<status value="active" /> <experimental value="false" /> <subjectType value="Patient" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="questionnaire" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="section89975948" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item94471703" /> <text value="Souhaitez-vous remplir ce formulaire en français?"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="boolean" /> <enableWhen> <question value="refRt" /> <operator value="!=" /> <answerString value="_demo_acc_s_sant_men63300900" /> </enableWhen> <enableBehavior value="all" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="onFrenchForm" /> <text value="Souhaitez-vous remplir ce formulaire en français?"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="boolean" /> <enableWhen> <question value="refRt" /> <operator value="=" /> <answerString value="_demo_acc_s_sant_men63300900" /> </enableWhen> <enableBehavior value="all" /> <initial> <valueString value="Y" /> </initial> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="(onFrenchForm.r == 'Y' && refRt.r == '_demo_acc_s_sant_men63300900') || item94471703.r == 'Y'" /> <language value="text/fhirpath" /> <expression value="(%resource.repeat(item).where(linkId='onFrenchForm').answer.exists(value = 'Y') and %resource.repeat(item).where(linkId='refRt').answer.exists(value = '_demo_acc_s_sant_men63300900')) or %resource.repeat(item).where(linkId='item94471703').answer.exists(value = 'Y')" /> </valueExpression> </extension> <linkId value="section47452923" /> <type value="group" /> <item> <linkId value="section35521488" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="section76158872" /> <type value="group" /> <item> <linkId value="item86011312" /> <text value="L’équipe des Services communautaires de santé mentale et de traitement des dépendances de l’Hôpital de Cornwall offre un éventail complet de services de traitement des problèmes de santé mentale et des dépendances aux personnes de tous âges, des nouveau-nés aux personnes âgées [Note: Les Services aux adultes sont coordonnés par l’entremise d’AccèsSMT]. Nous offrons du counseling individuel, familial et de groupe selon les besoins des clients. Nous offrons aussi un soutien clinique aux personnes qui s’occupent de bébés et de tout-petits ainsi qu’aux aidants dont les proches sont aux prises avec un trouble de santé mentale ou de dépendance. Nos services sont offerts dans nos bureaux, à domicile, dans les écoles et en milieu hospitalier, et comprennent ce qui suit:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="L’équipe des Services communautaires de santé mentale et de traitement des dépendances de l’Hôpital de Cornwall offre un éventail complet de services de traitement des problèmes de santé mentale et des dépendances aux personnes de tous âges, des nouveau-nés aux personnes âgées [Note: Les Services aux adultes sont coordonnés par l’entremise d’AccèsSMT]. Nous offrons du counseling individuel, familial et de groupe selon les besoins des clients. Nous offrons aussi un soutien clinique aux personnes qui s’occupent de bébés et de tout-petits ainsi qu’aux aidants dont les proches sont aux prises avec un trouble de santé mentale ou de dépendance. Nos services sont offerts dans nos bureaux, à domicile, dans les écoles et en milieu hospitalier, et comprennent ce qui suit:" /> </extension> </text> <type value="display" /> </item> <item> <linkId value="item68891569" /> <text value="• Services de santé mentale pour les enfants et les jeunes" /> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-supportHyperlink"> <extension url="label"> <valueString value="AccèsSMT" /> </extension> <extension url="link"> <valueUri value="https://oceanhealthmap.ca/referrals/NewReferral.html?rtRef=_demo_acc_s_sant_men63300900" /> </extension> </extension> <linkId value="item87502558" /> <text value="• Services de santé mentale pour adultes [par l’entremise d’AccèsSMT, comme indiqué ci-dessus]" /> <type value="display" /> </item> <item> <linkId value="item4908010" /> <text value="• Services de santé mentale gériatriques" /> <type value="display" /> </item> <item> <linkId value="item82471453" /> <text value="• Services de traitement des dépendances" /> <type value="display" /> </item> <item> <linkId value="item6546268" /> <text value="• Services de soutien par les pairs" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="section25321155" /> <text value="Si votre patient est en situation de crise et a besoin d’une aide immédiate:" /> <type value="group" /> <item> <linkId value="item53515877" /> <text value="• Contactez un service de crise local • Dites à votre patient de se rendre au service d’urgence de l’hôpital le plus proche • Appelez le 911"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="• Contactez un service de crise local • Dites à votre patient de se rendre au service d’urgence de l’hôpital le plus proche • Appelez le 911" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> </item> <item> <linkId value="item73013633" /> <text value="* Indique un champ obligatoire"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Consentement" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section38344247" /> <text value="Consentement"> <extension 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/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item65347091" /> <text value="Autre" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="section654059" /> <type value="group" /> <enableWhen> <question value="item65347091" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior 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<valueString value="Adresse (si différente de ci-dessus):" /> </extension> </text> <type value="text" /> </item> <item> <linkId value="item25729500" /> <text value="Numéro de tél.:" /> <type value="string" /> </item> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="text-decoration:underline;" /> </extension> </extension> <linkId value="section41688168" /> <text value="Parent / tuteur 2:" /> <type value="group" /> <item> <linkId value="item92193935" /> <text value="Nom:" /> <type value="string" /> </item> <item> <linkId value="item24852225" /> <text value="Relation avec le patient:" /> <type value="string" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Address:" /> </extension> </extension> <linkId value="item90386906" /> <text value="Adresse (si différente de ci-dessus):"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Adresse (si différente de ci-dessus):" /> </extension> </text> <type value="text" /> </item> <item> <linkId value="item1853238" /> <text value="Numéro de tél.:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Who has custody: {{answer}}" /> </extension> </extension> <linkId value="item39570112" /> <text value="Si les parents sont séparés/divorcés, qui a la garde de l’enfant:" /> <type value="choice" /> <repeats value="false" /> <answerOption> <valueCoding> <extension 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value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='section55770179').select(item.where(linkId='item66113446').exists(answer) | item.where(linkId='item87799750').exists(answer)).count() * 100 / 2 != 0" /> </valueExpression> </extension> </extension> <linkId value="item72965441" /> <text value="Restriction alimentaire" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Restriction alimentaire ({{answer}})" /> </extension> <extension url="listSeparator"> <valueString value=";" /> </extension> </extension> <linkId value="section55770179" /> <type value="group" /> <enableWhen> <question value="item72965441" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item87799750" /> <text value="Fréquence par jour:" /> <type value="string" /> </item> <item> <linkId value="item66113446" /> <text value="Fréquence par semaine:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item99555835" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="ScriptUtil.percentComplete( section51255713 ) != 0" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='section51255713').select(item.where(linkId='item34926111').exists(answer) | item.where(linkId='item64698719').exists(answer)).count() * 100 / 2 != 0" /> </valueExpression> </extension> </extension> <linkId value="item99555835" /> <text value="Frénésie alimentaire / hyperphagie" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Frénésie alimentaire / hyperphagie ({{answer}})" /> </extension> <extension url="listSeparator"> <valueString value=";" /> </extension> </extension> <linkId value="section51255713" /> <type value="group" /> <enableWhen> <question value="item99555835" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item64698719" /> <text value="Fréquence par jour:" /> <type value="string" /> </item> <item> <linkId value="item34926111" /> <text value="Fréquence par semaine:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item1023698" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="ScriptUtil.percentComplete( section72829055 ) != 0" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='section72829055').select(item.where(linkId='item33365833').exists(answer) | item.where(linkId='item39335449').exists(answer)).count() * 100 / 2 != 0" /> </valueExpression> </extension> </extension> <linkId value="item1023698" /> <text value="Vomissements" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Vomissements ({{answer}})" /> </extension> <extension url="listSeparator"> <valueString value=";" /> </extension> </extension> <linkId value="section72829055" /> <type value="group" /> <enableWhen> <question value="item1023698" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item33365833" /> <text value="Fréquence par jour:" /> <type value="string" /> </item> <item> <linkId value="item39335449" /> <text value="Fréquence par semaine:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> 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0" /> </valueExpression> </extension> </extension> <linkId value="item50818846" /> <text value="Laxatifs" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Laxatifs ({{answer}})" /> </extension> <extension url="listSeparator"> <valueString value=";" /> </extension> </extension> <linkId value="section12225867" /> <type value="group" /> <enableWhen> <question value="item50818846" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item7330151" /> <text value="Fréquence par jour:" /> <type value="string" /> </item> <item> <linkId value="item19916884" /> <text value="Fréquence par semaine:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item87155271" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="ScriptUtil.percentComplete( section86887923 ) != 0" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='section86887923').select(item.where(linkId='item69932235').exists(answer) | item.where(linkId='item43117195').exists(answer)).count() * 100 / 2 != 0" /> </valueExpression> </extension> </extension> <linkId value="item87155271" /> <text value="Diurétiques" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Diurétiques ({{answer}})" /> </extension> <extension url="listSeparator"> <valueString value=";" /> </extension> </extension> <linkId value="section86887923" /> <type value="group" /> <enableWhen> <question value="item87155271" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item43117195" /> <text value="Fréquence par jour:" /> <type value="string" /> </item> <item> <linkId value="item69932235" /> <text value="Fréquence par semaine:" /> <type value="string" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item4587780" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension 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value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item43437113" /> <text value="Trouble déficitaire de l’attention avec hyperactivité" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item19133749" /> <text value="Trouble / problèmes de comportement" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item46418991" /> <text value="Difficulté à gérer les facteurs de stress de la vie" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item86471184" /> <text value="Trouble du sommeil" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="item40556730" /> <text value="Autre" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="section30991256" /> <type value="group" /> <enableWhen> <question value="item40556730" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Autre: {{answer}}" /> </extension> </extension> <linkId value="item90158318" /> <text value="Veuillez préciser:" /> <type value="text" /> <required value="true" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="section33533705" /> <text value="Autres détails pertinents" /> <type value="group" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Détails des raisons de l’aiguillage: {{answer}}" /> </extension> </extension> <linkId value="item89857237" /> <text value="Détails des raisons de l’aiguillage (p. ex. : pourquoi maintenant? 