{% for currentItem in QuestionnaireResponse.item.where((linkId = 'patient_header') or (linkId = 'additionalinfo_header') or (linkId = '274716928898') or (linkId = '324277291256') or (linkId = '751330438729') or (linkId = '234264354051') or (linkId = '674405234837') or (linkId = '536888455666') or (linkId = '189996950901') or (linkId = '351905130587') or (linkId = 'cpp_header') or (linkId = 'preferredconsultlocation_header') or (linkId = 'supportingdocumentation_header') or (linkId = 'supportingdocumentation_attachment' and answer.exists()) or (linkId = 'referrer_header')) %}{% if currentItem.linkId = 'patient_header' %}Patient Information {% for currentItem in currentItem.item.where((linkId = 'patient_surname' and answer.exists()) or (linkId = 'patient_firstname' and answer.exists()) or (linkId = 'patient_date_of_birth' and answer.exists()) or (linkId = 'patient_gender' and answer.exists()) or (linkId = 'patient_hc_pc' and answer.exists()) or (linkId = 'patient_hc_number' and answer.exists()) or (linkId = 'patient_hc_vc' and answer.exists()) or (linkId = 'patient_address_line1' and answer.exists()) or (linkId = 'patient_address_line2' and answer.exists()) or (linkId = 'patient_address_city' and answer.exists()) or (linkId = 'patient_address_province' and answer.exists()) or (linkId = 'patient_address_postalcode' and answer.exists()) or (linkId = 'patient_phone_mobile' and answer.exists()) or (linkId = 'patient_phone_home' and answer.exists()) or (linkId = 'patient_phone_business' and answer.exists()) or (linkId = 'patient_email' and answer.exists())) %}{% if currentItem.linkId = 'patient_surname' %}{% if currentItem.answer.exists() %}Surname {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_firstname' %}{% if currentItem.answer.exists() %}First Name {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_date_of_birth' %}{% if currentItem.answer.exists() %}DOB {% for answer in currentItem.answer %}{{ answer.value.ofType(date) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_gender' %}{% if currentItem.answer.exists() %}Gender {% for answer in currentItem.answer %}{% if answer.value.code = 'male' %}Male{% endif %}{% if answer.value.code = 'female' %}Female{% endif %}{% if answer.value.code = 'other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_hc_pc' %}{% if currentItem.answer.exists() %}HN PC {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_hc_number' %}{% if currentItem.answer.exists() %}HN {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_hc_vc' %}{% if currentItem.answer.exists() %}HN VC {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_address_line1' %}{% if currentItem.answer.exists() %}Address {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_address_line2' %}{% if currentItem.answer.exists() %}Address Line 2 {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_address_city' %}{% if currentItem.answer.exists() %}City {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_address_province' %}{% if currentItem.answer.exists() %}Province {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_address_postalcode' %}{% if currentItem.answer.exists() %}Postal Code {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_phone_mobile' %}{% if currentItem.answer.exists() %}Mobile # {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_phone_home' %}{% if currentItem.answer.exists() %}Home # {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_phone_business' %}{% if currentItem.answer.exists() %}Business # {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'patient_email' %}{% if currentItem.answer.exists() %}Email {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'additionalinfo_header' %}[Optional] Additional Patient Information {% for currentItem in currentItem.item.where((linkId = 'additionalinfo_sexassignedatbirth' and answer.exists()) or (linkId = 'additionalinfo_pronouns' and answer.exists()) or (linkId = 'additionalinfo_pronouns_other' and answer.exists()) or (linkId = 'additionalinfo_preferredlanguage' and answer.exists()) or (linkId = 'additionalinfo_preferredlanguage_specify' and answer.exists()) or (linkId = 'additionalinfo_preferredlanguage_translatorrequired' and answer.exists()) or (linkId = 'additionalinfo_preferredname_select' and answer.exists()) or (linkId = 'additionalinfo_preferredname' and answer.exists()) or (linkId = 'additionalinfo_bestmethodofcontact' and answer.exists()) or (linkId = 'additionalinfo_bestmethodofcontact_voicemails' and