value.code = 'Questioning' %}Questioning{% endif %}{% if answer.value.code = 'Transsexual' %}Transsexual{% endif %}{% if answer.value.code = 'Two spirit' %}Two spirit{% endif %}{% if answer.value.code = 'Unknown' %}Unknown{% endif %}{% if answer.value.code = 'Declined to say' %}Declined to say{% endif %}{% if answer.value.code = 'Other' %}Other{% endif %}{% endfor %}{% endcapture %}Gender: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item95522413' %}{% if currentItem.answer.exists() %}Specify: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item46201687' %}{% if currentItem.answer.exists() %}Preferred pharmacy: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item87562344' %}{% if currentItem.answer.exists() %}Will you continue to provide care for this patient once discharged from the program they have been matched to: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section42718029' %}Please refer directly to Access Mental Health and Addictions (Eastern Ontario)

{% endif %}{% if currentItem.linkId = 'section26493963' %}Geriatric Service(s) Requested {% for currentItem in currentItem.item.where((linkId = 'section74007085') or (linkId = 'section35972024') or (linkId = 'section97884944')) %}{% if currentItem.linkId = 'section74007085' %}Reason for Referral {% for currentItem in currentItem.item.where((linkId = 'r4r1' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'r4r2' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'r4r3' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item44376849' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item35681571' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item32743465' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'r4rOther' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section22948054')) %}{% if currentItem.linkId = 'r4r1' %}Diagnosis / Diagnostic clarification{% endif %}{% if currentItem.linkId = 'r4r2' %}Substance use withdrawal management / Stabilization on Opioid Agonist Therapy{% endif %}{% if currentItem.linkId = 'r4r3' %}Substance use treatment / treatment recommendations{% endif %}{% if currentItem.linkId = 'item44376849' %}Medication recommendations / review{% endif %}{% if currentItem.linkId = 'item35681571' %}Mental health treatment / treatment recommendations{% endif %}{% if currentItem.linkId = 'item32743465' %}Responsive Behaviour Management{% endif %}{% if currentItem.linkId = 'r4rOther' %}Other{% endif %}{% if currentItem.linkId = 'section22948054' %}{% for currentItem in currentItem.item.where((linkId = 'r4rOtherSpecified' and answer.exists())) %}{% if currentItem.linkId = 'r4rOtherSpecified' %}{% if currentItem.answer.exists() %}Please specify: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section35972024' %}Contact to Book Appointment
{% for currentItem in currentItem.item.where((linkId = 'item73344060' and answer.exists()) or (linkId = 'item49952973' and answer.exists())) %}{% if currentItem.linkId = 'item73344060' %}{% if currentItem.answer.exists() %}Name: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item49952973' %}{% if currentItem.answer.exists() %}Phone number: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section97884944' %}Additional Relevant Details
{% for currentItem in currentItem.item.where((linkId = 'item29068319' and answer.exists()) or (linkId = 'item56782650' and answer.exists())) %}{% if currentItem.linkId = 'item29068319' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Details on reason for referral: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item56782650' %}{% if currentItem.answer.exists() %}History: {% 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 currentItem.linkId = 'section69847124' %}Child / Youth Service(s) Requested {% for currentItem in currentItem.item.where((linkId = 'section99492249') or (linkId = 'section6468568') or (linkId = 'section18972728') or (linkId = 'section66346248')) %}{% if currentItem.linkId = 'section99492249' %}Reason for Referral {% for currentItem in currentItem.item.where((linkId = 'item76744208' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item7916443' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item64392358' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item14275892' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item84616916' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item3104556' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item53574417' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item45753134' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item54312281' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item71572236' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item93941389' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item24861720' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item46190781' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item49247275' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item10332520' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section35671588')) %}{% if currentItem.linkId = 'item76744208' %}Diagnosis / Diagnostic clarification{% endif %}{% if currentItem.linkId = 'item7916443' %}Substance use withdrawal management / Stabilization on Opioid Agonist Therapy{% endif %}{% if currentItem.linkId = 'item64392358' %}Substance use treatment / treatment recommendations{% endif %}{% if currentItem.linkId = 'item14275892' %}Medication recommendations / review{% endif %}{% if currentItem.linkId = 'item84616916' %}Mental health