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value="Toxicomanie / dépendance" /> <type value="group" /> <enableWhen> <question value="item28218801" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section55467446" /> <code value="Gériatrie" /> <display value="Gériatrie" /> </answerCoding> </enableWhen> <enableWhen> <question value="item28218801" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section55467446" /> <code value="Enfants/jeunes" /> <display value="Enfants/jeunes" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="item15213756" /> <text value="Le patient consomme-t-il de l’alcool ou des drogues une fois par semaine ou plus souvent:" /> <type value="choice" /> <required value="true" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item15213756" /> <code value="Non" /> <display value="Non" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item15213756" /> <code value="Oui" /> <display value="Oui" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="border-style:solid;" /> </extension> <linkId value="section31036662" /> <type value="group" /> <enableWhen> <question 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value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section80630026" /> <text value="Profil cumulatif du patient" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item16201253.r != ''" /> <language value="text/fhirpath" /> <expression value="%context.item.where(linkId='item16201253').answer.exists()" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="section82537102" /> <text value="Problèmes actuels:" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.prob`" /> </valueExpression> </extension> <linkId value="item16201253" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item25739934.r != ''" /> <language value="text/fhirpath" /> <expression value="%context.item.where(linkId='item25739934').answer.exists()" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="section45363302" /> <text value="Antécédents médicaux:" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.pmhx`" /> </valueExpression> </extension> <linkId value="item25739934" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item51211229.r != ''" /> <language value="text/fhirpath" /> <expression value="%context.item.where(linkId='item51211229').answer.exists()" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="section94430790" /> <text value="Liste des médicaments actuels:" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.rx`" /> </valueExpression> </extension> <linkId value="item51211229" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item99082227" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Supporting Documentation Attached" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section16934864" /> <text value="Documents justificatifs" /> <type value="group" /> <enableWhen> <question value="item28218801" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section16934864" /> <code value="Gériatrie" /> <display value="Gériatrie" /> </answerCoding> </enableWhen> <enableWhen> <question value="item28218801" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section16934864" /> <code value="Enfants/jeunes" /> <display value="Enfants/jeunes" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <item> <linkId value="item93511954" /> <text value="Veuillez confirmer que les documents suivants sont joints:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item16201253.r == '' || item25739934.r == ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='item16201253').answer.empty() or %resource.repeat(item).where(linkId='item25739934').answer.empty()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item65123098" /> <text value="Profil cumulatif du patient" /> <type value="boolean" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="item51211229.r == ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='item51211229').answer.empty()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item65033221" /> <text value="Liste des médicaments actuels" /> <type value="boolean" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item9309258" /> <text value="Résultats des examens de laboratoire pertinents" /> <type value="boolean" /> </item> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="onFrenchForm.r != 'Y' || item94471703.r != 'Y' && refRt.r != '_demo_acc_s_sant_men63300900'" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='onFrenchForm').answer.exists(value != 'Y') or %resource.repeat(item).where(linkId='item94471703').answer.exists(value != 'Y') and %resource.repeat(item).where(linkId='refRt').answer.exists(value != '_demo_acc_s_sant_men63300900')" /> </valueExpression> </extension> <linkId value="section20479968" /> <type value="group" /> <item> <linkId value="section24117073" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="section80579193" /> <type value="group" /> <item> <linkId value="item72208971" /> <text value="Community Addiction and Mental Health Services of the Cornwall Hospital offers comprehensive mental health and addiction treatment for people across the lifespan, from infants to seniors [Please note: Adult services are coordinated through AccessMHA]. We provide individual, family and group counseling depending upon the service and client need. We also offer clinical support to caregivers with infants and toddlers and to caregivers who have loved ones experiencing mental illness or addiction issues. Services are offered in a variety of settings including office, home based, schools, and hospitals. Services include:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Community Addiction and Mental Health Services of the Cornwall Hospital offers comprehensive mental health and addiction treatment for people across the lifespan, from infants to seniors [Please note: Adult services are coordinated through AccessMHA]. We provide individual, family and group counseling depending upon the service and client need. We also offer clinical support to caregivers with infants and toddlers and to caregivers who have loved ones experiencing mental illness or addiction issues. Services are offered in a variety of settings including office, home based, schools, and hospitals. Services include:" /> </extension> </text> <type value="display" /> </item> <item> <linkId value="item89957513" /> <text value="• Child and Youth Mental Health Services" /> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-supportHyperlink"> <extension url="label"> <valueString value="AccessMHA" /> </extension> <extension url="link"> <valueUri value="https://ocean.cognisantmd.com/referrals/NewReferral.html?rtRef=access_mental_health-10764619" /> </extension> </extension> <linkId value="item16093830" /> <text value="• Adult Mental Health [via AccessMHA as noted above]" /> <type value="display" /> </item> <item> <linkId value="item81456582" /> <text value="• Geriatric Mental Health" /> <type value="display" /> </item> <item> <linkId value="item20551892" /> <text value="• Addiction Services" /> <type value="display" /> </item> <item> <linkId value="item62366631" /> <text value="• Peer Support" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <linkId value="section82774710" /> <text value="If your patient is in crisis and requires immediate help:" /> <type value="group" /> <item> <linkId value="item53445051" /> <text value="• Contact your local crisis service •Direct them to your nearest emergency department • Call 911"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="• Contact your local crisis service •Direct them to your nearest emergency department • Call 911" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> </item> <item> <linkId value="item84851356" /> <text value="* Indicates required field"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Consent" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section7327232" /> <text value="Consent"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="text-decoration:underline;" /> </extension> </text> <type value="group" /> <item> <linkId value="consent1" /> <text value="Is patient aware of and in agreement with this referral:" /> <type value="choice" /> <required value="true" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/targetConstraint"> <extension url="key"> <valueId value="item72268061" /> </extension> <extension url="severity"> <valueCode value="error" /> </extension> <extension url="human"> <valueString value="Please obey rules specified in instructions" /> </extension> <extension url="expression"> <valueExpression> <description value="consent1.r == 'Y'" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='consent1').answer.exists(value = 'Y')" /> </valueExpression> </extension> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="section8127287" /> <type value="group" /> <enableWhen> <question value="consent1" /> <operator value="=" /> <answerCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item72268061" /> <text value="See image"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="<img src="#img-2" alt="untitled" />" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/referencesContained"> <valueReference> <reference value="#img-2" /> </valueReference> </extension> </text> <type value="display" /> </item> </item> <item> <linkId value="section93356971" /> <type value="group" /> <enableWhen> <question value="consent1" /> <operator value="=" /> <answerCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="consent2" /> <text value="Is patient capable to consent to treatment:" /> <type value="choice" /> <required value="true" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_consent2" /> <code value="N" /> <display value="N" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_consent2" /> <code value="Y" /> <display value="Y" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_consent2" /> <code value="Unknown" /> <display value="Unknown" /> </valueCoding> </answerOption> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="text-decoration:underline;" /> </extension> </extension> <linkId value="section23411132" /> <text value="Substitute Decision Maker/Power of Attorney/Public Guardian & Trustee" /> <type value="group" /> <enableWhen> <question value="consent2" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_consent2" /> <code value="N" /> <display value="N" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <item> <linkId value="item46990902" /> <text value="Name:" /> <type value="string" /> <required value="true" /> </item> <item> <linkId value="item25445618" /> <text value="Telephone:" /> <type value="string" /> <required value="true" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item30101457" /> <type value="display" /> </item> </item> <item> <linkId value="section67083359" /> <type value="group" /> <enableWhen> <question value="consent1" /> <operator value="=" /> <answerCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Patient Information" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section19247319" /> <text value="Patient Information"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="text-decoration:underline;" /> </extension> </text> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://ontariohealth.ca/fhir/eforms/CodeSystem/on-item-controls" /> <code value="push-button" /> </coding> </valueCodeableConcept> </extension> <linkId value="lang" /> <text value="Main spoken language:" /> <type value="choice" /> <required value="true" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="English" /> <display value="English" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="French" /> <display value="French" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="Other" /> <display value="Other" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptLanguage`" /> </valueExpression> </extension> <linkId value="item69641905" /> <text value="Please specify:" /> <type value="string" /> <enableWhen> <question value="lang" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="Other" /> <display value="Other" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <linkId value="francophone" /> <text value="Francophone:" /> <type value="choice" /> <enableWhen> <question value="lang" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="English" /> <display value="English" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <required value="true" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="lang.r == 'French'" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='lang').answer.exists(value = 'French')" /> </valueExpression> </extension> </extension> <linkId value="item18133286" /> <text value="Francophone: Yes" /> <type value="display" /> </item> <item> <linkId value="item97277940" /> <text value="French language services required:" /> <type value="choice" /> <enableWhen> <question value="lang" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="French" /> <display value="French" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <required value="true" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="francophone.r == 'Y'" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='francophone').answer.exists(value = 'Y')" /> </valueExpression> </extension> </extension> <linkId value="item88164848" /> <text value="French language services required: No" /> <type value="display" /> </item> <item> <linkId value="interpreterServices" /> <text value="Interpreter required:" /> <type value="choice" /> <enableWhen> <question value="lang" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_lang" /> <code value="Other" /> <display value="Other" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> <required value="true" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> </item> <item> <linkId value="item8684758" /> <text value="Preferred phone number:" /> <type value="string" /> <required value="true" /> </item> <item> <linkId value="item89989692" /> <text value="Does patient consent to being contacted via email:" /> <type value="choice" /> <required value="true" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Email Address: {{answer}}" /> </extension> </extension> <linkId value="item90635821" /> <text value="Email Address (if not included above):"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Email Address (if not included above):" /> </extension> </text> <type value="string" /> <enableWhen> <question value="item89989692" /> <operator value="=" /> <answerCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="drop-down" /> </coding> </valueCodeableConcept> </extension> <linkId