answer.exists()) or (linkId = 'additionalinfo_alternatecontact_select' and answer.exists()) or (linkId = 'additionalinfo_alternatecontact_name' and answer.exists()) or (linkId = 'additionalinfo_alternatecontact_phone' and answer.exists()) or (linkId = 'additionalinfo_alternatecontact_relationship' and answer.exists()) or (linkId = 'additionalinfo_alternatecontact_bookingcontact' and answer.exists()) or (linkId = 'additionalinfo_unsafecontacts_select' and answer.exists()) or (linkId = 'additionalinfo_unsafecontacts_speakwithpatientdirectly' and answer.exists()) or (linkId = 'additionalinfo_unsafecontacts_donotspeakwith' and answer.exists()) or (linkId = 'additionalinfo_accessibilityconcernsordisability_selectt' and answer.exists()) or (linkId = 'additionalinfo_accessibilityconcernsordisability' and answer.exists()) or (linkId = 'additionalinfo_specialconsiderations_select' and answer.exists()) or (linkId = 'additionalinfo_specialconsiderations' and answer.exists()) or (linkId = '780152781664' and answer.exists()) or (linkId = '273459321091' and answer.exists())) %}{% if currentItem.linkId = 'additionalinfo_sexassignedatbirth' %}{% if currentItem.answer.exists() %}Sex assigned at birth {% for answer in currentItem.answer %}{% if answer.value.code = 'LA3-6' %}Female{% endif %}{% if answer.value.code = 'LA2-8' %}Male{% endif %}{% if answer.value.display = 'Intersex' %}Intersex{% endif %}{% if answer.value.code = 'LA4489-6' %}Unknown{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_pronouns' %}{% if currentItem.answer.exists() %}Pronouns {% for answer in currentItem.answer %}{% if answer.value.code = 'LA29519-8' %}She/Her{% endif %}{% if answer.value.code = 'LA29518-0' %}He/Him{% endif %}{% if answer.value.code = 'LA29519-8' %}They/Them{% endif %}{% if answer.value.display = 'Other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_pronouns_other' %}{% if currentItem.answer.exists() %}Other Pronouns {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_preferredlanguage' %}{% if currentItem.answer.exists() %}Preferred language {% for answer in currentItem.answer %}{% if answer.value.code = 'en' %}English{% endif %}{% if answer.value.code = 'fr' %}French{% endif %}{% if answer.value.display = 'Other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_preferredlanguage_specify' %}{% if currentItem.answer.exists() %}Specify {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_preferredlanguage_translatorrequired' %}{% if currentItem.answer.exists() %}Translator required {% for answer in currentItem.answer %}{% if answer.value.display = 'Translator Required' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_preferredname_select' %}{% if currentItem.answer.exists() %}Preferred name {% for answer in currentItem.answer %}{% if answer.value.display = 'Preferred Name' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_preferredname' %}{% if currentItem.answer.exists() %}Preferred Name: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_bestmethodofcontact' %}{% if currentItem.answer.exists() %}Best method of contact {% for answer in currentItem.answer %}{% if answer.value.code = 'phone' %}Mobile{% endif %}{% if answer.value.code = 'phone' %}Home{% endif %}{% if answer.value.code = 'phone' %}Business{% endif %}{% if answer.value.code = 'email' %}Email{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_bestmethodofcontact_voicemails' %}{% if currentItem.answer.exists() %}Voicemails acceptable {% for answer in currentItem.answer %}{% if answer.value.display = ' Voicemails acceptable' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_alternatecontact_select' %}{% if currentItem.answer.exists() %}Alternate contact {% for answer in currentItem.answer %}{% if answer.value.display = 'Alternate contact' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_alternatecontact_name' %}{% if currentItem.answer.exists() %}Name {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_alternatecontact_phone' %}{% if currentItem.answer.exists() %}Alternate contact phone # {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_alternatecontact_relationship' %}{% if currentItem.answer.exists() %}Relationship {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_alternatecontact_bookingcontact' %}{% if currentItem.answer.exists() %}Is Alternate contact the appointment booking contact? {% for answer in currentItem.answer %}{% if answer.value.display = 'Yes' %}Yes{% endif %}{% if