{
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  "id": "dr-garvey-chilopora-QR",
  "text": {
    "status": "generated",
    "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient Information<br/> Height (cm): 170<br/>Weight (kg): 80<br/><span/><br/>Referral Information<br/> Reason for Referral: Some reason<br/>Pregnancy History<br/> Total number of pregnancies: 2<br/>Number of vaginal deliveries: 1<br/>Number of C-sections: 1<br/>Number of miscarriages/pregnancy losses/ectopic pregnancies: 3<br/>Number of abortions/pregnancy terminations: 2<br/>Menstrual History<br/> <span/> 2025-01-03<br/>Number of days between periods: 32<br/>Number of days period lasts: 8<br/>Are patient's periods painful: <span style=\"font-weight:bold;color:#AA0000;\">Yes</span><br/>Are patient's periods heavy: <span style=\"font-weight:bold;color:#AA0000;\">Yes</span><br/>Number of pads/tampons used on the heaviest day of period: 3<br/>Gynecologic History<br/> <span style=\"font-weight:bold;color:#AA0000;\">Abnormal pap tests</span><br/><span style=\"font-weight:bold;color:#AA0000;\">Fibroids</span><br/><span style=\"font-weight:bold;color:#AA0000;\">Endometriosis</span><br/><span style=\"font-weight:bold;color:#AA0000;\">Ovarian cysts</span><br/><span style=\"font-weight:bold;color:#AA0000;\">Sexually transmitted infection(s)</span><br/>Gonorrhea; Chlamydia; Herpes; Genital warts; Syphilis; Other<br/>Date of last pap test: 2026-02-28<br/>Patient is sexually active: Yes<br/>With: Both<br/>Form of birth control used: Birth Control pill / patch / ring; Condoms; IUD (hormone); IUD (copper); Pull-out/withdrawal; Calendar / Natural Family Planning; Partner had vasectomy; Permanent tubal sugery; Subdermal implant; None<br/><span/><br/>Medical History<br/> High blood pressure<br/>Diabetes<br/>Blood clots in lungs/legs<br/>Migraine headaches<br/>Liver disease/hepatitis<br/>Osteoporosis<br/>Infertility<br/>Cancer<br/>Type(s): <span style=\"font-weight:bold;color:#AA0000;\">Unknown</span><br/>Thyroid problems<br/>Asthma<br/>Anxiety/ Depression<br/>Incontinence (urine/stool)<br/>Constipation<br/>Frequent bladder infections<br/>Other: Stuff<br/>Medications<br/>  Aspirin<br/>Allergies<br/>  <span style=\"font-weight:bold;color:#AA0000;\">Cats</span><br/>Past Medical History<br/>  None<br/>Family History<br/> High blood pressure<br/>Heart Disease/Stroke<br/>Diabetes<br/>Bad reaction to anesthetic<br/>Breast Cancer<br/>Uterine Cancer<br/>Ovarian Cancer<br/>Colon/Bowel Cancer<br/>Other Cancer(s): Unknown<br/>Social History<br/> Smoker: Yes<br/>Number of years: 3<br/>Number of cigarettes per day: 20<br/>Consumes alcohol: Yes<br/>Number of drinks per week on average: 2<br/>Uses recreational and/or street drugs: <span style=\"font-weight:bold;color:#A6A900;\">Yes</span><br/>Specify: unknown<br/>Consumes caffeine: <span style=\"font-weight:bold;color:#A6A900;\">Yes</span><br/>Number of cups of coffee/tea/cola per day: 2</div>"
  },
  "questionnaire": "http://ontariohealth.ca/legacy/Questionnaire/dr-garvey-chilopora-|0",
  "status": "completed",
  "subject": {
    "reference": "Patient/pat-53234",
    "display": "MOMO ABBAS"
  },
  "authored": "2026-03-09T16:17:14.658Z",
  "author": {
    "reference": "Practitioner/smart-Practitioner-71482713",
    "type": "Practitioner",
    "display": "Susan Clark"
  },
  "item": [
    {
      "linkId": "questionnaire",
      "item": [
        {
          "linkId": "section47163071",
          "text": "Patient Information",
          "item": [
            {
              "linkId": "item29578021",
              "text": "Height (cm):",
              "answer": [
                {
                  "valueString": "170"
                }
              ]
            },
            {
              "linkId": "item67890802",
              "text": "Weight (kg):",
              "answer": [
                {
                  "valueString": "80"
                }
              ]
            }
          ]
        },
        {
          "linkId": "section2763158",
          "text": "Referral Information",
          "item": [
            {
              "linkId": "item48807357",
              "text": "Reason for Referral:",
              "answer": [
                {
                  "valueString": "Some reason"
                }
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            },
            {
              "linkId": "section42000384",
              "text": "Pregnancy History",
              "item": [
                {
                  "linkId": "item67762889",
                  "text": "Total number of pregnancies:",
                  "answer": [
                    {
                      "valueInteger": 2
                    }
                  ]
                },
                {
                  "linkId": "item91252875",
                  "text": "Number of vaginal deliveries:",
                  "answer": [
                    {
                      "valueInteger": 1
                    }
                  ]
                },
                {
                  "linkId": "item47328769",
                  "text": "Number of C-sections:",
                  "answer": [
                    {
                      "valueInteger": 1
                    }
                  ]
                },
                {
                  "linkId": "item36834119",
                  "text": "Number of miscarriages/pregnancy losses/ectopic pregnancies:",
                  "answer": [
                    {
                      "valueInteger": 3
                    }
                  ]
                },
                {
                  "linkId": "item29828101",
                  "text": "Number of abortions/pregnancy terminations:",
                  "answer": [
                    {
                      "valueInteger": 2
                    }
                  ]
                }
              ]
            },
            {
              "linkId": "section41623208",
              "text": "Menstrual History",
              "item": [
                {
                  "linkId": "item68062550",
                  "text": "Date of Last Menstrual Period:",
                  "answer": [
                    {
                      "valueDate": "2025-01-03"
                    }
                  ]
                },
                {
                  "linkId": "item35661442",
                  "text": "Number of days between periods:",
                  "answer": [
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                      "valueInteger": 32
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                {
                  "linkId": "item34464904",
                  "text": "Number of days period lasts:",
                  "answer": [
                    {
                      "valueInteger": 8
                    }
                  ]
                },
                {
                  "linkId": "item12983596",
                  "text": "Are patient's periods painful:",
                  "answer": [
                    {
                      "valueCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
                        "code": "Y",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item93188178",
                  "text": "Are patient's periods heavy:",
                  "answer": [
                    {
                      "valueCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