value="ptLivingSituation" /> <text value="Living Situation:" /> <type value="choice" /> <required value="true" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="Alone" /> <display value="Alone" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="With Family/Spouse" /> <display value="With Family/Spouse" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="Supportive Housing" /> <display value="Supportive Housing" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="5" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="Foster Home" /> <display value="Foster Home" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="Residence" /> <display value="Residence" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="No Fixed Address" /> <display value="No Fixed Address" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="Other" /> <display value="Other" /> </valueCoding> </answerOption> </item> <item> <linkId value="ptLivingSituationOther" /> <text value="Specify Other:" /> <type value="string" /> <enableWhen> <question value="ptLivingSituation" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_ptLivingSituation" /> <code value="Other" /> <display value="Other" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> </item> <item> <linkId value="item92766213" /> <text value="Does patient have access to technology for virtual care:" /> <type value="choice" /> <required value="true" /> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="N" /> <display value="No" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/unknown" /> <code value="NotSure" /> <display value="Not sure" /> </valueCoding> </answerOption> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Additional details/information: {{answer}}" /> </extension> </extension> <linkId value="item60373042" /> <text value="Please provide any additional comment/information:" /> <type value="text" /> <enableWhen> <question value="item92766213" /> <operator value="=" /> <answerCoding> <system value="http://terminology.hl7.org/CodeSystem/v2-0532" /> <code value="Y" /> <display value="Yes" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="drop-down" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Gender: {{answer}}" /> </extension> </extension> <linkId value="item47156976" /> <text value="Gender (if different from above):"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Gender (if different from above):" /> </extension> </text> <type value="choice" /> <repeats value="false" /> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="1" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Male" /> <display value="Male" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="2" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Female" /> <display value="Female" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="3" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Gender queer" /> <display value="Gender queer" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="4" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Intersex" /> <display value="Intersex" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="5" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Nonbinary" /> <display value="Nonbinary" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Questioning" /> <display value="Questioning" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Transsexual" /> <display value="Transsexual" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Two spirit" /> <display value="Two spirit" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension url="http://hl7.org/fhir/StructureDefinition/itemWeight"> <valueDecimal value="0" /> </extension> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item47156976" /> <code value="Unknown" /> <display value="Unknown" /> </valueCoding> </answerOption> <answerOption> <valueCoding> <extension 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<item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="item.where(linkId='item46201687').answer.exists()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptPreferredPharmacy`" /> </valueExpression> </extension> <linkId value="item46201687" /> <text value="Preferred pharmacy:" /> <type value="text" /> <enableBehavior value="all" /> </item> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#008800;" /> </extension> <extension url="negativeStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <linkId value="item87562344" /> <text value="Will 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<valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="section21872532" /> <text value="Contact to Book Appointment" /> <type value="group" /> <item> <linkId value="item32202077" /> <text value="Name:" /> <type value="string" /> <required value="true" /> </item> <item> <linkId value="item70278476" /> <text value="Phone number:" /> <type value="string" /> <required value="true" /> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="section66346248" /> <text value="Additional Relevant Details" /> <type value="group" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension 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value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item26391012" /> <text value="Other Agencies / Programs" /> <type value="boolean" /> </item> <item> <linkId value="item84673008" /> <text value="Details:" /> <type value="text" /> <enableWhen> <question value="item26391012" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item43581865" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section56633689" /> <text value="Past Mental Health / Substance Use Supports / Treatments" /> <type value="group" /> <enableWhen> <question value="item96075834" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section56633689" /> <code value="Geriatric Services" /> <display value="Geriatric Services" /> </answerCoding> </enableWhen> <enableWhen> <question value="item96075834" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section56633689" /> <code value="Child / Youth Services" /> <display value="Child / Youth Services" /> </answerCoding> </enableWhen> 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/> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item11986289" /> <text value="Psychologist" /> <type value="boolean" /> </item> <item> <linkId value="item33474757" /> <text value="Details:" /> <type value="text" /> <enableWhen> <question value="item11986289" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item76753898" /> <text value="Case Worker" /> <type value="boolean" /> </item> <item> <linkId value="item45747256" /> <text value="Details:" /> <type value="text" /> <enableWhen> <question value="item76753898" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item56421735" /> <text value="Other Agencies / Programs" /> <type value="boolean" /> </item> <item> <linkId value="item62676779" /> <text value="Details:" /> <type value="text" /> <enableWhen> <question value="item56421735" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item3522983" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section60045200" /> <text value="Alert(s)" /> <type value="group" /> <enableWhen> <question value="item96075834" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section60045200" /> <code value="Geriatric Services" /> <display value="Geriatric Services" /> </answerCoding> </enableWhen> <enableWhen> <question value="item96075834" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section60045200" /> <code value="Child / Youth Services" /> <display value="Child / Youth Services" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <item> <linkId value="item46673492" /> <text value="Select all that apply:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Select all that apply:" /> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-style:italic;" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <linkId value="item71240775" /> <text value="Pregnant/Post-partum" /> <type value="boolean" /> <enableWhen> <question value="item96075834" /> <operator value="!=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_item96075834" /> <code value="Geriatric Services" /> <display value="Geriatric Services" /> </answerCoding> </enableWhen> <enableBehavior value="all" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.allg`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> <extension url="negativeStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <linkId value="alertAllergies" /> <text value="Allergies" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <linkId value="section45860591" /> <type value="group" /> <enableWhen> <question value="alertAllergies" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.allg`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Allergies: {{answer}}" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <linkId value="item62106942" /> <text value="Details:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Details: " /> </extension> </text> <type value="text" /> <required value="true" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> <extension url="negativeStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <linkId value="item1779139" /> <text value="Other" /> <type value="boolean" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:grey;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="listSeparator"> <valueString value=";" /> </extension> </extension> <linkId value="section26075565" /> <type value="group" /> <enableWhen> <question value="item1779139" /> <operator value="=" /> <answerBoolean value="true" /> </enableWhen> <enableBehavior value="all" /> <item> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="text"> <valueString value="Other Alert(s): {{answer}}" /> </extension> <extension url="answerStyle"> <valueString value="font-weight:bold;color:#AA0000;" /> </extension> </extension> <linkId value="alertOtherDetails" /> <text value="Details:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml"> <valueString value="Details: " /> </extension> </text> <type value="text" /> <required value="true" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item14225800" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="(item96075834.p == '1' || item96075834.p == '2') && (prob.r != '' || pmhx.r != '' || rx.r != '')" /> <language value="text/fhirpath" /> <expression value="(%resource.repeat(item).where(linkId='item96075834').answer.value.weight() = '1' or %resource.repeat(item).where(linkId='item96075834').answer.value.weight() = '2') and (%context.repeat(item).where(linkId='prob').answer.exists() or %context.repeat(item).where(linkId='pmhx').answer.exists() or %context.repeat(item).where(linkId='rx').answer.exists())" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section21033319" /> <text value="Patient CPP" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="prob.r != ''" /> <language value="text/fhirpath" /> <expression value="%context.item.where(linkId='prob').answer.exists()" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="i_ncurrent_problems_n" /> <text value="Current Problems:" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.prob`" /> </valueExpression> </extension> <linkId value="prob" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="pmhx.r != ''" /> <language value="text/fhirpath" /> <expression value="%context.item.where(linkId='pmhx').answer.exists()" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="i_npast_medical_histo" /> <text value="Past Medical History:" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.pmhx`" /> </valueExpression> </extension> <linkId value="pmhx" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="rx.r != ''" /> <language value="text/fhirpath" /> <expression value="%context.item.where(linkId='rx').answer.exists()" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="style"> <valueString value="font-weight:bold;" /> </extension> </extension> <linkId value="i_nmedications_n" /> <text value="Medications:" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-ptCpp.rx`" /> </valueExpression> </extension> <linkId value="rx" /> <type value="text" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="text"> <valueString value="#blank_line#" /> </extension> </extension> <linkId value="item10040823" /> <type value="display" /> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="background-color:white;border-style:solid;" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="text"> <valueString value="Supporting Documentation Attached" /> </extension> <extension url="style"> <valueString value="font-weight:bold;text-decoration:underline;" /> </extension> </extension> <linkId value="section57590463" /> <text value="Supporting Documentation" /> <type value="group" /> <enableWhen> <question value="item96075834" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section57590463" /> <code value="Geriatric Services" /> <display value="Geriatric Services" /> </answerCoding> </enableWhen> <enableWhen> <question value="item96075834" /> <operator value="=" /> <answerCoding> <system value="http://ontariohealth.ca/legacy/CodeSystem/cornwall-community-h_section57590463" /> <code value="Child / Youth Services" /> <display value="Child / Youth Services" /> </answerCoding> </enableWhen> <enableBehavior value="any" /> <item> <linkId value="item22373827" /> <text value="Please confirm attachment of the following:"> <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style"> <valueString value="font-weight:bold;" /> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="prob.r == '' || pmhx.r == ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='prob').answer.empty() or %resource.repeat(item).where(linkId='pmhx').answer.empty()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item87137746" /> <text value="Patient CPP" /> <type value="boolean" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression"> <valueExpression> <description value="rx.r == ''" /> <language value="text/fhirpath" /> <expression value="%resource.repeat(item).where(linkId='rx').answer.empty()" /> </valueExpression> </extension> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item69598044" /> <text value="Current medication list" /> <type value="boolean" /> <required value="true" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control" /> <code value="check-box" /> </coding> </valueCodeableConcept> </extension> <linkId value="item626051" /> <text value="Relevant labs" /> <type value="boolean" /> </item> </item> </item> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="section83550810" /> <text value="Export Analytics [PSM REVIEWED 2021.02.04]" /> <type value="group" /> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="noAttachmentWarning" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="item87137746.r == 'Y' || item69598044.r == 'Y' || item626051.r == 'Y' || item65123098.r == 'Y' || item65033221.r == 'Y' || item9309258.r == 'Y' ? 