treatment / treatment recommendations{% endif %}{% if currentItem.linkId = 'item3104556' %}Self-harming behaviours{% endif %}{% if currentItem.linkId = 'item53574417' %}Aggression and violence towards others{% endif %}{% if currentItem.linkId = 'item45753134' %}Experiencing violence{% endif %}{% if currentItem.linkId = 'item54312281' %}Suicidal ideation or attempts{% endif %}{% if currentItem.linkId = 'item71572236' %}Family conflict including child / parent relationship difficulties{% endif %}{% if currentItem.linkId = 'item93941389' %}Self-esteem issues{% endif %}{% if currentItem.linkId = 'item24861720' %}School related issues{% endif %}{% if currentItem.linkId = 'item46190781' %}Gender identity / sexual orientation{% endif %}{% if currentItem.linkId = 'item49247275' %}Difficulties regulating emotions{% endif %}{% if currentItem.linkId = 'item10332520' %}Trauma{% endif %}{% if currentItem.linkId = 'section35671588' %}{% for currentItem in currentItem.item.where((linkId = 'item58778456' and answer.exists())) %}{% if currentItem.linkId = 'item58778456' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Other: {{answer}}{% 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 currentItem.linkId = 'section6468568' %}Working Diagnosis/Presenting Problem {% for currentItem in currentItem.item.where((linkId = 'item94424455' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item60166022' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section24987206') or (linkId = 'item7871097' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item35653741' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section82717742') or (linkId = 'item65652334' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section76044159') or (linkId = 'item12081173' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section28118605') or (linkId = 'item80944161' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item38161937' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item24951129' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item39395736' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item93828343' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section84197402')) %}{% if currentItem.linkId = 'item94424455' %}Depression{% endif %}{% if currentItem.linkId = 'item60166022' %}Bipolar disorder{% endif %}{% if currentItem.linkId = 'section24987206' %}{% for currentItem in currentItem.item.where((linkId = 'item87953533' and answer.exists())) %}{% if currentItem.linkId = 'item87953533' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Anxiety Disorder(s): {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item7871097' %}Obsessive compulsive disorder{% endif %}{% if currentItem.linkId = 'item35653741' %}Post-traumatic stress disorder{% endif %}{% if currentItem.linkId = 'section82717742' %}Schizophrenia/Psychosis: {% for currentItem in currentItem.item.where((linkId = 'item33609770' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item42139539' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item20895854' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item81534007' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item20680763' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item64680671' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item57525098' and answer.exists())) %}{% if currentItem.linkId = 'item33609770' %}Delusions{% endif %}{% if currentItem.linkId = 'item42139539' %}Hallucinations{% endif %}{% if currentItem.linkId = 'item20895854' %}Disorganization of thinking and behaviour{% endif %}{% if currentItem.linkId = 'item81534007' %}Functional decline{% endif %}{% if currentItem.linkId = 'item20680763' %}Apathy{% endif %}{% if currentItem.linkId = 'item64680671' %}Decreased motivation{% endif %}{% if currentItem.linkId = 'item57525098' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}{{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %}, {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item65652334' %}Substance use and addiction{% endif %}{% if currentItem.linkId = 'section76044159' %}{% for currentItem in currentItem.item.where((linkId = 'item15023581' and answer.exists())) %}{% if currentItem.linkId = 'item15023581' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Personality Disorder: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item12081173' %}Eating disorder{% endif %}{% if currentItem.linkId = 'section28118605' %}{% for currentItem in currentItem.item.where((linkId = 'item63786721' and answer.exists()) or (linkId = 'section43189380') or (linkId = 'section37298905')) %}{% if currentItem.linkId = 'item63786721' %}{% if currentItem.answer.exists() %}Is your patient willing to get help for their eating disorder: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section43189380' %}Eating Disorder Symptoms: {% for currentItem in currentItem.item.where((linkId = 'section86876890') or (linkId = 'section66417605') or (linkId = 'section22301000') or (linkId = 'section61364453') or (linkId = 'section63385369') or (linkId = 'section41065967')) %}{% if currentItem.linkId = 'section86876890' %}Food Restriction ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item51125262' and answer.exists()) or (linkId = 'item59981602' and answer.exists())) %}{% if currentItem.linkId = 'item51125262' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item59981602' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section66417605' %}Binge Eating ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item27950801' and