                        "code": "Y",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item9542494",
                  "text": "Number of pads/tampons used on the heaviest day of period:",
                  "answer": [
                    {
                      "valueInteger": 3
                    }
                  ]
                }
              ]
            },
            {
              "linkId": "section87236956",
              "text": "Gynecologic History",
              "item": [
                {
                  "linkId": "section90671878",
                  "item": [
                    {
                      "linkId": "item27527635",
                      "text": "None",
                      "answer": [
                        {
                          "valueBoolean": false
                        }
                      ]
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                    {
                      "linkId": "section95740632",
                      "item": [
                        {
                          "linkId": "item97846576",
                          "text": "Abnormal pap tests",
                          "answer": [
                            {
                              "valueBoolean": true
                            }
                          ]
                        },
                        {
                          "linkId": "item76524094",
                          "text": "Fibroids",
                          "answer": [
                            {
                              "valueBoolean": true
                            }
                          ]
                        },
                        {
                          "linkId": "item62031353",
                          "text": "Endometriosis",
                          "answer": [
                            {
                              "valueBoolean": true
                            }
                          ]
                        },
                        {
                          "linkId": "item78555427",
                          "text": "Ovarian cysts",
                          "answer": [
                            {
                              "valueBoolean": true
                            }
                          ]
                        },
                        {
                          "linkId": "item86136829",
                          "text": "Sexually transmitted infection(s)",
                          "answer": [
                            {
                              "valueBoolean": true
                            }
                          ]
                        },
                        {
                          "linkId": "item50977523",
                          "text": "Specify:",
                          "answer": [
                            {
                              "valueCoding": {
                                "extension": [
                                  {
                                    "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                                    "valueDecimal": 1
                                  }
                                ],
                                "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
                                "code": "Gonorrhea",
                                "display": "Gonorrhea"
                              }
                            },
                            {
                              "valueCoding": {
                                "extension": [
                                  {
                                    "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                                    "valueDecimal": 2
                                  }
                                ],
                                "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
                                "code": "Chlamydia",
                                "display": "Chlamydia"
                              }
                            },
                            {
                              "valueCoding": {
                                "extension": [
                                  {
                                    "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                                    "valueDecimal": 3
                                  }
                                ],
                                "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
                                "code": "Herpes",
                                "display": "Herpes"
                              }
                            },
                            {
                              "valueCoding": {
                                "extension": [
                                  {
                                    "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                                    "valueDecimal": 4
                                  }
                                ],
                                "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
                                "code": "Genital warts",
                                "display": "Genital warts"
                              }
                            },
                            {
                              "valueCoding": {
                                "extension": [
                                  {
                                    "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                                    "valueDecimal": 5
                                  }
                                ],
                                "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
                                "code": "Syphilis",
                                "display": "Syphilis"
                              }
                            },
                            {
                              "valueCoding": {
                                "extension": [
                                  {
                                    "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                                    "valueDecimal": 0
                                  }
                                ],
                                "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item50977523",
                                "code": "Other",
                                "display": "Other"
                              }
                            }
                          ]
                        }
                      ]
                    }
                  ]
                },
                {
                  "linkId": "item127317",
                  "text": "Date of last pap test:",
                  "answer": [
                    {
                      "valueDate": "2026-02-28"
                    }
                  ]
                },
                {
                  "linkId": "item54300787",
                  "text": "Patient is sexually active:",
                  "answer": [
                    {
                      "valueCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
                        "code": "Y",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item96682694",
                  "text": "With:",