'Did you forget to attach a file? / Avez-vous oublié de joindre un document?' : ''" /> <language value="text/fhirpath" /> <expression value="iif((%resource.repeat(item).where(linkId='item87137746').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item69598044').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item626051').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item65123098').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item65033221').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item9309258').answer.exists(value = 'Y') ), 'Did you forget to attach a file? / Avez-vous oublié de joindre un document?', '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression"> <valueExpression> <language value="text/fhirpath" /> <expression value="%`var-refRt`" /> </valueExpression> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/question-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="refRt" /> <text value="refRt:" /> <type value="string" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="referralDescription" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() { var descs = []; if (item96075834.r == 'Geriatric Services' || item28218801.p == '1') { descs.push('Access Mental Health and Addictions Program (Geriatric Services)'); } if (item96075834.r == 'Child / Youth Services' || item28218801.p == '2') { descs.push('Access Mental Health and Addictions Program (Child / Youth Services)'); } return descs.join('; '); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='item96075834').answer.exists(value = 'Geriatric Services') or %resource.repeat(item).where(linkId='item28218801').answer.value.weight() = '1','Access Mental Health and Addictions Program (Geriatric Services)') | iif(%resource.repeat(item).where(linkId='item96075834').answer.exists(value = 'Child / Youth Services') or %resource.repeat(item).where(linkId='item28218801').answer.value.weight() = '2','Access Mental Health and Addictions Program (Child / Youth Services)')).aggregate($total & iif($total='', $this, '; ' + $this), '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="referralService" /> <text value="MENTAL_HEALTH_ASSESSMENT_AND_REFERRAL" /> <type value="display" /> </item> <item> <linkId value="ax_languageBarrier" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (interpreterServices.r == 'Y' || item69600178.r == 'Oui') {descs+='TRUE';} if (interpreterServices.r == 'N' || item69600178.r == 'Non') {descs+='FALSE';} if (interpreterServices.r == '' && item69600178.r == '') {descs+='FALSE';} return descs; })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='interpreterServices').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item69600178').answer.exists(value = 'Oui'),'TRUE') | iif(%resource.repeat(item).where(linkId='interpreterServices').answer.exists(value = 'N') or %resource.repeat(item).where(linkId='item69600178').answer.exists(value = 'Non'),'FALSE') | iif(%resource.repeat(item).where(linkId='interpreterServices').answer.empty() and %resource.repeat(item).where(linkId='item69600178').answer.empty(),'FALSE')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <linkId value="ax_lab_fbs" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (onFrenchForm.r == 'Y' && refRt.r == '_demo_acc_s_sant_men63300900' || item94471703.r == 'Y') {descs+='TRUE';} if (onFrenchForm.r != 'Y' || item94471703.r != 'Y' && refRt.r != '_demo_acc_s_sant_men63300900' ) {descs+='FALSE';} return descs; })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='onFrenchForm').answer.exists(value = 'Y') and %resource.repeat(item).where(linkId='refRt').answer.exists(value = '_demo_acc_s_sant_men63300900') or %resource.repeat(item).where(linkId='item94471703').answer.exists(value = 'Y'),'TRUE') | iif(%resource.repeat(item).where(linkId='onFrenchForm').answer.exists(value != 'Y') or %resource.repeat(item).where(linkId='item94471703').answer.exists(value != 'Y') and %resource.repeat(item).where(linkId='refRt').answer.exists(value != '_demo_acc_s_sant_men63300900'),'FALSE')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="ax_language" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (lang.r == 'English' || item53251990.r == 'Anglais') {descs+='English';} if (lang.r == 'French' || item53251990.r == 'Français') {descs+='French';} if (lang.r == 'Other') {descs+= 'Other: ' + item69641905.r;} if (item53251990.r == 'Autre') {descs+= 'Other: ' + item22100237.r;} return descs; })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='lang').answer.exists(value = 'English') or %resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Anglais'),'English') | iif(%resource.repeat(item).where(linkId='lang').answer.exists(value = 'French') or %resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Français'),'French') | iif(%resource.repeat(item).where(linkId='lang').answer.exists(value = 'Other'),'Other: ' + %resource.repeat(item).where(linkId='item69641905').answer.value) | iif(%resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Autre'),'Other: ' + %resource.repeat(item).where(linkId='item22100237').answer.value)).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <linkId value="ax_reasonForReferral" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (r4r1.r == 'Y' || item76744208.r == 'Y' || item54060805.r == 'Y' || item90686790.r == 'Y' || item41822197.r == 'Y' || item75512976.r == 'Y') { descs+= 'Diagnosis / Diagnostic Clarification' +'; '; } if (r4r2.r == 'Y' || item7916443.r == 'Y' || item37517159.r == 'Y' || item20817558.r == 'Y' || item73936819.r == 'Y' || item93970593.r == 'Y') { descs+= 'Substance Use Withdrawal Management' +'; '; } if (r4r3.r == 'Y' || item64392358.r == 'Y' || item12841092.r == 'Y' || item7783840.r == 'Y' || item89687517.r == 'Y' || item6660334.r == 'Y') { descs+= 'Substance Use Treatment / Treatment Recommendations' +'; '; } if (item44376849.r == 'Y' || item14275892.r == 'Y' || item83689316.r == 'Y' || item64934451.r == 'Y' || item64944709.r == 'Y' || item7665406.r == 'Y') { descs+= 'Medication Recommendations / Review' +'; '; } if (item35681571.r == 'Y' || item84616916.r == 'Y' || item46224624.r == 'Y' || item94072441.r == 'Y' || item35048963.r == 'Y' || item28409703.r == 'Y') { descs+= 'Mental Health Treatment / Treatment Recommendations' +'; '; } if (item32743465.r == 'Y' || item81001366.r == 'Y') { descs+= 'Responsive Behaviour Management' +'; '; } if (item93941389.r == 'Y' || item28424670.r == 'Y') { descs+= 'Self-Esteem Issues' +'; '; } if (item24861720.r == 'Y' || item80603308.r == 'Y') { descs+= 'School Related Issues' +'; '; } if (item46190781.r == 'Y' || item12159999.r == 'Y') { descs+= 'Gender Identity / Sexual Orientation' +'; '; } if (item49247275.r == 'Y' || item32002193.r == 'Y') { descs+= 'Difficulties Regulating Emotions' +'; '; } if (r4rOther.r == 'Y' || item63777237.r == 'Y' || item25886109.r == 'Y' || item98968631.r == 'Y' || item23513972.r == 'Y') { descs+= 'Other' +'; '; } return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='r4r1').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item76744208').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item54060805').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item90686790').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item41822197').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item75512976').answer.exists(value = 'Y'),'Diagnosis / Diagnostic Clarification' +'; ') | iif(%resource.repeat(item).where(linkId='r4r2').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item7916443').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item37517159').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item20817558').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item73936819').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item93970593').answer.exists(value = 'Y'),'Substance Use Withdrawal Management' +'; ') | iif(%resource.repeat(item).where(linkId='r4r3').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item64392358').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item12841092').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item7783840').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item89687517').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item6660334').answer.exists(value = 'Y'),'Substance Use Treatment / Treatment Recommendations' +'; ') | iif(%resource.repeat(item).where(linkId='item44376849').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item14275892').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item83689316').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item64934451').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item64944709').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item7665406').answer.exists(value = 'Y'),'Medication Recommendations / Review' +'; ') | iif(%resource.repeat(item).where(linkId='item35681571').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item84616916').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item46224624').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item94072441').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item35048963').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item28409703').answer.exists(value = 'Y'),'Mental Health Treatment / Treatment Recommendations' +'; ') | iif(%resource.repeat(item).where(linkId='item32743465').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item81001366').answer.exists(value = 'Y'),'Responsive Behaviour Management' +'; ') | iif(%resource.repeat(item).where(linkId='item93941389').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item28424670').answer.exists(value = 'Y'),'Self-Esteem Issues' +'; ') | iif(%resource.repeat(item).where(linkId='item24861720').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item80603308').answer.exists(value = 'Y'),'School Related Issues' +'; ') | iif(%resource.repeat(item).where(linkId='item46190781').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item12159999').answer.exists(value = 'Y'),'Gender Identity / Sexual Orientation' +'; ') | iif(%resource.repeat(item).where(linkId='item49247275').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item32002193').answer.exists(value = 'Y'),'Difficulties Regulating Emotions' +'; ') | iif(%resource.repeat(item).where(linkId='r4rOther').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item63777237').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item25886109').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item98968631').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item23513972').answer.exists(value = 'Y'),'Other' +'; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="ax_diagnosis" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (item58135328.r == 'Y' || item2356348.r == 'Y') { descs+= 'Cognition / Dementia' +'; '; } if (item94424455.r == 'Y' || item15643336.r == 'Y' || item77452728.r == 'Y' || item80118709.r == 'Y') { descs+= 'Depression' +'; '; } if (item10332520.r == 'Y' || item85037680.r == 'Y') { descs+= 'Trauma' +'; '; } if (item60166022.r == 'Y' || item30343743.r == 'Y' || item39727284.r == 'Y' || item84138704.r == 'Y') { descs+= 'Bipolar Disorder' +'; '; } if (item83992629.r == 'Y' || item36855558.r == 'Y' || item99422615.r == 'Y' || item63467845.r == 'Y') { descs+= 'Anxiety Disorder(s)' +'; '; } if (item7871097.r == 'Y' || item93984015.r == 'Y' || item59458865.r == 'Y' || item50658526.r == 'Y') { descs+= 'Obsessive Compulsive Disorder' +'; '; } if (item35653741.r == 'Y' || item27659494.r == 'Y' || item22412314.r == 'Y' || item27761130.r == 'Y') { descs+= 'Post-Traumatic Stress Disorder' +'; '; } if (item57160522.r == 'Y' || item9737619.r == 'Y' || item58575895.r == 'Y' || item94901958.r == 'Y') { descs+= 'Schizophrenia / Psychosis' +'; '; } if (item65652334.r == 'Y' || item69836295.r == 'Y' || item35092606.r == 'Y' || item48664374.r == 'Y' || item71728972.r == 'Y') { descs+= 'Substance Use and Addiction' +'; '; } if (item58121667.r == 'Y' || item93532917.r == 'Y' || item29567046.r == 'Y' || item45446236.r == 'Y') { descs+= 'Personality Disorder' +'; '; } if (item12081173.r == 'Y' || item49957366.r == 'Y' || item28514649.r == 'Y' || item99992061.r == 'Y') { descs+= 'Eating Disorder' +'; '; } if (item80944161.r == 'Y' || item98201917.r == 'Y' || item10093168.r == 'Y' || item47953947.r == 'Y') { descs+= 'Neurodevelopmental Disorders' +'; '; } if (item38161937.r == 'Y' || item52303515.r == 'Y' || item89336505.r == 'Y' || item43437113.r == 'Y') { descs+= 'Attention Deficit Hyperactivity Disorder' +'; '; } if (item24951129.r == 'Y' || item48648203.r == 'Y' || item80287888.r == 'Y' || item19133749.r == 'Y') { descs+= 'Behavioural Issues / Disorders' +'; '; } if (item39395736.r == 'Y' || item66256289.r == 'Y' || item13730026.r == 'Y' || item46418991.r == 'Y') { descs+= 'Difficulty Coping with Life Stressors' +'; '; } if (item93828343.r == 'Y' || item69695776.r == 'Y' || item80474498.r == 'Y' || item86471184.r == 'Y') { descs+= 'Sleep Disorders' +'; '; } return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='item58135328').