answer.exists()) or (linkId = 'item87675656' and answer.exists())) %}{% if currentItem.linkId = 'item27950801' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item87675656' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section22301000' %}Vomiting ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item24147970' and answer.exists()) or (linkId = 'item35568361' and answer.exists())) %}{% if currentItem.linkId = 'item24147970' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item35568361' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section61364453' %}Laxatives ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item26935054' and answer.exists()) or (linkId = 'item60714459' and answer.exists())) %}{% if currentItem.linkId = 'item26935054' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item60714459' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section63385369' %}Diuretics ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item50599805' and answer.exists()) or (linkId = 'item54566189' and answer.exists())) %}{% if currentItem.linkId = 'item50599805' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item54566189' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section41065967' %}Ipecac Diet Pills ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item54590026' and answer.exists()) or (linkId = 'item92592944' and answer.exists())) %}{% if currentItem.linkId = 'item54590026' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item92592944' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section37298905' %}Eating Disorder Supporting Documentation: {% for currentItem in currentItem.item.where((linkId = 'item70500531' and answer.exists()) or (linkId = 'item3081140' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'item70500531' %}{% if currentItem.answer.exists() %}Lab results (potassium, hemoglobin, EKG): {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item3081140' %}Labs (potassium, hemoglobin, EKG) attached{% 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 = 'item80944161' %}Neurodevelopmental disorders{% endif %}{% if currentItem.linkId = 'item38161937' %}Attention deficit hyperactivity disorder{% endif %}{% if currentItem.linkId = 'item24951129' %}Behavioural issues / disorders{% endif %}{% if currentItem.linkId = 'item39395736' %}Difficulty coping with life stressors{% endif %}{% if currentItem.linkId = 'item93828343' %}Sleep disorders{% endif %}{% if currentItem.linkId = 'section84197402' %}{% for currentItem in currentItem.item.where((linkId = 'item60502787' and answer.exists())) %}{% if currentItem.linkId = 'item60502787' %}{% if currentItem.answer.exists() %}Other: {{answer}} {% 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 currentItem.linkId = 'section18972728' %}Parent / Guardian Information
{% for currentItem in currentItem.item.where((linkId = 'section83259951') or (linkId = 'section84918692') or (linkId = 'item10648746' and answer.exists()) or (linkId = 'item3076250' and answer.exists()) or (linkId = 'item40784438' and answer.exists()) or (linkId = 'item46660985' and answer.exists()) or (linkId = 'section21872532')) %}{% if currentItem.linkId = 'section83259951' %}Parent / Guardian #1:
{% for currentItem in currentItem.item.where((linkId = 'item44699531' and answer.exists()) or (linkId = 'item48287495' and answer.exists()) or (linkId = 'item9171159' and answer.exists()) or (linkId = 'item9354350' and answer.exists())) %}{% if currentItem.linkId = 'item44699531' %}{% if currentItem.answer.exists() %}Name: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item48287495' %}{% if currentItem.answer.exists() %}Relationship to patient: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item9171159' %}{% if currentItem.answer.exists() %}Address: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item9354350' %}{% if currentItem.answer.exists() %}Telephone: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section84918692' %}Parent / Guardian #2:
{% for currentItem in currentItem.item.where((linkId = 'item94806245' and answer.exists()) or (linkId = 'item11114743' and answer.exists()) or (linkId = 'item49771817' and answer.exists()) or (linkId = 'item14995305' and answer.exists())) %}{% if currentItem.linkId = 'item94806245' %}{% if currentItem.answer.exists() %}Name: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item11114743' %}{% if currentItem.answer.exists() %}Relationship to patient: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item49771817' %}{% if currentItem.answer.exists() %}Address: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item14995305' %}{% if currentItem.answer.exists() %}Telephone: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item10648746' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{% if answer.value.code = 'Parent #1' %}Parent #1{% endif %}{% if answer.value.code = 'Parent #2' %}Parent #2{% endif %}{% if answer.value.code = 'Joint' %}Joint{% endif %}{% if answer.value.code = 'Other' %}Other{% endif %}{% endfor %}{% endcapture %}Who has custody: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item3076250' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}{{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item40784438' %}{% if currentItem.answer.exists() %}CAS involvement: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item46660985' %}{% if currentItem.answer.exists() %}Contact information: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section21872532' %}Contact to Book Appointment