answer.value.display = 'No' %}No{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_unsafecontacts_select' %}{% if currentItem.answer.exists() %}Unsafe contact persons (do not speak with) {% for answer in currentItem.answer %}{% if answer.value.display = 'Unsafe contact persons (do not speak with)' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_unsafecontacts_speakwithpatientdirectly' %}{% if currentItem.answer.exists() %}Only speak with patient directly {% for answer in currentItem.answer %}{% if answer.value.display = 'Only speak with patient directly' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_unsafecontacts_donotspeakwith' %}{% if currentItem.answer.exists() %}Do not speak with: {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_accessibilityconcernsordisability_selectt' %}{% if currentItem.answer.exists() %}Accessibility concerns or disability {% for answer in currentItem.answer %}{% if answer.value.display = 'Accessibility concerns or disability' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_accessibilityconcernsordisability' %}{% if currentItem.answer.exists() %}Specific {% for answer in currentItem.answer %}{% if answer.value.code = '129839007' %}Falls risk{% endif %}{% if answer.value.code = '301621006' %}Patient requires lift{% endif %}{% if answer.value.code = '105503008' %}Wheelchair{% endif %}{% if answer.value.code = '15188001' %}Hearing impaired{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %};{% else %}and{% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_specialconsiderations_select' %}{% if currentItem.answer.exists() %}Special considerations {% for answer in currentItem.answer %}{% if answer.value.display = 'Special considerations (e.g. barriers, tips for care delivery, 3rd party insurance, patient requires escort, cognitive issues)' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'additionalinfo_specialconsiderations' %}{% if currentItem.answer.exists() %}Details of special considerations {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = '780152781664' %}{% if currentItem.answer.exists() %}Payer Type {% for answer in currentItem.answer %}{% if answer.value.display = 'OHIP' %}OHIP{% endif %}{% if answer.value.display = 'WSIB Case' %}WSIB Case{% endif %}{% if answer.value.display = 'DND' %}DND{% endif %}{% if answer.value.display = 'IFH' %}IFH{% endif %}{% if answer.value.display = 'RAMQ' %}RAMQ{% endif %}{% if answer.value.display = 'Other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = '273459321091' %}{% if currentItem.answer.exists() %}Other payer {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '274716928898' %}Select Exam Request(s) {% for currentItem in currentItem.item.where((linkId = '966479448516' and answer.exists())) %}{% if currentItem.linkId = '966479448516' %}{% if currentItem.answer.exists() %}Radiology modality selection {% for answer in currentItem.answer %}{% if answer.value.code = '77477000' %}Computerized axial tomography{% endif %}{% if answer.value.code = '113091000' %}Magnetic resonance imaging{% endif %}{% if answer.value.code = '363680008' %}Radiographic imaging procedure{% endif %}{% if answer.value.code = '16310003' %}Ultrasound Requisition{% endif %}{% if answer.value.code = '241686001' %}Dual energy X-ray absorptiometry (procedure){% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '324277291256' %}Triage Considerations {% for currentItem in currentItem.item.where((linkId = '649843000897' and answer.exists()) or (linkId = '871328372177' and answer.exists())) %}{% if currentItem.linkId = '649843000897' %}{% if currentItem.answer.exists() %}Requested Priority {% for answer in currentItem.answer %}{% if answer.value.code = 'routine' %}Routine{% endif %}{% if answer.value.code = 'urgent' %}Urgent{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = '871328372177' %}{% if currentItem.answer.exists() %}Reason for urgent triage {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '751330438729' %}CT Request: Clinical History / Indication {% for currentItem in currentItem.item.where((linkId = '573180718837' and answer.exists())) %}{% if currentItem.linkId = '573180718837' %}{% if currentItem.answer.exists() %}Reason for exam: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '234264354051' %}MRI Request: Clinical History / Indication {% for currentItem in currentItem.item.where((linkId = '980027687215' and answer.exists())) %}{% if currentItem.linkId = '980027687215' %}{% if