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item2356348').answer.exists(value = 'Y'),'Cognition / Dementia' +'; ') | iif(%resource.repeat(item).where(linkId='item94424455').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item15643336').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item77452728').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item80118709').answer.exists(value = 'Y'),'Depression' +'; ') | iif(%resource.repeat(item).where(linkId='item10332520').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item85037680').answer.exists(value = 'Y'),'Trauma' +'; ') | iif(%resource.repeat(item).where(linkId='item60166022').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item30343743').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item39727284').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item84138704').answer.exists(value = 'Y'),'Bipolar Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item83992629').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item36855558').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item99422615').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item63467845').answer.exists(value = 'Y'),'Anxiety Disorder(s)' +'; ') | iif(%resource.repeat(item).where(linkId='item7871097').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item93984015').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item59458865').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item50658526').answer.exists(value = 'Y'),'Obsessive Compulsive Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item35653741').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item27659494').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item22412314').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item27761130').answer.exists(value = 'Y'),'Post-Traumatic Stress Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item57160522').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item9737619').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item58575895').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item94901958').answer.exists(value = 'Y'),'Schizophrenia / Psychosis' +'; ') | iif(%resource.repeat(item).where(linkId='item65652334').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item69836295').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item35092606').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item48664374').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item71728972').answer.exists(value = 'Y'),'Substance Use and Addiction' +'; ') | iif(%resource.repeat(item).where(linkId='item58121667').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item93532917').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item29567046').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item45446236').answer.exists(value = 'Y'),'Personality Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item12081173').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item49957366').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item28514649').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item99992061').answer.exists(value = 'Y'),'Eating Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item80944161').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item98201917').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item10093168').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item47953947').answer.exists(value = 'Y'),'Neurodevelopmental Disorders' +'; ') | iif(%resource.repeat(item).where(linkId='item38161937').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item52303515').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item89336505').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item43437113').answer.exists(value = 'Y'),'Attention Deficit Hyperactivity Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item24951129').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item48648203').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item80287888').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item19133749').answer.exists(value = 'Y'),'Behavioural Issues / Disorders' +'; ') | iif(%resource.repeat(item).where(linkId='item39395736').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item66256289').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item13730026').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item46418991').answer.exists(value = 'Y'),'Difficulty Coping with Life Stressors' +'; ') | iif(%resource.repeat(item).where(linkId='item93828343').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item69695776').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item80474498').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item86471184').answer.exists(value = 'Y'),'Sleep Disorders' +'; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="ax_lab_tg" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (item47156976.r == 'Male' || item98979066.r == 'Homme') { descs+= 'Male' ; } if (item47156976.r == 'Female' || item98979066.r == 'Femme') { descs+= 'Female' ; } if (item47156976.r == 'Gender queer' || item98979066.r == 'Genre queer') { descs+= 'Gender Queer' ; } if (item47156976.r == 'Intersex' || item98979066.r == 'Intersexué(e)') { descs+= 'Intersex' ; } if (item47156976.r == 'Nonbinary' || item98979066.r == 'Non binaire') { descs+= 'Nonbinary' ; } if (item47156976.r == 'Questioning' || item98979066.r == 'En questionnement') { descs+= 'Questioning' ; } if (item47156976.r == 'Transsexual' || item98979066.r == 'Transsexuel(le)') { descs+= 'Transsexual' ; } if (item47156976.r == 'Two spirit' || item98979066.r == 'Bispirituel(le)') { descs+= 'Two Spirit' ; } if (item47156976.r == 'Unknown' || item98979066.r == 'Inconnu') { descs+= 'Unknown' ; } if (item47156976.r == 'Declined to say' || item98979066.r == 'Refuse de répondre') { descs+= 'Declined to Say' ; } if (item47156976.r == 'Other' || item98979066.r == 'Autre') { descs+= 'Other' ; } return descs.substring(0, (descs.length-0)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Male') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Homme'),'Male') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Female') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Femme'),'Female') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Gender queer') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Genre queer'),'Gender Queer') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Intersex') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Intersexué(e)'),'Intersex') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Nonbinary') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Non binaire'),'Nonbinary') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Questioning') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'En questionnement'),'Questioning') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Transsexual') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Transsexuel(le)'),'Transsexual') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Two spirit') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Bispirituel(le)'),'Two Spirit') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Unknown') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Inconnu'),'Unknown') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Declined to say') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Refuse de répondre'),'Declined to Say') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Other') or %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Autre'),'Other')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="ax_lab_hdl" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (ptLivingSituation.r == 'Alone' || item42679017.p == '1') { descs+= 'Alone' ; } if (ptLivingSituation.r == 'With Family/Spouse' || item42679017.p == '2') { descs+= 'With Family/Spouse' ; } if (ptLivingSituation.r == 'Supportive Housing' || item42679017.p == '3') { descs+= 'Supportive Housing' ; } if (ptLivingSituation.r == 'Foster Home' || item42679017.p == '4') { descs+= 'Foster Home' ; } if (ptLivingSituation.r == 'Residence' || item42679017.p == '5') { descs+= 'Residence' ; } if (ptLivingSituation.r == 'No Fixed Address' || item42679017.p == '6') { descs+= 'No Fixed Address' ; } if (ptLivingSituation.r == 'Other' || item42679017.p == '7') { descs+= 'Other' ; } return descs.substring(0, (descs.length-0)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Alone') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '1','Alone') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'With Family/Spouse') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '2','With Family/Spouse') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Supportive Housing') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '3','Supportive Housing') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Foster Home') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '4','Foster Home') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Residence') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '5','Residence') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'No Fixed Address') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '6','No Fixed Address') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Other') or %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '7','Other')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden"> <valueBoolean value="true" /> </extension> <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info"> <extension url="enableWhenExpression"> <valueExpression> <description value="false" /> <language value="text/fhirpath" /> <expression value="false" /> </valueExpression> </extension> </extension> <linkId value="ax_lab_ldl" /> <text> <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression"> <valueExpression> <description value="(function() {; var descs = ""; if (riskHospitalization.r == 'Y' || item1131572.p == '2') { descs+= 'Hospital Visit / Hospitalization' +'; '; } if (riskSuicide.r == 'Y' || item54312281.r == 'Y' || item65514873.r == 'Y' || item57097806.p == '2') { descs+= 'Suicide Attempt / Ideation' +'; '; } if (riskSelfHarm.r == 'Y' || item3104556.r == 'Y' || item67814819.r == 'Y' || item85423664.p == '2') { descs+= 'Deliberate Self-Harm' +'; '; } if (riskHomicidalThreats.r == 'Y' || item90244509.p == '2') { descs+= 'Homicidal Threats / Ideation' +'; '; } if (riskViolence.r == 'Y' || item53574417.r == 'Y' || item48440940.r == 'Y' || item25263968.p == '2') { descs+= 'Violent Behaviour' +'; '; } if (riskLegal.r == 'Y' || item9851311.p == '2') { descs+= 'Legal Involvement' +'; '; } if (item20409433.r == 'Y' || item45753134.r == 'Y' || item5510019.r == 'Y' || item67727582.p == '2') { descs+= 'Experiencing Violence' +'; '; } if (item71572236.r == 'Y' || item94206719.r == 'Y') { descs+= 'Family Conflict' +'; '; } return descs.substring(0, (descs.length-2)); })()" /> <language value="text/fhirpath" /> <expression value="(iif(%resource.repeat(item).where(linkId='riskHospitalization').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item1131572').answer.value.weight() = '2','Hospital Visit / Hospitalization' +'; ') | iif(%resource.repeat(item).where(linkId='riskSuicide').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item54312281').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item65514873').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item57097806').answer.value.weight() = '2','Suicide Attempt / Ideation' +'; ') | iif(%resource.repeat(item).where(linkId='riskSelfHarm').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item3104556').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item67814819').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item85423664').answer.value.weight() = '2','Deliberate Self-Harm' +'; ') | iif(%resource.repeat(item).where(linkId='riskHomicidalThreats').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item90244509').answer.value.weight() = '2','Homicidal Threats / Ideation' +'; ') | iif(%resource.repeat(item).where(linkId='riskViolence').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item53574417').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item48440940').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item25263968').answer.value.weight() = '2','Violent Behaviour' +'; ') | iif(%resource.repeat(item).where(linkId='riskLegal').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item9851311').answer.value.weight() = '2','Legal Involvement' +'; ') | iif(%resource.repeat(item).where(linkId='item20409433').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item45753134').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item5510019').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item67727582').answer.value.weight() = '2','Experiencing Violence' +'; ') | iif(%resource.repeat(item).where(linkId='item71572236').answer.exists(value = 'Y') or %resource.repeat(item).where(linkId='item94206719').answer.exists(value = 'Y'),'Family Conflict' +'; ')).aggregate($total & $this, '')" /> </valueExpression> </extension> </text> <type value="display" /> </item> </item> </item> </Questionnaire>