{% for currentItem in currentItem.item.where((linkId = 'item32202077' and answer.exists()) or (linkId = 'item70278476' and answer.exists())) %}{% if currentItem.linkId = 'item32202077' %}{% if currentItem.answer.exists() %}Name: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item70278476' %}{% if currentItem.answer.exists() %}Phone number: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section66346248' %}Additional Relevant Details
{% for currentItem in currentItem.item.where((linkId = 'item77636870' and answer.exists()) or (linkId = 'item96302958' and answer.exists())) %}{% if currentItem.linkId = 'item77636870' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Details on reason for referral: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item96302958' %}{% if currentItem.answer.exists() %}History: {% 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 currentItem.linkId = 'section6772368' %}Adult Service(s) Requested {% for currentItem in currentItem.item.where((linkId = 'section82421758') or (linkId = 'section79937927') or (linkId = 'section8754391')) %}{% if currentItem.linkId = 'section82421758' %}Reason for Referral {% for currentItem in currentItem.item.where((linkId = 'item54060805' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item83689316' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item46224624' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item12841092' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item37517159' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section66931410')) %}{% if currentItem.linkId = 'item54060805' %}Diagnosis / Diagnostic clarification{% endif %}{% if currentItem.linkId = 'item83689316' %}Medication recommendations / review{% endif %}{% if currentItem.linkId = 'item46224624' %}Mental health treatment / treatment recommendations{% endif %}{% if currentItem.linkId = 'item12841092' %}Substance use treatment / treatment recommendations{% endif %}{% if currentItem.linkId = 'item37517159' %}Substance use withdrawal management / Stabilization on Opioid Agonist Therapy{% endif %}{% if currentItem.linkId = 'section66931410' %}{% for currentItem in currentItem.item.where((linkId = 'item64681868' and answer.exists())) %}{% if currentItem.linkId = 'item64681868' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Other: {{answer}}{% 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 currentItem.linkId = 'section79937927' %}Working Diagnosis/Presenting Problem {% for currentItem in currentItem.item.where((linkId = 'item15643336' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item30343743' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section63384506') or (linkId = 'item93984015' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item27659494' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section64603508') or (linkId = 'item69836295' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section21470922') or (linkId = 'item49957366' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section49945054') or (linkId = 'item58135328' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item98201917' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item52303515' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item48648203' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item66256289' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item69695776' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section57284993')) %}{% if currentItem.linkId = 'item15643336' %}Depression{% endif %}{% if currentItem.linkId = 'item30343743' %}Bipolar disorder{% endif %}{% if currentItem.linkId = 'section63384506' %}{% for currentItem in currentItem.item.where((linkId = 'item76992896' and answer.exists())) %}{% if currentItem.linkId = 'item76992896' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Anxiety Disorder(s): {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item93984015' %}Obsessive compulsive disorder{% endif %}{% if currentItem.linkId = 'item27659494' %}Post-traumatic stress disorder{% endif %}{% if currentItem.linkId = 'section64603508' %}Schizophrenia/Psychosis: {% for currentItem in currentItem.item.where((linkId = 'item36522846' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item74768430' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item24838065' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item39531524' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item32356945' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item84949422' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item93130751' and answer.exists())) %}{% if currentItem.linkId = 'item36522846' %}Delusions{% endif %}{% if currentItem.linkId = 'item74768430' %}Hallucinations{% endif %}{% if currentItem.linkId = 'item24838065' %}Disorganization of thinking and behaviour{% endif %}{% if currentItem.linkId = 'item39531524' %}Functional decline{% endif %}{% if currentItem.linkId = 'item32356945' %}Apathy{% endif %}{% if currentItem.linkId = 'item84949422' %}Decreased motivation{% endif %}{% if currentItem.linkId = 'item93130751' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}{{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}, {% else %}, {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item69836295' %}Substance use and addiction{% endif %}{% if currentItem.linkId = 'section21470922' %}{% for currentItem in currentItem.item.where((linkId = 'item78056373' and answer.exists())) %}{% if currentItem.linkId = 