                  "answer": [
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 3
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                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item96682694",
                        "code": "Both",
                        "display": "Both"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item86913170",
                  "text": "Form of birth control used:",
                  "answer": [
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                      "valueCoding": {
                        "extension": [
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                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 1
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Birth Control pill / patch / ring",
                        "display": "Birth Control pill / patch / ring"
                      }
                    },
                    {
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                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 2
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Condoms",
                        "display": "Condoms"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 3
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "IUD (hormone)",
                        "display": "IUD (hormone)"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 4
                          }
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                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "IUD (copper)",
                        "display": "IUD (copper)"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 5
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Pull-out/withdrawal",
                        "display": "Pull-out/withdrawal"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 0
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Calendar / Natural Family Planning",
                        "display": "Calendar / Natural Family Planning"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 0
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Partner had vasectomy",
                        "display": "Partner had vasectomy"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 0
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Permanent tubal sugery",
                        "display": "Permanent tubal sugery"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 0
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "Subdermal implant",
                        "display": "Subdermal implant"
                      }
                    },
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 0
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item86913170",
                        "code": "None",
                        "display": "None"
                      }
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "linkId": "section4572141",
          "text": "Medical History",
          "item": [
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              "linkId": "section61677093",
              "item": [
                {
                  "linkId": "item16667176",
                  "text": "High blood pressure",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
                  ]
                },
                {
                  "linkId": "item18948376",
                  "text": "Diabetes",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
                  ]
                },
                {
                  "linkId": "item35434575",
                  "text": "Blood clots in lungs/legs",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
                  ]
                },
                {
                  "linkId": "item69273958",
                  "text": "Migraine headaches",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
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                {
                  "linkId": "item47066864",
                  "text": "Liver disease/hepatitis",
                  "answer": [
                    {
                      "valueBoolean": true
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                  ]
                },
                {
                  "linkId": "item75358255",
                  "text": "Osteoporosis",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
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                },
                {
                  "linkId": "item41631847",
                  "text": "Infertility",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
                  ]
                },
                {
                  "linkId": "item18292760",
                  "text": "Cancer",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
                  ]
                },
                {
                  "linkId": "item66877002",
                  "text": "Type(s):",
                  "answer": [
                    {
                      "valueString": "Unknown"
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                  ]
                },
                {
                  "linkId": "item77134898",
                  "text": "Thyroid problems",
                  "answer": [
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                      "valueBoolean": true
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                  ]
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                {
                  "linkId": "item880791",
                  "text": "Asthma",
                  "answer": [
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                      "valueBoolean": true
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                  ]
                },
                {
                  "linkId": "item72238932",
                  "text": "Anxiety/ Depression",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
                  ]
                },
                {
                  "linkId": "item37884318",
                  "text": "Incontinence (urine/stool)",
                  "answer": [
                    {
                      "valueBoolean": true
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                {
                  "linkId": "item41904126",
                  "text": "Constipation",
                  "answer": [
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                      "valueBoolean": true
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                {
                  "linkId": "item51470870",
                  "text": "Frequent bladder infections",
                  "answer": [
                    {
                      "valueBoolean": true
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                },
                {
                  "linkId": "item15815594",
                  "text": "Other",
                  "answer": [
                    {
                      "valueBoolean": true
                    }
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                },
                {
                  "linkId": "item78475900",
                  "text": "Specify:",
                  "answer": [
                    {
                      "valueString": "Stuff"
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                  ]
                }