  
    
      
      
    
  
  
    
  
  
    
      
        
        
      
    
    
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
      
      
    
  
  
    
      
    
  
  
  
  
  <status value="active" />
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        <valueString value="font-weight:bold;text-decoration:underline;" />
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    <linkId value="questionnaire" />
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      <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="background-color:white;border-style:solid;" />
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      <linkId value="section89975948" />
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              <code value="check-box" />
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              <language value="text/fhirpath" />
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        <linkId value="item94471703" />
        <text value="Souhaitez-vous remplir ce formulaire en français?">
          <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="font-weight:bold;" />
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        <type value="boolean" />
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          <question value="refRt" />
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            <valueString value="font-weight:bold;" />
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            <text value="L’équipe des Services communautaires de santé mentale et de traitement des dépendances de l’Hôpital de Cornwall offre un éventail complet de services de traitement des problèmes de santé mentale et des dépendances aux personnes de tous âges, des nouveau-nés aux personnes âgées [Note: Les Services aux adultes sont coordonnés par l’entremise d’AccèsSMT]. Nous offrons du counseling individuel, familial et de groupe selon les besoins des clients. Nous offrons aussi un soutien clinique aux personnes qui s’occupent de bébés et de tout-petits ainsi qu’aux aidants dont les proches sont aux prises avec un trouble de santé mentale ou de dépendance. Nos services sont offerts dans nos bureaux, à domicile, dans les écoles et en milieu hospitalier, et comprennent ce qui suit:">
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                <valueString value="L’équipe des Services communautaires de santé mentale et de traitement des dépendances de l’Hôpital de Cornwall offre un éventail complet de services de traitement des problèmes de santé mentale et des dépendances aux personnes de tous âges, des nouveau-nés aux personnes âgées [Note: Les Services aux adultes sont coordonnés par l’entremise d’AccèsSMT]. Nous offrons du counseling individuel, familial et de groupe selon les besoins des clients. Nous offrons aussi un soutien clinique aux personnes qui s’occupent de bébés et de tout-petits ainsi qu’aux aidants dont les proches sont aux prises avec un trouble de santé mentale ou de dépendance.<br/>Nos services sont offerts dans nos bureaux, à domicile, dans les écoles et en milieu hospitalier, et comprennent ce qui suit:" />
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          <item>
            <linkId value="item68891569" />
            <text value="•  Services de santé mentale pour les enfants et les jeunes" />
            <type value="display" />
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            <type value="display" />
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          <text value="Si votre patient est en situation de crise et a besoin d’une aide immédiate:" />
          <type value="group" />
          <item>
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            <text value="• Contactez un service de crise local • Dites à votre patient de se rendre au service d’urgence de l’hôpital le plus proche • Appelez le 911">
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          <text value="* Indique un champ obligatoire">
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          <type value="display" />
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          <valueString value="background-color:white;border-style:solid;" />
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        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/group-note-info">
          <extension url="text">
            <valueString value="Consentement" />
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            <valueString value="font-weight:bold;text-decoration:underline;" />
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        <linkId value="section38344247" />
        <text value="Consentement">
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            <valueString value="text-decoration:underline;" />
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        <type value="group" />
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                <code value="push-button" />
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          <linkId value="item34143726" />
          <text value="Le patient est-il au courant de cet aiguillage et consent-il à participer:" />
          <type value="choice" />
          <required value="true" />
          <repeats value="false" />
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              <code value="Non" />
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              <code value="Oui" />
              <display value="Oui" />
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        <item>
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            <extension url="key">
              <valueId value="item90790889" />
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            <extension url="severity">
              <valueCode value="error" />
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            <extension url="human">
              <valueString value="Please obey rules specified in instructions" />
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              <valueExpression>
                <description value="item34143726.r == 'Oui'" />
                <language value="text/fhirpath" />
                <expression value="%resource.repeat(item).where(linkId='item34143726').answer.exists(value = 'Oui')" />
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          <extension url="http://hl7.org/fhir/StructureDefinition/rendering-style">
            <valueString value="background-color:grey;border-style:solid;" />
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          <linkId value="section2585986" />
          <type value="group" />
          <enableWhen>
            <question value="item34143726" />
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              <expression value="(iif(%resource.repeat(item).where(linkId='onFrenchForm').answer.exists(value = 'Y')  and  %resource.repeat(item).where(linkId='refRt').answer.exists(value = '_demo_acc_s_sant_men63300900')  or  %resource.repeat(item).where(linkId='item94471703').answer.exists(value = 'Y'),'TRUE') | iif(%resource.repeat(item).where(linkId='onFrenchForm').answer.exists(value != 'Y')   or  %resource.repeat(item).where(linkId='item94471703').answer.exists(value != 'Y')  and  %resource.repeat(item).where(linkId='refRt').answer.exists(value != '_demo_acc_s_sant_men63300900'),'FALSE')).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
          <valueBoolean value="true" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
          <extension url="enableWhenExpression">
            <valueExpression>
              <description value="false" />
              <language value="text/fhirpath" />
              <expression value="false" />
            </valueExpression>
          </extension>
        </extension>
        <linkId value="ax_language" />
        <text>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <description value="(function() {; var descs = "";  if (lang.r == 'English' || item53251990.r == 'Anglais') {descs+='English';}      if (lang.r == 'French' || item53251990.r == 'Français') {descs+='French';}     if (lang.r == 'Other') {descs+= 'Other: ' + item69641905.r;}     if (item53251990.r == 'Autre') {descs+= 'Other: ' + item22100237.r;}        return descs;   })()" />
              <language value="text/fhirpath" />
              <expression value="(iif(%resource.repeat(item).where(linkId='lang').answer.exists(value = 'English')  or  %resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Anglais'),'English') | iif(%resource.repeat(item).where(linkId='lang').answer.exists(value = 'French')  or  %resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Français'),'French') | iif(%resource.repeat(item).where(linkId='lang').answer.exists(value = 'Other'),'Other: ' + %resource.repeat(item).where(linkId='item69641905').answer.value) | iif(%resource.repeat(item).where(linkId='item53251990').answer.exists(value = 'Autre'),'Other: ' + %resource.repeat(item).where(linkId='item22100237').answer.value)).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
      <item>
        <linkId value="ax_reasonForReferral" />
        <text>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <description value="(function() {; var descs = ""; if (r4r1.r == 'Y' || item76744208.r == 'Y' || item54060805.r == 'Y' || item90686790.r == 'Y' || item41822197.r == 'Y' || item75512976.r == 'Y') { descs+= 'Diagnosis / Diagnostic Clarification' +'; '; }     if (r4r2.r == 'Y' || item7916443.r == 'Y' || item37517159.r == 'Y' || item20817558.r == 'Y' || item73936819.r == 'Y' || item93970593.r == 'Y') { descs+= 'Substance Use Withdrawal Management' +'; '; }     if (r4r3.r == 'Y' || item64392358.r == 'Y' || item12841092.r == 'Y' || item7783840.r == 'Y' || item89687517.r == 'Y' || item6660334.r == 'Y') { descs+= 'Substance Use Treatment / Treatment Recommendations' +'; '; }     if (item44376849.r == 'Y' || item14275892.r == 'Y' || item83689316.r == 'Y' || item64934451.r == 'Y' || item64944709.r == 'Y' || item7665406.r == 'Y') { descs+= 'Medication Recommendations / Review' +'; '; }     if (item35681571.r == 'Y' || item84616916.r == 'Y' || item46224624.r == 'Y' || item94072441.r == 'Y' || item35048963.r == 'Y' || item28409703.r == 'Y') { descs+= 'Mental Health Treatment / Treatment Recommendations' +'; '; }     if (item32743465.r == 'Y' || item81001366.r == 'Y') { descs+= 'Responsive Behaviour Management' +'; '; }     if (item93941389.r == 'Y'  || item28424670.r == 'Y') { descs+= 'Self-Esteem Issues' +'; '; }     if (item24861720.r == 'Y' || item80603308.r == 'Y') { descs+= 'School Related Issues' +'; '; }     if (item46190781.r == 'Y' || item12159999.r == 'Y') { descs+= 'Gender Identity / Sexual Orientation' +'; '; }     if (item49247275.r == 'Y' || item32002193.r == 'Y') { descs+= 'Difficulties Regulating Emotions' +'; '; }     if (r4rOther.r == 'Y' || item63777237.r == 'Y' || item25886109.r == 'Y' || item98968631.r == 'Y' || item23513972.r == 'Y') { descs+= 'Other' +'; '; }      return descs.substring(0, (descs.length-2));  })()" />