'item78056373' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Personality Disorder: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item49957366' %}Eating disorder{% endif %}{% if currentItem.linkId = 'section49945054' %}{% for currentItem in currentItem.item.where((linkId = 'item14172544' and answer.exists()) or (linkId = 'section48634770') or (linkId = 'section76234248')) %}{% if currentItem.linkId = 'item14172544' %}{% if currentItem.answer.exists() %}Is your patient willing to get help for their eating disorder: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section48634770' %}Eating Disorder Symptoms: {% for currentItem in currentItem.item.where((linkId = 'section25775304') or (linkId = 'section95278861') or (linkId = 'section99603636') or (linkId = 'section38063481') or (linkId = 'section46355324') or (linkId = 'section28796065')) %}{% if currentItem.linkId = 'section25775304' %}Food Restriction ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item61635110' and answer.exists()) or (linkId = 'item98651256' and answer.exists())) %}{% if currentItem.linkId = 'item61635110' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item98651256' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section95278861' %}Binge Eating ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item57159239' and answer.exists()) or (linkId = 'item41565133' and answer.exists())) %}{% if currentItem.linkId = 'item57159239' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item41565133' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section99603636' %}Vomiting ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item84040836' and answer.exists()) or (linkId = 'item55269309' and answer.exists())) %}{% if currentItem.linkId = 'item84040836' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item55269309' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section38063481' %}Laxatives ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item8579740' and answer.exists()) or (linkId = 'item18591742' and answer.exists())) %}{% if currentItem.linkId = 'item8579740' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item18591742' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section46355324' %}Diuretics ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item57163107' and answer.exists()) or (linkId = 'item13755415' and answer.exists())) %}{% if currentItem.linkId = 'item57163107' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item13755415' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section28796065' %}Ipecac Diet Pills ({{answer}}) {% for currentItem in currentItem.item.where((linkId = 'item35385735' and answer.exists()) or (linkId = 'item68045590' and answer.exists())) %}{% if currentItem.linkId = 'item35385735' %}{% if currentItem.answer.exists() %}Frequency per day: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item68045590' %}{% if currentItem.answer.exists() %}Frequency per week: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 currentItem.linkId = 'section76234248' %}Eating Disorder Supporting Documentation: {% for currentItem in currentItem.item.where((linkId = 'item58458531' and answer.exists()) or (linkId = 'item73052895' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'item58458531' %}{% if currentItem.answer.exists() %}Lab results (potassium, hemoglobin, EKG): {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item73052895' %}Lab results (potassium, hemoglobin, EKG) attached{% 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 = 'item58135328' %}Dementia{% endif %}{% if currentItem.linkId = 'item98201917' %}Neurodevelopmental disorders{% endif %}{% if currentItem.linkId = 'item52303515' %}Attention deficit hyperactivity disorder{% endif %}{% if currentItem.linkId = 'item48648203' %}Behavioural issues / disorders{% endif %}{% if currentItem.linkId = 'item66256289' %}Difficulty coping with life stressors{% endif %}{% if currentItem.linkId = 'item69695776' %}Sleep disorders{% endif %}{% if currentItem.linkId = 'section57284993' %}{% for currentItem in currentItem.item.where((linkId = 'item58990948' and answer.exists())) %}{% if currentItem.linkId = 'item58990948' %}{% if currentItem.answer.exists() %}Other: {{answer}} {% 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 currentItem.linkId = 'section8754391' %}Additional Relevant Details
{% for currentItem in currentItem.item.where((linkId = 'item52716823' and answer.exists()) or (linkId = 'item26666461' and answer.exists())) %}{% if currentItem.linkId = 'item52716823' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Details on reason for referral: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item26666461' %}{% if currentItem.answer.exists() %}History: {% 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 currentItem.linkId = 'alertsSection' %}Substance Use