currentItem.answer.exists() %}Reason for exam: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '674405234837' %}X-Ray Request: Clinical History / Indication {% for currentItem in currentItem.item.where((linkId = '510703120136' and answer.exists())) %}{% if currentItem.linkId = '510703120136' %}{% if currentItem.answer.exists() %}Reason for exam: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '536888455666' %}Ultrasound Request: Clinical History / Indication {% for currentItem in currentItem.item.where((linkId = '296349058128' and answer.exists())) %}{% if currentItem.linkId = '296349058128' %}{% if currentItem.answer.exists() %}Reason for exam: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '189996950901' %}BMD Request: Clinical History / Indication {% for currentItem in currentItem.item.where((linkId = '799876967585' and answer.exists())) %}{% if currentItem.linkId = '799876967585' %}{% if currentItem.answer.exists() %}Reason for exam: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = '351905130587' %}Supporting Documentation {% for currentItem in currentItem.item.where((linkId = '707642937857' and answer.exists())) %}{% if currentItem.linkId = '707642937857' %}{% if currentItem.answer.exists() %}Reason for exam: {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'cpp_header' %}Cumulative Patient Profile {% for currentItem in currentItem.item.where((linkId = 'cpp_separate' and answer.exists()) or (linkId = 'cpp_currentprob' and answer.exists()) or (linkId = 'cpp_pastmedicalhistory' and answer.exists()) or (linkId = 'cpp_currentmedications' and answer.exists()) or (linkId = 'cpp_familyhistory' and answer.exists()) or (linkId = 'cpp_allergies' and answer.exists())) %}{% if currentItem.linkId = 'cpp_separate' %}{% if currentItem.answer.exists() %}CPP attached separately {% for answer in currentItem.answer %}{% if answer.value.display = 'CPP attached separately (if not entered below)' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'cpp_currentprob' %}{% if currentItem.answer.exists() %}Current Problem List {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'cpp_pastmedicalhistory' %}{% if currentItem.answer.exists() %}Past Medical History {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'cpp_currentmedications' %}{% if currentItem.answer.exists() %}Current Medication {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'cpp_familyhistory' %}{% if currentItem.answer.exists() %}Family History {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'cpp_allergies' %}{% if currentItem.answer.exists() %}Allergies {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'preferredconsultlocation_header' %}Preferred Consultant or Location {% for currentItem in currentItem.item.where((linkId = 'preferredconsultlocation_selector' and answer.exists()) or (linkId = 'preferredconsultlocation_specify') or (linkId = 'preferredconsultlocation_willingtotravel' and answer.exists()) or (linkId = 'preferredconsultlocation_otherconsiderations' and answer.exists())) %}{% if currentItem.linkId = 'preferredconsultlocation_selector' %}{% if currentItem.answer.exists() %}Preferred consultant or location {% for answer in currentItem.answer %}{% if answer.value.display = 'Preferred consultant or location' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'preferredconsultlocation_specify' %}Please specify either a preferred consultant or location
{% for currentItem in currentItem.item.where((linkId = 'preferredconsultlocation_consultant' and answer.exists()) or (linkId = 'preferredconsultlocation_location' and answer.exists())) %}{% if currentItem.linkId = 'preferredconsultlocation_consultant' %}{% if currentItem.answer.exists() %}Consultant {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'preferredconsultlocation_location' %}{% if currentItem.answer.exists() %}Location {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'preferredconsultlocation_willingtotravel' %}{% if currentItem.answer.exists() %}Patient willing to travel for shorter wait time {% for answer in currentItem.answer %}{% if answer.value.display = 'Patient willing to travel for shorter wait time' %}Yes{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'preferredconsultlocation_otherconsiderations' %}{% if currentItem.answer.exists() %}Other {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'supportingdocumentation_header' %}Supporting Documentation
Please attach all relevant laboratory and diagnostic investigations.