              <language value="text/fhirpath" />
              <expression value="(iif(%resource.repeat(item).where(linkId='r4r1').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item76744208').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item54060805').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item90686790').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item41822197').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item75512976').answer.exists(value = 'Y'),'Diagnosis / Diagnostic Clarification' +'; ') | iif(%resource.repeat(item).where(linkId='r4r2').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item7916443').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item37517159').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item20817558').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item73936819').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item93970593').answer.exists(value = 'Y'),'Substance Use Withdrawal Management' +'; ') | iif(%resource.repeat(item).where(linkId='r4r3').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item64392358').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item12841092').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item7783840').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item89687517').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item6660334').answer.exists(value = 'Y'),'Substance Use Treatment / Treatment Recommendations' +'; ') | iif(%resource.repeat(item).where(linkId='item44376849').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item14275892').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item83689316').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item64934451').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item64944709').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item7665406').answer.exists(value = 'Y'),'Medication Recommendations / Review' +'; ') | iif(%resource.repeat(item).where(linkId='item35681571').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item84616916').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item46224624').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item94072441').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item35048963').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item28409703').answer.exists(value = 'Y'),'Mental Health Treatment / Treatment Recommendations' +'; ') | iif(%resource.repeat(item).where(linkId='item32743465').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item81001366').answer.exists(value = 'Y'),'Responsive Behaviour Management' +'; ') | iif(%resource.repeat(item).where(linkId='item93941389').answer.exists(value = 'Y')   or  %resource.repeat(item).where(linkId='item28424670').answer.exists(value = 'Y'),'Self-Esteem Issues' +'; ') | iif(%resource.repeat(item).where(linkId='item24861720').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item80603308').answer.exists(value = 'Y'),'School Related Issues' +'; ') | iif(%resource.repeat(item).where(linkId='item46190781').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item12159999').answer.exists(value = 'Y'),'Gender Identity / Sexual Orientation' +'; ') | iif(%resource.repeat(item).where(linkId='item49247275').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item32002193').answer.exists(value = 'Y'),'Difficulties Regulating Emotions' +'; ') | iif(%resource.repeat(item).where(linkId='r4rOther').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item63777237').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item25886109').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item98968631').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item23513972').answer.exists(value = 'Y'),'Other' +'; ')).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
          <valueBoolean value="true" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
          <extension url="enableWhenExpression">
            <valueExpression>
              <description value="false" />
              <language value="text/fhirpath" />
              <expression value="false" />
            </valueExpression>
          </extension>
        </extension>
        <linkId value="ax_diagnosis" />
        <text>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <description value="(function() {; var descs = "";   if (item58135328.r == 'Y' || item2356348.r == 'Y') { descs+= 'Cognition / Dementia' +'; '; }     if (item94424455.r == 'Y' || item15643336.r == 'Y' || item77452728.r == 'Y' || item80118709.r == 'Y') { descs+= 'Depression' +'; '; }     if (item10332520.r == 'Y' || item85037680.r == 'Y') { descs+= 'Trauma' +'; '; }     if (item60166022.r == 'Y' || item30343743.r == 'Y' || item39727284.r == 'Y' || item84138704.r == 'Y') { descs+= 'Bipolar Disorder' +'; '; }     if (item83992629.r == 'Y' || item36855558.r == 'Y' || item99422615.r == 'Y' || item63467845.r == 'Y') { descs+= 'Anxiety Disorder(s)' +'; '; }     if (item7871097.r == 'Y' || item93984015.r == 'Y' || item59458865.r == 'Y' || item50658526.r == 'Y') { descs+= 'Obsessive Compulsive Disorder' +'; '; }    if (item35653741.r == 'Y' || item27659494.r == 'Y' || item22412314.r == 'Y' || item27761130.r == 'Y') { descs+= 'Post-Traumatic Stress Disorder' +'; '; }     if (item57160522.r == 'Y' || item9737619.r == 'Y' || item58575895.r == 'Y' || item94901958.r == 'Y') { descs+= 'Schizophrenia / Psychosis' +'; '; }     if (item65652334.r == 'Y' || item69836295.r == 'Y' || item35092606.r == 'Y' || item48664374.r == 'Y' || item71728972.r == 'Y') { descs+= 'Substance Use and Addiction' +'; '; }     if (item58121667.r == 'Y' || item93532917.r == 'Y' || item29567046.r == 'Y' || item45446236.r == 'Y') { descs+= 'Personality Disorder' +'; '; }     if (item12081173.r == 'Y' || item49957366.r == 'Y' || item28514649.r == 'Y' || item99992061.r == 'Y') { descs+= 'Eating Disorder' +'; '; }     if (item80944161.r == 'Y' || item98201917.r == 'Y' || item10093168.r == 'Y' || item47953947.r == 'Y') { descs+= 'Neurodevelopmental Disorders' +'; '; }     if (item38161937.r == 'Y' || item52303515.r == 'Y' || item89336505.r == 'Y' || item43437113.r == 'Y') { descs+= 'Attention Deficit Hyperactivity Disorder' +'; '; }     if (item24951129.r == 'Y' || item48648203.r == 'Y' || item80287888.r == 'Y' || item19133749.r == 'Y') { descs+= 'Behavioural Issues / Disorders' +'; '; }     if (item39395736.r == 'Y' || item66256289.r == 'Y' || item13730026.r == 'Y' || item46418991.r == 'Y') { descs+= 'Difficulty Coping with Life Stressors' +'; '; }     if (item93828343.r == 'Y' || item69695776.r == 'Y' || item80474498.r == 'Y' || item86471184.r == 'Y') { descs+= 'Sleep Disorders' +'; '; }    return descs.substring(0, (descs.length-2));  })()" />
              <language value="text/fhirpath" />
              <expression value="(iif(%resource.repeat(item).where(linkId='item58135328').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item2356348').answer.exists(value = 'Y'),'Cognition / Dementia' +'; ') | iif(%resource.repeat(item).where(linkId='item94424455').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item15643336').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item77452728').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item80118709').answer.exists(value = 'Y'),'Depression' +'; ') | iif(%resource.repeat(item).where(linkId='item10332520').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item85037680').answer.exists(value = 'Y'),'Trauma' +'; ') | iif(%resource.repeat(item).where(linkId='item60166022').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item30343743').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item39727284').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item84138704').answer.exists(value = 'Y'),'Bipolar Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item83992629').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item36855558').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item99422615').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item63467845').answer.exists(value = 'Y'),'Anxiety Disorder(s)' +'; ') | iif(%resource.repeat(item).where(linkId='item7871097').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item93984015').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item59458865').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item50658526').answer.exists(value = 'Y'),'Obsessive Compulsive Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item35653741').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item27659494').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item22412314').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item27761130').answer.exists(value = 'Y'),'Post-Traumatic Stress Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item57160522').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item9737619').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item58575895').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item94901958').answer.exists(value = 'Y'),'Schizophrenia / Psychosis' +'; ') | iif(%resource.repeat(item).where(linkId='item65652334').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item69836295').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item35092606').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item48664374').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item71728972').answer.exists(value = 'Y'),'Substance Use and Addiction' +'; ') | iif(%resource.repeat(item).where(linkId='item58121667').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item93532917').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item29567046').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item45446236').answer.exists(value = 'Y'),'Personality Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item12081173').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item49957366').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item28514649').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item99992061').answer.exists(value = 'Y'),'Eating Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item80944161').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item98201917').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item10093168').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item47953947').answer.exists(value = 'Y'),'Neurodevelopmental Disorders' +'; ') | iif(%resource.repeat(item).where(linkId='item38161937').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item52303515').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item89336505').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item43437113').answer.exists(value = 'Y'),'Attention Deficit Hyperactivity Disorder' +'; ') | iif(%resource.repeat(item).where(linkId='item24951129').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item48648203').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item80287888').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item19133749').answer.exists(value = 'Y'),'Behavioural Issues / Disorders' +'; ') | iif(%resource.repeat(item).where(linkId='item39395736').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item66256289').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item13730026').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item46418991').answer.exists(value = 'Y'),'Difficulty Coping with Life Stressors' +'; ') | iif(%resource.repeat(item).where(linkId='item93828343').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item69695776').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item80474498').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item86471184').answer.exists(value = 'Y'),'Sleep Disorders' +'; ')).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