{% for currentItem in currentItem.item.where((linkId = 'item35092606' and answer.exists()) or (linkId = 'section22804305')) %}{% if currentItem.linkId = 'item35092606' %}{% if currentItem.answer.exists() %}Patient uses alcohol or drugs weekly or more often: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section22804305' %}{% for currentItem in currentItem.item.where((linkId = 'item52764779' and answer.exists()) or (linkId = 'item38942058' and answer.exists()) or (linkId = 'item61002259' and answer.exists()) or (linkId = 'item56765754' and answer.exists()) or (linkId = 'section49565195')) %}{% if currentItem.linkId = 'item52764779' %}{% if currentItem.answer.exists() %}Patient spends a lot of time either getting, using, or recovering from the effects of alcohol/drugs: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item38942058' %}{% if currentItem.answer.exists() %}Patient continues to use alcohol or drugs even though it’s causing problems: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item61002259' %}{% if currentItem.answer.exists() %}Patient experiences withdrawal problems or use substances to stop being sick: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item56765754' %}{% if currentItem.answer.exists() %}Is your patient interested in receiving help for their substance use: {% for answer in currentItem.answer %}{% if answer.value.code = 'Y' %}Yes{% endif %}{% if answer.value.code = 'N' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'section49565195' %}Substance(s) {% for currentItem in currentItem.item.where((linkId = 'item94125625' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section3261989') or (linkId = 'item77072016' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section83457961') or (linkId = 'item6432321' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section20477687') or (linkId = 'item66274125' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section75200176') or (linkId = 'item2610466' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section62243220') or (linkId = 'item44896292' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section41199031') or (linkId = 'item77009770' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section78036375') or (linkId = 'item47069965' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section30474031') or (linkId = 'item59722140' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section39082915') or (linkId = 'item96329619' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section64087752') or (linkId = 'item61053169' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section68093255') or (linkId = 'item53114676' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section43016997') or (linkId = 'item48559313' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section15915996') or (linkId = 'item79621342' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section64058651') or (linkId = 'item55594173' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section46146356') or (linkId = 'item62931644' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section14094081') or (linkId = 'section97001254')) %}{% if currentItem.linkId = 'item94125625' %}Alcohol{% endif %}{% if currentItem.linkId = 'section3261989' %}{% for currentItem in currentItem.item.where((linkId = 'item4537802' and answer.exists()) or (linkId = 'item41146844' and answer.exists())) %}{% if currentItem.linkId = 'item4537802' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item41146844' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item77072016' %}Amphetamine / other stimulants{% endif %}{% if currentItem.linkId = 'section83457961' %}{% for currentItem in currentItem.item.where((linkId = 'item76908948' and answer.exists()) or (linkId = 'item41949111' and answer.exists())) %}{% if currentItem.linkId = 'item76908948' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item41949111' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item6432321' %}Barbiturates{% endif %}{% if currentItem.linkId = 'section20477687' %}{% for currentItem in currentItem.item.where((linkId = 'item62314885' and answer.exists()) or (linkId = 'item57225242' and answer.exists())) %}{% if currentItem.linkId = 'item62314885' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item57225242' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item66274125' %}Benzodiazepines{% endif %}{% if currentItem.linkId = 'section75200176' %}{% for currentItem in currentItem.item.where((linkId = 'item26436063' and answer.exists()) or (linkId = 'item62292065' and answer.exists())) %}{% if currentItem.linkId = 'item26436063' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item62292065' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item2610466' %}Cannabis{% endif %}{% if currentItem.linkId = 'section62243220' %}{% for currentItem in currentItem.item.where((linkId = 'item39207942' and answer.exists()) or (linkId = 'item14210867' and answer.exists())) %}{% if currentItem.linkId = 'item39207942' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item14210867' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item44896292' %}Cocaine / Crack{% endif %}{% if currentItem.linkId = 'section41199031' %}{% for currentItem in currentItem.item.where((linkId = 'item40411559' and answer.exists()) or (linkId = 'item54214687' and answer.exists())) %}{% if currentItem.linkId = 'item40411559' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item54214687' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item77009770' %}Ecstasy / MDMA{% endif %}{% if currentItem.linkId = 'section78036375' %}{% for currentItem in currentItem.item.where((linkId = 'item11614353' and answer.exists()) or (linkId = 'item10159180' and answer.exists())) %}{% if currentItem.linkId = 'item11614353' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item10159180' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item47069965' %}Glue / Inhalants{% endif %}{% if currentItem.linkId = 'section30474031' %}{% for currentItem in currentItem.item.where((linkId = 'item72751725' and answer.exists()) or (linkId = 'item25083610' and answer.exists())) %}{% if currentItem.linkId = 