              ]
            }
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        },
        {
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          "text": "Medications",
          "item": [
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              "answer": [
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                  "valueString": "Aspirin"
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              ]
            }
          ]
        },
        {
          "linkId": "allergies",
          "text": "Allergies",
          "item": [
            {
              "linkId": "allg",
              "answer": [
                {
                  "valueString": "Cats"
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              ]
            }
          ]
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        {
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          "text": "Past Medical History",
          "item": [
            {
              "linkId": "pmhx",
              "answer": [
                {
                  "valueString": "None"
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              ]
            }
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        {
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          "text": "Family History",
          "item": [
            {
              "linkId": "section48519309",
              "item": [
                {
                  "linkId": "item65894204",
                  "text": "High blood pressure",
                  "answer": [
                    {
                      "valueBoolean": true
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                  ]
                },
                {
                  "linkId": "item82516489",
                  "text": "Heart Disease/Stroke",
                  "answer": [
                    {
                      "valueBoolean": true
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                },
                {
                  "linkId": "item30885585",
                  "text": "Diabetes",
                  "answer": [
                    {
                      "valueBoolean": true
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                },
                {
                  "linkId": "item4088333",
                  "text": "Bad reaction to anesthetic",
                  "answer": [
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                      "valueBoolean": true
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                {
                  "linkId": "item37784990",
                  "text": "Breast Cancer",
                  "answer": [
                    {
                      "valueBoolean": true
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                },
                {
                  "linkId": "item53504294",
                  "text": "Uterine Cancer",
                  "answer": [
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                      "valueBoolean": true
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                {
                  "linkId": "item4801402",
                  "text": "Ovarian Cancer",
                  "answer": [
                    {
                      "valueBoolean": true
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                },
                {
                  "linkId": "item75842905",
                  "text": "Colon/Bowel Cancer",
                  "answer": [
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                      "valueBoolean": true
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                {
                  "linkId": "item22994219",
                  "text": "Other Cancer(s)",
                  "answer": [
                    {
                      "valueBoolean": true
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                },
                {
                  "linkId": "item29254997",
                  "text": "Specify:",
                  "answer": [
                    {
                      "valueString": "Unknown"
                    }
                  ]
                }
              ]
            }
          ]
        },
        {
          "linkId": "i_nsocial_history_n",
          "text": "Social History",
          "item": [
            {
              "linkId": "section64573544",
              "item": [
                {
                  "linkId": "item57834583",
                  "text": "Smoker:",
                  "answer": [
                    {
                      "valueCoding": {
                        "extension": [
                          {
                            "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                            "valueDecimal": 2
                          }
                        ],
                        "system": "http://ontariohealth.ca/legacy/CodeSystem/dr-garvey-chilopora-_item57834583",
                        "code": "Yes",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item10529961",
                  "text": "Number of years:",
                  "answer": [
                    {
                      "valueString": "3"
                    }
                  ]
                },
                {
                  "linkId": "item44127211",
                  "text": "Number of cigarettes per day:",
                  "answer": [
                    {
                      "valueString": "20"
                    }
                  ]
                },
                {
                  "linkId": "item151992",
                  "text": "Consumes alcohol:",
                  "answer": [
                    {
                      "valueCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
                        "code": "Y",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item94627251",
                  "text": "Number of drinks per week on average:",
                  "answer": [
                    {
                      "valueString": "2"
                    }
                  ]
                },
                {
                  "linkId": "item93764222",
                  "text": "Uses recreational and/or street drugs:",
                  "answer": [
                    {
                      "valueCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
                        "code": "Y",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item74607677",
                  "text": "Specify:",
                  "answer": [
                    {
                      "valueString": "unknown"
                    }
                  ]
                },
                {
                  "linkId": "item33664919",
                  "text": "Consumes caffeine:",
                  "answer": [
                    {
                      "valueCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0532",
                        "code": "Y",
                        "display": "Yes"
                      }
                    }
                  ]
                },
                {
                  "linkId": "item45718527",
                  "text": "Number of cups of coffee/tea/cola per day:",
                  "answer": [
                    {
                      "valueString": "2"
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}