          <valueBoolean value="true" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
          <extension url="enableWhenExpression">
            <valueExpression>
              <description value="false" />
              <language value="text/fhirpath" />
              <expression value="false" />
            </valueExpression>
          </extension>
        </extension>
        <linkId value="ax_lab_tg" />
        <text>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <description value="(function() {; var descs = "";  if (item47156976.r == 'Male' || item98979066.r == 'Homme') { descs+= 'Male' ; }    if (item47156976.r == 'Female' || item98979066.r == 'Femme') { descs+= 'Female' ; }    if (item47156976.r == 'Gender queer' || item98979066.r == 'Genre queer') { descs+= 'Gender Queer' ; }    if (item47156976.r == 'Intersex' || item98979066.r == 'Intersexué(e)') { descs+= 'Intersex' ; }    if (item47156976.r == 'Nonbinary' || item98979066.r == 'Non binaire') { descs+= 'Nonbinary' ; }    if (item47156976.r == 'Questioning' || item98979066.r == 'En questionnement') { descs+= 'Questioning' ; }    if (item47156976.r == 'Transsexual' || item98979066.r == 'Transsexuel(le)') { descs+= 'Transsexual' ; }    if (item47156976.r == 'Two spirit' || item98979066.r == 'Bispirituel(le)') { descs+= 'Two Spirit' ; }    if (item47156976.r == 'Unknown' || item98979066.r == 'Inconnu') { descs+= 'Unknown' ; }    if (item47156976.r == 'Declined to say' || item98979066.r == 'Refuse de répondre') { descs+= 'Declined to Say' ; }    if (item47156976.r == 'Other' || item98979066.r == 'Autre') { descs+= 'Other' ; }     return descs.substring(0, (descs.length-0));  })()" />
              <language value="text/fhirpath" />
              <expression value="(iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Male')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Homme'),'Male') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Female')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Femme'),'Female') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Gender queer')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Genre queer'),'Gender Queer') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Intersex')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Intersexué(e)'),'Intersex') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Nonbinary')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Non binaire'),'Nonbinary') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Questioning')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'En questionnement'),'Questioning') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Transsexual')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Transsexuel(le)'),'Transsexual') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Two spirit')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Bispirituel(le)'),'Two Spirit') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Unknown')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Inconnu'),'Unknown') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Declined to say')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Refuse de répondre'),'Declined to Say') | iif(%resource.repeat(item).where(linkId='item47156976').answer.exists(value = 'Other')  or  %resource.repeat(item).where(linkId='item98979066').answer.exists(value = 'Autre'),'Other')).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
          <valueBoolean value="true" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
          <extension url="enableWhenExpression">
            <valueExpression>
              <description value="false" />
              <language value="text/fhirpath" />
              <expression value="false" />
            </valueExpression>
          </extension>
        </extension>
        <linkId value="ax_lab_hdl" />
        <text>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <description value="(function() {; var descs = "";  if (ptLivingSituation.r == 'Alone' || item42679017.p == '1') { descs+= 'Alone' ; }   if (ptLivingSituation.r == 'With Family/Spouse' || item42679017.p == '2') { descs+= 'With Family/Spouse' ; }   if (ptLivingSituation.r == 'Supportive Housing' || item42679017.p == '3') { descs+= 'Supportive Housing' ; }   if (ptLivingSituation.r == 'Foster Home' || item42679017.p == '4') { descs+= 'Foster Home' ; }   if (ptLivingSituation.r == 'Residence' || item42679017.p == '5') { descs+= 'Residence' ; }   if (ptLivingSituation.r == 'No Fixed Address' || item42679017.p == '6') { descs+= 'No Fixed Address' ; }   if (ptLivingSituation.r == 'Other' || item42679017.p == '7') { descs+= 'Other' ; }    return descs.substring(0, (descs.length-0));  })()" />
              <language value="text/fhirpath" />
              <expression value="(iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Alone')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '1','Alone') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'With Family/Spouse')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '2','With Family/Spouse') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Supportive Housing')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '3','Supportive Housing') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Foster Home')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '4','Foster Home') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Residence')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '5','Residence') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'No Fixed Address')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '6','No Fixed Address') | iif(%resource.repeat(item).where(linkId='ptLivingSituation').answer.exists(value = 'Other')  or  %resource.repeat(item).where(linkId='item42679017').answer.value.weight() = '7','Other')).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
      <item>
        <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
          <valueBoolean value="true" />
        </extension>
        <extension url="http://ontariohealth.ca/fhir/eforms/StructureDefinition/display-note-info">
          <extension url="enableWhenExpression">
            <valueExpression>
              <description value="false" />
              <language value="text/fhirpath" />
              <expression value="false" />
            </valueExpression>
          </extension>
        </extension>
        <linkId value="ax_lab_ldl" />
        <text>
          <extension url="http://hl7.org/fhir/StructureDefinition/cqf-expression">
            <valueExpression>
              <description value="(function() {; var descs = "";  if (riskHospitalization.r == 'Y' || item1131572.p == '2') { descs+= 'Hospital Visit / Hospitalization' +'; '; }     if (riskSuicide.r == 'Y' || item54312281.r == 'Y' || item65514873.r == 'Y' || item57097806.p == '2') { descs+= 'Suicide Attempt / Ideation' +'; '; }     if (riskSelfHarm.r == 'Y' || item3104556.r == 'Y' || item67814819.r == 'Y' || item85423664.p == '2') { descs+= 'Deliberate Self-Harm' +'; '; }     if (riskHomicidalThreats.r == 'Y' || item90244509.p == '2') { descs+= 'Homicidal Threats / Ideation' +'; '; }     if (riskViolence.r == 'Y' || item53574417.r == 'Y' || item48440940.r == 'Y' || item25263968.p == '2') { descs+= 'Violent Behaviour' +'; '; }     if (riskLegal.r == 'Y' || item9851311.p == '2') { descs+= 'Legal Involvement' +'; '; }     if (item20409433.r == 'Y' || item45753134.r == 'Y' || item5510019.r == 'Y' || item67727582.p == '2') { descs+= 'Experiencing Violence' +'; '; }      if (item71572236.r == 'Y' || item94206719.r == 'Y') { descs+= 'Family Conflict' +'; '; }      return descs.substring(0, (descs.length-2));  })()" />
              <language value="text/fhirpath" />
              <expression value="(iif(%resource.repeat(item).where(linkId='riskHospitalization').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item1131572').answer.value.weight() = '2','Hospital Visit / Hospitalization' +'; ') | iif(%resource.repeat(item).where(linkId='riskSuicide').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item54312281').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item65514873').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item57097806').answer.value.weight() = '2','Suicide Attempt / Ideation' +'; ') | iif(%resource.repeat(item).where(linkId='riskSelfHarm').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item3104556').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item67814819').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item85423664').answer.value.weight() = '2','Deliberate Self-Harm' +'; ') | iif(%resource.repeat(item).where(linkId='riskHomicidalThreats').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item90244509').answer.value.weight() = '2','Homicidal Threats / Ideation' +'; ') | iif(%resource.repeat(item).where(linkId='riskViolence').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item53574417').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item48440940').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item25263968').answer.value.weight() = '2','Violent Behaviour' +'; ') | iif(%resource.repeat(item).where(linkId='riskLegal').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item9851311').answer.value.weight() = '2','Legal Involvement' +'; ') | iif(%resource.repeat(item).where(linkId='item20409433').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item45753134').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item5510019').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item67727582').answer.value.weight() = '2','Experiencing Violence' +'; ') | iif(%resource.repeat(item).where(linkId='item71572236').answer.exists(value = 'Y')  or  %resource.repeat(item).where(linkId='item94206719').answer.exists(value = 'Y'),'Family Conflict' +'; ')).aggregate($total & $this, '')" />
            </valueExpression>
          </extension>
        </text>
        <type value="display" />
      </item>
    </item>
  </item>
</Questionnaire>