{% for currentItem in currentItem.item.where((linkId = 'supportingdocumentation_details' and answer.exists())) %}{% if currentItem.linkId = 'supportingdocumentation_details' %}{% if currentItem.answer.exists() %}Personal Health Information that is medically relevant has not been disclosed at the request of the patient. {% for answer in currentItem.answer %}{% if answer.value.display = 'Personal Health Information that is medically relevant has not been disclosed at the request of the patient.' %}Personal Health Information that is medically relevant has not been disclosed at the request of the patient.{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}; {% else %}; {% endif %}{% endif %}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if currentItem.linkId = 'supportingdocumentation_attachment' %}{% if currentItem.answer.exists() %}Add Attachments {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_header' %}Referrer's Information {% for currentItem in currentItem.item.where((linkId = 'referrer_sitename' and answer.exists()) or (linkId = 'referrer_address_line1' and answer.exists()) or (linkId = 'referrer_address_line2' and answer.exists()) or (linkId = 'referrer_address_city' and answer.exists()) or (linkId = 'referrer_address_province' and answer.exists()) or (linkId = 'referrer_address_postalcode' and answer.exists()) or (linkId = 'referrer_phone' and answer.exists()) or (linkId = 'referrer_fax' and answer.exists()) or (linkId = 'referrer_billing' and answer.exists()) or (linkId = 'referrer_professionalid' and answer.exists()) or (linkId = 'referrer_signature' and answer.exists()) or (linkId = 'referrer_role' and answer.exists())) %}{% if currentItem.linkId = 'referrer_sitename' %}{% if currentItem.answer.exists() %}Site Name {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_address_line1' %}{% if currentItem.answer.exists() %}Address (Line 1) {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_address_line2' %}{% if currentItem.answer.exists() %}Address (Line 2) {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_address_city' %}{% if currentItem.answer.exists() %}City {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_address_province' %}{% if currentItem.answer.exists() %}Province {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_address_postalcode' %}{% if currentItem.answer.exists() %}Postal Code {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_phone' %}{% if currentItem.answer.exists() %}Phone # {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_fax' %}{% if currentItem.answer.exists() %}Fax # {% for answer in currentItem.answer %}{{ answer.value.ofType(string) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_billing' %}{% if currentItem.answer.exists() %}Billing Number {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_professionalid' %}{% if currentItem.answer.exists() %}Professional ID {% for answer in currentItem.answer %}{{ answer.value.ofType(integer) }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_signature' %}{% if currentItem.answer.exists() %}Signed {% for answer in currentItem.answer %}{{ answer.value }}{% endfor %}{% endif %}{% endif %}{% if currentItem.linkId = 'referrer_role' %}{% if currentItem.answer.exists() %}Role {% for answer in currentItem.answer %}{% if answer.value.code = '309398001' %}Allied Health Professional{% endif %}{% if answer.value.code = '62247001' %}Family Physician{% endif %}{% if answer.value.code = '449161006' %}Physician Assistant{% endif %}{% if answer.value.code = '398130009' %}Medical Student{% endif %}{% if answer.value.code = '106292003' %}Nurse{% endif %}{% if answer.value.code = '224571005' %}Nurse Practitioner{% endif %}{% if answer.value.code = '405277009' %}Resident{% endif %}{% if answer.value.code = '69280009' %}Specialist{% endif %}{% if answer.value.display = 'Other' %}Other{% endif %}{% endfor %}{% endif %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}{% endif %}{% if forloop.last.not() %}{% if forloop.nextitem %}
{% else %}
{% endif %}{% endif %}{% endfor %}