'item72751725' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item25083610' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item59722140' %}Hallucinogens{% endif %}{% if currentItem.linkId = 'section39082915' %}{% for currentItem in currentItem.item.where((linkId = 'item16149586' and answer.exists()) or (linkId = 'item81520184' and answer.exists())) %}{% if currentItem.linkId = 'item16149586' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item81520184' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item96329619' %}Heroin / Opium{% endif %}{% if currentItem.linkId = 'section64087752' %}{% for currentItem in currentItem.item.where((linkId = 'item61958916' and answer.exists()) or (linkId = 'item71381338' and answer.exists())) %}{% if currentItem.linkId = 'item61958916' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item71381338' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item61053169' %}Methamphetamines (e.g. crystal meth){% endif %}{% if currentItem.linkId = 'section68093255' %}{% for currentItem in currentItem.item.where((linkId = 'item27857212' and answer.exists()) or (linkId = 'item77928975' and answer.exists())) %}{% if currentItem.linkId = 'item27857212' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item77928975' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item53114676' %}Other psycho-active substances{% endif %}{% if currentItem.linkId = 'section43016997' %}{% for currentItem in currentItem.item.where((linkId = 'item94432223' and answer.exists()) or (linkId = 'item19904264' and answer.exists())) %}{% if currentItem.linkId = 'item94432223' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item19904264' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item48559313' %}Over-the-counter{% endif %}{% if currentItem.linkId = 'section15915996' %}{% for currentItem in currentItem.item.where((linkId = 'item47492338' and answer.exists()) or (linkId = 'item89642224' and answer.exists())) %}{% if currentItem.linkId = 'item47492338' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item89642224' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item79621342' %}Codeine{% endif %}{% if currentItem.linkId = 'section64058651' %}{% for currentItem in currentItem.item.where((linkId = 'item82689508' and answer.exists()) or (linkId = 'item39431728' and answer.exists())) %}{% if currentItem.linkId = 'item82689508' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item39431728' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item55594173' %}Prescription opioids{% endif %}{% if currentItem.linkId = 'section46146356' %}{% for currentItem in currentItem.item.where((linkId = 'item65520315' and answer.exists()) or (linkId = 'item45732685' and answer.exists())) %}{% if currentItem.linkId = 'item65520315' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item45732685' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'item62931644' %}Steroids{% endif %}{% if currentItem.linkId = 'section14094081' %}{% for currentItem in currentItem.item.where((linkId = 'item46494006' and answer.exists()) or (linkId = 'item33747841' and answer.exists())) %}{% if currentItem.linkId = 'item46494006' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item33747841' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section97001254' %}{% for currentItem in currentItem.item.where((linkId = 'item89811835' and answer.exists()) or (linkId = 'item82275320' and answer.exists()) or (linkId = 'item93180189' and answer.exists())) %}{% if currentItem.linkId = 'item89811835' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endcapture %}Other: {{answer}}{% endif %}{% endif %}{% if currentItem.linkId = 'item82275320' %}{% if currentItem.answer.exists() %}Amount used: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item93180189' %}{% if currentItem.answer.exists() %}Frequency: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% 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 %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}
{% endif %}{% if currentItem.linkId = 'riskIssueSection' %}Risk Issue(s)
{% for currentItem in currentItem.item.where((linkId = 'riskHospitalization' and answer.exists()) or (linkId = 'riskSuicide' and answer.exists()) or (linkId = 'riskSelfHarm' and answer.exists()) or (linkId = 'riskHomicidalThreats' and answer.exists()) or (linkId = 'riskViolence' and answer.exists()) or (linkId = 'riskLegal' and answer.exists()) or (linkId = 'item20409433' and answer.exists())) %}{% if currentItem.linkId = 'riskHospitalization' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Relevant Hospital Visit / Hospitalization:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Relevant Hospital Visit / Hospitalization:
{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'riskSuicide' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Suicide Attempt / Ideation:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Suicide Attempt / Ideation:
{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'riskSelfHarm' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Deliberate Self-Harm:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Deliberate Self-Harm:
{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'riskHomicidalThreats' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Homicidal Threats / Ideation:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Homicidal Threats / Ideation:
{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'riskViolence' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Violent Behaviour:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Violent Behaviour:
{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'riskLegal' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Legal Involvement:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Legal Involvement:
{% endif %}{% endif %}{% endif %}{% if currentItem.linkId = 'item20409433' %}{% if currentItem.answer.exists() %}{% if currentItem.answer.value.ofType(Coding).code = 'Y' %}Experiencing Violence:{% elsif currentItem.answer.value.ofType(Coding).code = 'N' %}No Experiencing Violence:
{% endif %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section50848440' %}Current Mental Health / Substance Use Supports / Treatments
{% for currentItem in currentItem.item.where((linkId = 'item18600294' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item25570573' and answer.exists()) or (linkId = 'item89288084' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item76981462' and answer.exists()) or (linkId = 'item71298135' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item21107102' and answer.exists()) or (linkId = 'item26391012' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item84673008' and answer.exists())) %}{% if currentItem.linkId = 'item18600294' %}Psychiatrist{% endif %}{% if currentItem.linkId = 'item25570573' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item89288084' %}Psychologist{% endif %}{% if currentItem.linkId = 'item76981462' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item71298135' %}Case Worker{% endif %}{% if currentItem.linkId = 'item21107102' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item26391012' %}Other Agencies / Programs{% endif %}{% if currentItem.linkId = 'item84673008' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section56633689' %}Past Mental Health / Substance Use Supports / Treatments
{% for currentItem in currentItem.item.where((linkId = 'item80445267' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item40661955' and answer.exists()) or (linkId = 'item11986289' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item33474757' and answer.exists()) or (linkId = 'item76753898' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item45747256' and answer.exists()) or (linkId = 'item56421735' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item62676779' and answer.exists())) %}{% if currentItem.linkId = 'item80445267' %}Psychiatrist{% endif %}{% if currentItem.linkId = 'item40661955' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item11986289' %}Psychologist{% endif %}{% if currentItem.linkId = 'item33474757' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item76753898' %}Case Worker{% endif %}{% if currentItem.linkId = 'item45747256' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'item56421735' %}Other Agencies / Programs{% endif %}{% if currentItem.linkId = 'item62676779' %}{% if currentItem.answer.exists() %}Details: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}
{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section60045200' %}Alert(s)
{% for currentItem in currentItem.item.where((linkId = 'item71240775' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'section45860591') or (linkId = 'section26075565')) %}{% if currentItem.linkId = 'item71240775' %}Pregnant/Post-partum{% endif %}{% if currentItem.linkId = 'section45860591' %}{% for currentItem in currentItem.item.where((linkId = 'item62106942' and answer.exists())) %}{% if currentItem.linkId = 'item62106942' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Allergies: {{answer}}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'section26075565' %}{% for currentItem in currentItem.item.where((linkId = 'alertOtherDetails' and answer.exists())) %}{% if currentItem.linkId = 'alertOtherDetails' %}{% if currentItem.answer.exists() %}{% capture answer %}{% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endcapture %}Other Alert(s): {{answer}}{% 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 currentItem.linkId = 'section21033319' %}Patient CPP
{% for currentItem in currentItem.item.where((linkId = 'i_ncurrent_problems_n') or (linkId = 'i_npast_medical_histo') or (linkId = 'i_nmedications_n')) %}{% if currentItem.linkId = 'i_ncurrent_problems_n' %}Current Problems:
{% for currentItem in currentItem.item.where((linkId = 'prob' and answer.exists())) %}{% if currentItem.linkId = 'prob' %}{% 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 currentItem.linkId = 'i_npast_medical_histo' %}Past Medical History:
{% for currentItem in currentItem.item.where((linkId = 'pmhx' and answer.exists())) %}{% if currentItem.linkId = 'pmhx' %}{% 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 currentItem.linkId = 'i_nmedications_n' %}Medications:
{% for currentItem in currentItem.item.where((linkId = 'rx' and answer.exists())) %}{% if currentItem.linkId = 'rx' %}{% 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 currentItem.linkId = 'section57590463' %}Supporting Documentation Attached {% for currentItem in currentItem.item.where((linkId = 'item87137746' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item69598044' and answer.exists(value.ofType(boolean)=true)) or (linkId = 'item626051' and answer.exists(value.ofType(boolean)=true))) %}{% if currentItem.linkId = 'item87137746' %}Patient CPP{% endif %}{% if currentItem.linkId = 'item69598044' %}Current medication list{% endif %}{% if currentItem.linkId = 'item626051' %}Relevant labs{% 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 %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}